Category: MoHealthNet Home

FROM: KIM EVANS, DIRECTOR

SUBJECT: EXTENSION OF THE TEMPORARY RETURNED MAIL POLICY FOR ALL MO HEALTHNET (MHN) PROGRAMS

MANUAL REVISION #
1885.020.00

DISCUSSION:

Temporary returned mail policy for all MHN programs introduced in IM-40 RETURNED MAIL REQUIREMENTS DURING THE TRANSITION PERIOD FOR ALL MO HEALTHNET (MHN) PROGRAMS has been extended. Continue to follow the instructions outlined in the memorandum until further notice.

Family MO HealthNet (MAGI) manual section 1885.020.00 Returned Mail has been updated to remove the end date for the temporary policy.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/sh

FROM: KIM EVANS, DIRECTOR

SUBJECT: FAMILY MO HEALTHNET (MAGI) MANUAL UPDATE TO EXCLUDE INCOME FOR CERTAIN TAX DEPENDENTS

MANUAL REVISION #
1805.030.20.10

DISCUSSION:

MAGI Manual section 1805.030.20.10 Income Excluded Under MAGI is updated to reflect policy changes with Child Tax Dependent income and Qualifying Relative Dependent income. These two income types, based on IRS threshold rules for the current tax year, are excluded from the MAGI household.

This manual section in conjunction with IRS Publication 501 for the current tax year should be used to determine Child Tax Dependent and Qualifying Relative Dependent thresholds.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/kl

FROM: KIM EVANS, DIRECTOR

SUBJECT: MO HEALTHNET (MHN) POLICY UPDATES FOR CONTINUOUS ELIGIBILITY FOR CHILDREN (CEC)

NON-MAGI MANUAL REVISION #

MAGI MANUAL REVISION #

DISCUSSION:

CEC was introduced in the 2023 Memorandum, IM-104 Continuous Eligibility for Children. The Centers for Medicare and Medicaid Services (CMS) has approved Missouri’s State Plan Amendment and MHN policy has been updated.

The following section was added to the Family MO HealthNet (MAGI) Manual:

• 1805.070.00 Continuous Eligibility for Children (CEC)

The remaining MHN manual sections listed above are updated to reflect CEC policy.

Note: CEC does not apply to the Non-MAGI Blind Pension (BP) or the Supplemental Nursing Care (SNC) programs.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vh

FROM: KIM EVANS, DIRECTOR

SUBJECT: RESTARTING CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) PREMIUMS, MO HEALTHNET SPEND DOWN (MHSD) PAYMENTS, AND TICKET TO WORK HEALTH ASSURANCE (TWHA) PREMIUM PAYMENTS; CONTINUOUS ELIGIBILITY FOR CHILDREN

DISCUSSION:

In May, 2024, the “unwinding” period, as a result of the Public Health Emergency (PHE), will be over, and normal operations will resume.

This means that beginning June 1, 2024, all participants who are eligible for Ticket to Work Health Assurance in the “premium group”, or Children’s Health Insurance Program in the “premium group”, or MO HealthNet Spend Down will have to pay their premium or pay/meet their spend down before their MO HealthNet (MHN) services are covered. Letters will be mailed in March to notify participants of this policy.

This means that participants will need to pay their June invoice in May to have coverage on June 1, 2024. They must pay their TWHA or CHIP premium each month after that for coverage to continue. If they are in the Spend Down program, they must pay/meet their spend down for any month after May 2024 for which they would like MO HealthNet coverage.

This does not change the amount of their premium or spend down. Participants can pay their premium or spend down online by creating an account at memberportal.mymohealthportal.com.

Between now and June 1, 2024, until a participant’s annual renewal is completed, MHD will continue to provide coverage as it did during the PHE. If, after their annual renewal, a participant moves to a category that requires a premium or Spend Down payment, their coverage will also continue, regardless of payment, until May 31, 2024. Children covered through the CHIP program will also have their coverage provided until May 31, 2024, regardless of payment. After May 31, 2024, children moving from Medicaid for Children to CHIP must pay the first invoice before they receive continuous coverage.

*Beginning January 1, 2024, Continuous Eligibility for Children has begun. This means children eligible for MO HealthNet will have continuous eligibility for 12 months, even if their family circumstances change, such as an increase in income. For children in the CHIP Premium program, payment of the first month’s CHIP premium will be required before an eligible child can be enrolled in CHIP, but further non-payment of CHIP premiums, after the first month’s premium is paid, will not terminate a child’s CHIP eligibility for the remaining duration of the 12-month period.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/

FROM: KIM EVANS, DIRECTOR

SUBJECT: INTRODUCING THE NON-MAGI APPLICATION LETTER

FORM REVISION #
IM-2NMA

DISCUSSION:

A new letter, Non-MAGI Application Letter (IM-2NMA) was created to help Family Support Division (FSD) staff.

The IM-2NMA will be mailed with an Aged, Blind, and Disabled Supplement (IM-1ABDS) and/or a Medical Review Team Packet (IM-61MRT). These forms will be mailed to participants who completed a MO HealthNet application and were approved for a MAGI program – Adult Expansion Group or any of the Family MO HealthNet programs, but indicated that they are disabled or blind.

The letter informs the participant that since they indicated that they are disabled or blind on the application and may be eligible for Non-MAGI programs including:

• MO HealthNet for the Aged, Blind, and Disabled Non-Spend Down
• MO HealthNet for the Aged, Blind, and Disabled Spend Down
• Ticket to Work Health Assurance
• Nursing Facility (Vendor) Coverage

FSD will explore coverage for these programs, but additional information is needed. If the participant wishes to explore Non-MAGI benefits, then the enclosed IM-1ABDS and/or IM-61MRT must be completed and returned.

If the participant does not want FSD to explore Non-MAGI programs, no action is needed and any benefits already approved will not be affected.

The IM-2NMA is available for FSD staff to access in the internal forms manual.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Updated processes will be provided to staff in a separate email memorandum.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2024 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI PROGRAMS

MANUAL REVISION #
1805.030.20.10
APPENDIX A
APPENDIX A (PE)
APPENDIX B
APPENDIX D
APPENDIX E
APPENDIX I

FORM REVISION #
IM-4PRM

DISCUSSION:

Effective April 1, 2024, the Federal Poverty Level (FPL) income guidelines increase for all MAGI programs, including Presumptive Eligibility (PE).

MAGI cases were adjusted on March 8, 2024 based on the new FPL income guidelines. Due to the Continuous Eligibility requirement during the Transition Period, cases that have not had an Annual Renewal in the last 12 months will not have coverage closed or reduced to a lower level of care.
Note: Changes in circumstance or applications processed prior to April 1, 2024 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.

MAGI MANUAL REVISION, PROGRAM DESCRIPTIONS, AND OTHER RESOURCES

MAGI Manual section 1805.030.20.10 Income Excluded Under MAGI has been updated to reflect an increase in the tax filer threshold for a child for earned income to $13,850 and unearned income to $1,250 based on the 2023 IRS Publication 501.

PRESUMPTIVE ELIGIBILITY

PE Manual Appendix A income standards are updated. These standards are effective from April 1, 2024 through March 31, 2025.

NECESSARY ACTION:

• Use the new FPL income guidelines beginning April 1, 2024
• Review this memorandum with appropriate staff.

KE/rc

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 $7,536 per month effective April 1, 2024. For applications taken on or after April 1, 2024, use $7,536 to determine the number of months of ineligibility for vendor level services.

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

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, 2024, 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 9, 2024, 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. However, due to the continuous enrollment condition, participants will not have coverage reduced to a lower level of care or cases closed until after their annual renewal is completed.

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, 2024 through March 31, 2025. 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 FAMIS Resources to resolve conflicting actions related to FPL.
• Review this memorandum with appropriate staff.

KE/st

FROM: KIM EVANS, DIRECTOR

SUBJECT: REVISION TO MO HEALTHNET (MHN) POLICY ALLOWING ACTIVE PARTICIPANTS TO MOVE FROM ONE MHN PROGRAM TO ANOTHER

MANUAL REVISION #
0840.010.00
0840.015.05
1890.000.00
1890.010.00
1890.010.10
1890.010.20

DISCUSSION:

MHN policy is updated with requirements for active participants moving from one program to another when a change in circumstance occurs, or upon request from the participant.

An active MHN participant does NOT require a new application to move from one program to another, as long as they remain in the same household. All actions should be completed ex parte (which means without contacting the participant), if possible.

Note: This policy does NOT change the existing policy for an active participant or applicant who is requesting a cash benefit. See 0804.025.00 MO HealthNet Application Concurrent With MHABD Cash Programs.

Policy updates shown below should be reviewed by all staff:

Non-MAGI Policy Manual

• 0840.010.00 Changes in Circumstances
• 0840.015.05 Pre-closing Ex Parte Review

MAGI Policy Manual

• 1890.000.00 Ex Parte Review Process
• 1890.010.00 Pre-closing Actions
• 1890.010.10 Eligibility Exists Under Another Category
• 1890.010.20 No Other Eligibility Exists

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj