IM-23 INTRODUCING THE COMBINED INCOME MAINTENANCE (IM) POLICY MANUAL

FROM: MANDI ADAMS, INTERIM DIRECTOR

SUBJECT: INTRODUCING THE COMBINED INCOME MAINTENANCE (IM) POLICY MANUAL

 

DISCUSSION:

The Family Support Division has launched a new Combined IM Policy Manual, containing policies for all IM programs:

  • MO HealthNet Programs
  • Temporary Assistance
  • SNAP
  • Aged, Blind, & Disabled Cash Programs

No changes to program policy were made with the transition to the Combined Manual, but the policy wording was re-written with plainer, less-technical language.

Shared policy sections were created for topics that have similar eligibility factors for all IM programs, such as Applications, Non-Financial Eligibility, Financial Eligibility, and Hearings, with program-specific differences noted throughout the sections. Program-specific eligibility factors can be found in separate policy sections for MO HealthNet, Temporary Assistance, and SNAP.

The integrated search function allows users to search by keyword or topic and see how that item is treated by each program. Policy is further streamlined by utilizing charts to organize details, such as types of income and resources or income limits, where possible.

A total of 16 individual manuals have been combined into the new manual, with SuN Bucks set to be added in the future. The current manuals will all be archived April 23, 2025. Memos, e-mail memos, and Hot Tips from 2024 and prior will also be archived.

The Combined Manual can be accessed the same way as the prior manuals – a link to the Combined IM Policy Manual has been added to dssmanuals.mo.gov. The Forms Manual, National Voter Registration (NVR) Manual, and manuals for other DSS divisions remain here as well.

An introduction video with an overview of the layout of the manual as well as how to navigate and search the manual is available here.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Staff questions and concerns should be sent through normal supervisory channels.

 

 

 

MA/mn

IM-19 2025 FAMILY MO HEALTHNET (MAGI) COST OF LIVING ADJUSTMENT (COLA) FOR SSA/SSI INCOME

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

 

IM-18 NURSING HOME COVERAGE FOR PARTICIPANTS ON QUALIFYING MODIFIED ADJUSTED GROSS INCOME (MAGI) LEVELS OF CARE

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

 

 

IM-17 2025 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI PROGRAMS

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

IM-15 UPDATE TO 1619 THRESHOLD

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

IM-14 INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY PENALTIES

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

IM-13 NON-MAGI FEDERAL POVERTY LEVEL ADJUSTMENT

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

Assistance Group Size Non-Spend Down OAA/PTD (85% FPL) Non-Spend Down AB (100% FPL)
1 $1109 $1305
2 $1499 $1763

QDWI income standards

Assistance Group Size QDWI (200% of FPL)
1 $2609
2 $3525

Medicare Savings Programs income standards

Assistance Group Size QMB (100% FPL) SLMB1 (120% FPL) SLMB2 (135% FPL)
1 $1305 $1565 $1761
2 $1763 $2115 $2380
3 $2221 $2665 $2999

Blind Pension sighted spouse monthly income maximum

Sighted Spouse (500% FPL) $8813

TWHA Income Standards and Premiums

Percent of FPL Type of Case Monthly Income Premium Amount
Less than 100% FPL Single $1305.00 or less non premium
  Couple $1763.00 or less non premium
100% FPL up to but not including 150% FPL Single $1305.01-1956.99 $52
  Couple $1763.01-2643.99 $71
150% FPL up to but not including 200% FPL Single $1957.00-2608.99 $78
  Couple $2644.00-3524.99 $106
200% FPL up to but not including 250% FPL Single $2609.00-3260.99 $130
  Couple $3525.00-4406.99 $176
250% FPL up to 300% FPL Single $3261.00-3913.00 $196
  Couple $4407.00-5288.00 $264

 

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

 

IM-148 UPDATES TO THE MISSOURI LONG-TERM CARE PARTNERSHIP PROGRAM SECTION OF THE DECEMBER 1973 ELIGIBILITY REQUIREMENTS MANUAL

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATES TO THE MISSOURI LONG-TERM CARE PARTNERSHIP PROGRAM SECTION OF THE DECEMBER 1973 ELIGIBILITY REQUIREMENTS MANUAL

MANUAL REVISION #
1030.055.00
1030.055.05
1030.055.10
1030.055.15
1030.055.20

 

DISCUSSION:

The Missouri Long-Term Care Partnership Program sections of the December 1973 Eligibility Requirements manual were updated to reflect current terminology, replace broken links, update contact information, and remove duplicated information. References to the Department of Insurance, Financial Institutions, and Professional Registration (DIFP) were replaced with the updated name Department of Commerce and Insurance (DCI).

The following sections are revised and replace all previously released policy and memorandums:

 

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Replace any previously saved contacts with the updated contact information.

 

 

 

KE/sh

IM-13 2020 MAGI COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION AND RAILROAD INCOME

FROM:  KIM EVANS, DIRECTOR

SUBJECT:   2020 MAGI COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION AND RAILROAD INCOME

DISCUSSION:

This memorandum informs staff that Railroad Retirement (RR) and Veterans Administration (VA) participants received a 1.6% Cost of Living Adjustment (COLA) for MAGI programs effective January 2020.

Cases Adjusted

Cases that included income types RR and/or VA Benefits in the eligibility system were subject to an automatic increase of 1.6% for those income types.  The eligibility system end dated the previous income and added a new piece of income evidence that reflected the adjusted income amount.

Cases That Did Not Adjust

Some cases did not adjust during this COLA.  These cases will require manual intervention from staff to add the increased income amounts.  As cases are reviewed, check 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 finalized the decision(s) and sent out the appropriate notices.  The reasons and notices that were sent are as follows:

  • Cases with no change were sent the IM-33C.
  • Cases that resulted in benefit reduction were sent an IM-80 allowing 10 days for the individual to respond to the proposed case action. The IM-33C was sent after the IM-80 expired.
  • Cases that resulted in individuals who no longer qualify were sent IM-80 PRE allowing 10 days for the individual to respond to the proposed case action. An IM-80PRE and IM-80 were sent, followed by the IM-33C.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

KE/kg

IM-137 MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) AUTHORIZED REPRESENTATIVE FAMIS ENHANCEMENT

FROM:  REGINALD E. McELHANNON, INTERIM DIRECTOR

SUBJECT:  MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) AUTHORIZED REPRESENTATIVE FAMIS ENHANCEMENT

 

DISCUSSION:

This is the fifth in a series of enhancements to FAMIS to provide current information to the Authorized Representative (AR) as well as the MHABD participant.

IM-77 November 14, 2016 introduced the first notices to be automatically sent to the MHABD AR.

IM-35 April 24, 2017 introduced the next notices to be automatically sent to the MHABD AR.

2017 IM Memorandum #89 dated July 11, 2017 introduced more notices to be automatically sent to the MHABD AR.

IM-165 December 27, 2017 introduced additional notices to the AR.

Effective September 2, 2019 FAMIS will introduce two new screens.  These screens will be used for MHABD authorized representatives only, and will allow for the entry of an AR for the head of household (HOH) and/or other eligibility unit (EU) members.  

  •  Select ADM Authorized Representative (FMNH/SELADMAR)
    Includes a list of all open ARs.  This screen will also list ARs that were added on this screen and then ended.  ARs that were ended prior to the conversion to FMNH will remain on the Representative List (FMJ1/AUTHREP) screen, and will not be added to FMNH.
  • MHABD Representative Detail (FMNG) AR specific information will be added to this screen. There is no fastpath to this screen, it must be accessed from FMNH/SELADMAR.

NOTE: Authorized representatives for Food Stamp (FS), Child Care (CC), and Temporary Assistance (TA) cases will continue to be entered and updated on Representative List (FMJ1/AUTHREP) and Representative Detail (FMJG).

FMNH and FMNG will allow the collection of more specific information about who the participant wants to represent them and in what manner.  Participants will be able to choose a Primary Authorized Representative.  Notices will only be mailed to the primary AR.    

MHABD ARs will now be designated for the individual, not the entire eligibility unit (EU).  Each spouse may select his/her own AR. 

Notices will now be sent to the AR for couple cases, IF they share the same primary AR, or if only the individual requesting or receiving benefits designates an AR.  

NOTE: Protected Health Information (PHI) Permission response of N will not prevent notices being mailed to an AR coded as primary. 

ARs previously entered on the Representative List (AUTHREP/FMJ1) screen will be converted to the new FMNH and FMNG screens September 1, 2019.  Information will be moved for all open ARs to the HOH only.  Primary role will be assigned based on the hierarchy previously developed, see IM-165 December 27, 2017.   At each contact and the annual reinvestigation, review converted ARs to ensure information is correct.  Converted ARs coded with a role of APP (application only) must be ended.  These can be re-entered with their correct role if they were not intended to be application only ARs. Converted ARs may be updated to indicate they are primary, or not, etc.  Type and Role may not be updated once entered or converted.  Closed ARs will not be converted to the new screen, and will remain on the AUTHREP screen. 

NOTE: Updating a converted AR to shared Y will NOT create a copy for the spouse.  It is necessary to end the converted AR, and re-enter as shared.  Do not enter the same AR for the spouse without ending the converted AR.  FAMIS will treat this as 2 separate ARs, not a single shared AR.

It may be necessary to:

  • review the IM6AR the participant submitted to determine the correct role was assigned when the AR was entered into FAMIS,
  • call a participant to ensure the AR is correct and has the correct authority, or
  • send an IM6ARR so the participant can end the AR designation.

When an application is registered and FSD staff indicates on the Application Detail screen that an AR has signed the MHABD application, the FMNG screen will appear immediately following Eligibility Unit Member Role (FM3Z/EUMEMROL) in the controlled flow.  If there is also a FS, CC, or TA application AUTHREP will follow FMNG.  If the same AR is listed for MHABD and another program the AR must be entered on both screens.

NOTE:  The AR’s address must not be entered as the mailing address on the Person Detail (PRSNDTL) screen.  When the AR’s address is entered, the participant does not receive a copy of notices.

Representatives with Application Only (APO) role

On the FMNG screen the AR role of APO will be used to indicate the AR has been designated to assist with the application process only.  An AR coded as APO will be ended by FAMIS upon the completion of the application (approval or rejection).   If a hearing is requested the staff member who receives the hearing request must make updates as follows:

  1. Cancel reject the application if appropriate,
  2. Update the hearing field to Y on the FMNG screen and
  3. Remove the AR end date if application was not cancel rejected.

When the hearing decision is received:

  1. Update the hearing request to N on the FMNG screen,
  2. Enter the current date as the end date, and
  3. Approve or reject as indicated by the hearing decision.

User guides have been developed to give further instructions for adding an Authorized Representative for MO HealthNet for the Aged, Blind, and Disabled and the hearing requested field.

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • At each contact or the annual reinvestigation, review Authorized Representatives to ensure information is correct and current.
  • Begin adding new MHABD authorized representatives on the FMNH/FMNG screens.

RM/vb

ATTACHMENTS: