Category: MoHealthNet Home

FROM: MANDI ADAMS, INTERIM DIRECTOR

SUBJECT: 2025 FAMILY MO HEALTHNET (MAGI) COST OF LIVING ADJUSTMENT (COLA) FOR SSA/SSI INCOME

DISCUSSION:

Effective April 1, 2025, MAGI cases will be updated to reflect a 2.5% COLA for Social Security Administration (SSA) and Supplemental Security Income (SSI) participants.

Cases Adjusted

Cases that include income types Social Security Adult (disability or received off disabled/deceased spouse), Social Security Adult (retirement), Social Security Child (disability or received off disabled/deceased parent), and SSI are subject to an automatic increase of 2.5%. The eligibility system will end date the previous income and add a new piece of income evidence that reflects the adjusted income amount.

Cases That Did Not Adjust

Some cases will not adjust during COLA. These cases will require manual intervention from staff to add the increased income amounts. As cases are reviewed, check the income on each case to determine if the current income is entered. Update and verify income as required using established procedures.

Notices

For case updates made as a result of COLA, the eligibility system will finalize the decision(s) and send out the appropriate notices.

Note: Due to the Continuous Eligibility requirement during the Transition Period, no cases will have coverage closed or reduced to a lower level of care until an annual renewal has been completed.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

MA/vh

FROM: MANDI ADAMS, INTERIM DIRECTOR

SUBJECT: NURSING HOME COVERAGE FOR PARTICIPANTS ON QUALIFYING MODIFIED ADJUSTED GROSS INCOME (MAGI) LEVELS OF CARE

MANUAL REVISION #
0815.005.00
0815.030.00
1040.010.00
1040.015.15 
1040.020.10 
1040.020.40.15
1040.020.40.20 

DISCUSSION:

Participants on MAGI levels of care, with the exception of Uninsured Women’s Health Services (UWHS) and Extended Women’s Health Services (EWHS), can qualify for nursing home services if they meet specific medical criteria. The medical certification for these individuals is made by the Department of Health and Senior Services (DHSS). Participants eligible for nursing home services under MAGI levels of care are subject to transfer penalties but are not subject to resource limits or a surplus.

The Family Support Division (FSD) Nursing Facility (Vendor) Unit is notified when a participant meets the medical criteria for nursing home services. A new piece of evidence, MO Vendor Facility, has been added to the Missouri Eligibility Determination and Enrollment System (MEDES). This evidence provides the Nursing Home (Vendor) Unit a streamlined way to notify MO HealthNet Division (MHD) when individuals on MAGI levels of care meet the criteria for nursing home services.

There is no change in how MAGI staff process applications. The requirement, for participants claiming a disability and approved for Adult Expansion Group (AEG) coverage to also have eligibility explored for Mandatory Non-MAGI programs, has not changed. See Appendix K to determine which levels of care are considered mandatory.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

MA/rc

FROM: MANDI ADAMS, INTERIM DIRECTOR

SUBJECT: 2025 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI PROGRAMS

MANUAL REVISION #
APPENDIX A
APPENDIX A (PE)
APPENDIX B
APPENDIX D
APPENDIX E
APPENDIX I

FORM REVISION#
IM-4PRM

DISCUSSION:

Effective April 1, 2025, the Federal Poverty Level (FPL) income guidelines increase for all MAGI programs, including Presumptive Eligibility (PE).
MAGI cases were adjusted on February 22, 2025 based on the new FPL income guidelines. Changes in circumstance or applications processed prior to April 1, 2025 will need to be authorized before the FPL change can be viewed.

PREMIUM REFUNDS

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to:

• become eligible as a non-premium case;
• go from CHIP75 to CHIP74; or
• go from CHIP74 to CHIP73.

The refund process will take approximately 8 weeks to complete.

PRESUMPTIVE ELIGIBILITY

PE Manual Appendix A income standards are updated. These standards are effective from April 1, 2025 through March 31, 2026.

NECESSARY ACTION:

• Use the new FPL income guidelines beginning April 1, 2025
• Review this memorandum with appropriate staff.

MA/rc

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATE TO 1619 THRESHOLD

MANUAL REVISION #
Appendix J

DISCUSSION:

The threshold amount established by the Social Security Administration (SSA) to determine eligibility under Section 1619 of the Social Security Act has increased to $4,198 effective January 1, 2025. Additional information regarding 1619 eligibility is available in manual section 0850.005.20 Financial Need.

Eligibility Standards for Non-MAGI Programs (Appendix J) of the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual was updated to reflect the new threshold.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY PENALTIES

MANUAL REVISION #
APPENDIX J
APPENDIX N

DISCUSSION:

The average private pay nursing care rate increased to $7,909 per month effective April 1, 2025. For applications taken on or after April 1, 2025, use $7,909 to determine the number of months of ineligibility for vendor level services for a transfer of assets penalty.

Eligibility Standards for Non-MAGI Programs (Appendix J) of the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual lists the current average private pay nursing care rate.

Note: Maximum MMMNA was incorrect on the 12/2024 revision of the Eligibility Standards for Non-MAGI Programs appendix and has been corrected. The correct monthly amount is $3948 effective 1/1/2025.

Average Private Pay Nursing Home Rates (Appendix N) of the December 1973 Eligibility Requirements Manual lists the historical values for average private pay nursing care rates.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: NON-MAGI FEDERAL POVERTY LEVEL ADJUSTMENT

MANUAL REVISION #
Appendix J
Appendix K

DISCUSSION:

Effective April 1, 2025, the Federal Poverty Level (FPL) income guidelines increase for the following programs:

• MO HealthNet Non-Spend Down (MHNS)
• MO HealthNet Spend Down (MHSD)
• Ticket to Work Health Assurance (TWHA)
• Qualified Medicare Beneficiary (QMB)
• Specified Low Income Medicare Beneficiary (SLMB and SLMB2)
• Qualified Disabled Working Individuals (QDWI)
• MO HealthNet for Disabled Children (MHDC)
• Blind Pension (BP)

The weekend of March 8, 2025, programs with income eligibility based on the federal poverty level will be adjusted in the eligibility system.

Note: All MO HealthNet cases will be adjusted based on the new FPL income guidelines.

Premium Refunds

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to become eligible as a non-premium case. The refund process will take approximately 8 weeks to complete.

Program Descriptions

Appendix K in the Non-MAGI Policy Manual is updated to include the change in FPL income limits.

Income Standards

Appendix J in the Non-MAGI policy Manual is updated with the updated FPL income limits.

All FPL income guidelines are effective from April 1, 2025, through March 31, 2026. These standards may be referenced as needed for historical purposes.

MHABD income standards

QDWI income standards

Medicare Savings Programs income standards

Blind Pension sighted spouse monthly income maximum

TWHA Income Standards and Premiums

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Begin using the new FPL income guidelines for eligibility determinations effective April 2024 and ongoing.
• Follow the staff user guides in IM Resources to resolve conflicting actions related to FPL.
• Review this memorandum with appropriate staff.

KE/st

FROM: KIM EVANS, DIRECTOR

SUBJECT: JANUARY 2025 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME FOR ALL INCOME MAINTENANCE PROGRAMS EXCEPT MAGI MO HEALTHNET

MANUAL REVISION #
APPENDIX B
APPENDIX D
APPENDIX E
APPENDIX J
APPENDIX K

DISCUSSION:

In January 2025, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive a 2.5% Cost of Living Adjustment (COLA).

The weekend of December 14, 2024, a mass adjustment will be completed in the eligibility system for Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance (TA), and Non-MAGI MO HealthNet cases. Income increases for SSA, SSI, VA, and/or RR and other adjustments will be completed. Medicare Premium amounts and federal eligibility standards will also be updated.

Note: The 2025 COLA will have the following effect on SNAP cases:

• Increase in SNAP benefit reductions for January 2025.
• Increase in SNAP closures for December 2024.

SSI Increases

Non-MAGI Standards Adjustments

Supplementary Medical Insurance (SMI) Premium Adjustment

The standard SMI, commonly known as Medicare Part B, premium will increase for 2025 to $185.00. Premiums for Medicare participants who pay less than the standard premium amount will not have an increase of more than the amount of the increase in Social Security benefit the individual received.

Additional Non-MAGI Program Increases

Resource Limits for Medicare Savings Programs (QMB/SLMB/QI-1)

For a single individual, the resource limit increases to $9,660. For a married couple, the resource limit increases to $14,470. There is no change in policy regarding how to determine available resources.

Minimum and Maximum Spousal Share

The 2025 minimum spousal share is $31,584. The new maximum spousal share is $157,920. Both amounts become effective for any Division of Assets completed on or after January 1, 2025.

Substantial Gainful Activity (SGA)

The SGA monthly amounts increase and are as follows:

• $2,700 for statutorily blind individuals
• $1,620 for non-blind individuals

Appendices Updates

The following appendices were updated to show the new amounts:

• MO HealthNet for Aged, Blind, and Disabled Manual
  • Appendix B – Maintenance Standards for Allotments
  • Appendix E – HCB Income Maximums
  • Appendix J – Eligibility Standards for Non-MAGI Programs
  • Appendix K – MO HealthNet eligibility for Non-MAGI Programs

Note: Appendix J and Appendix K were updated to reference Resource Limits, instead of Asset Limits. Appendix K was updated to correct the Blind Pension and Supplemental Aid to the Blind grant amount to $828, as it was increased in 7/2024.

• December 1973 Eligibility Requirements Manual
  • Appendix D – Substantial Gainful Activity

Adjustments by Program and Mass Adjustment Process

All programs will be adjusted according to program. Review FAMIS Resources for further information about the mass adjustment process.

Senate Bill 577 (2007) authorized the disregard for Social Security COLA increases for certain MO HealthNet (MHN) programs with income eligibility based on federal poverty level (FPL) until the next FPL adjustment in April. All SSA, SSI, VA, and RR income sources will be updated with the new income amount and verification code “CO” for COLA adjustment.

Note: For budget months prior to January 2025, do not use the “CO” – COLA verification code.

Reports with Actions Needed

Reports with action needed will be distributed to the SNAP, TA, and MHN Program Managers for assignment. Follow the instructions in FAMIS Resources on how to process each type of report.

Request for Hearing/Continued Benefits

When a fair hearing is requested, follow current fair hearing request procedures.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Search “COLA” or “Adjustment” in FAMIS Resources for processing guidance.
• State Office will provide the SSA/SSI/VA/RR Needing Review report to designated staff.
• Allow MHN Policy for “CO” income verification to disregard SSA and SSI COLA Adjustments until the Federal Poverty Level (FPL) Adjustment in April.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: CLARIFICATION OF MAGI ZERO INCOME POLICY RELATED TO QUARTERLY INCOME ON IMES

MANUAL REVISION #
1805.030.05

DISCUSSION:

The Zero Income section of 1805.030.05 Income Evidence has been updated to clarify:

• Use reasonable compatibility to determine if the participant’s statement of zero income and the Electronically Obtained Income (EOI) result in eligibility in the same threshold.
• Quarterly wage information from IMES may not be current enough to cause a participant’s statement of zero income to be questionable.

Remember that the goal is to use Electronically Obtained Information (EOI) to confirm the participant’s stated income. Only send a request for information after all other options have been exhausted.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/rc

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATED REVISION DATE FOR ONLINE AGED, BLIND, AND DISABLED SUPPLEMENT (IM-1ABDS)

DISCUSSION:

The Aged, Blind, and Disabled Supplement (IM-1ABDS) was updated in 10/2023, but the revision date was not initially updated on the online form. The online form is now updated and will show the correct 10/2023 revision date for forms submitted after 9/11/2024.

FSD will accept the IM-1ABDS with the 8/2022 revision date as a valid form. Disregard the statement in Memo IM-89 OCTOBER 2023 – QUARTERLY FORMS UPDATE that the obsolete form may not be accepted.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATE TO THE DOCUMENTATION OF INCURRED MEDICAL EXPENSES IN THE MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) MANUAL

MANUAL REVISION #
0810.010.15.01

DISCUSSION:

MHABD Manual section 0810.010.15.01 Documentation of Incurred Medical Expenses is revised to state:

FSD processes documentation of medical expenses in a timely manner to ensure correct coverage and sends a Spend Down Notice to notify the participant:

• When the spend down liability was met;
• When documentation of incurred medical expenses did not meet the spend down liability; and
• When the documentation of incurred medical expenses was not allowed to meet the spend down and why the documentation was insufficient.

NECESSARY ACTION:

•  Review this memorandum with appropriate staff.

KE/sh