IM-66 FORM REVISIONS TO HEALTH INSURANCE PREMIUM PAYMENT PROGRAM (HIPP) APPLICATIONS AND AUTOMATIC WITHDRAWAL FORMS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  FORM REVISIONS TO HEALTH INSURANCE PREMIUM PAYMENT PROGRAM (HIPP) APPLICATIONS AND AUTOMATIC WITHDRAWAL FORMS

FORM REVISION #
HIPP-1
HIPP-A
MO 886-4704
MO 886-4705
MO 886-4706

 

DISCUSSION:

Multiple forms have been revised in the Department of Social Services (DSS) Forms Manual to provide updated versions of forms maintained by other divisions.

Application for Health Insurance Premium Payment Program (HIPP-1) and Application for Health Insurance Premium Payment Program for HIV/AIDS (HIPP-A) forms were updated by MO HealthNet Division with a revision date of 8/2020.

Ticket to Work Health Assurance Automatic Withdrawal Authorization (MO 886-4704), Spenddown Pay-In Automatic Withdrawal Authorization (MO 886-4705), and MO HealthNet for Kids Insurance Premium Payments Automatic Withdrawal Authorization (MO 886-4706) forms were updated by the Division of Finance and Administrative Services (DFAS) with a revision date of 1/2021. These forms now have form numbers and the form numbers were added to the DSS Forms Manual.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/cj

IM-65 UPDATES TO DURATION OF APPOINTMENT OF AN AUTHORIZED REPRESENTATIVE IN THE MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) MANUAL

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATES TO DURATION OF APPOINTMENT OF AN AUTHORIZED REPRESENTATIVE IN THE MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) MANUAL

MANUAL REVISION #
0803.020.10.20

 

DISCUSSION:

Section 0803.020.10.20 Duration of Appointment of Representative has been updated to remove the requirement that an application must be received within 30 days of the receipt of the signed Appointment of Authorized Representative (IM-6AR) form.

Additionally, this section has been modified to advise a signed IM-6AR must be received within 90 days of the date of the participant’s signature to be a valid IM-6AR.

EXAMPLE: An employee of the local hospital submits an IM-6AR on behalf of Aaron, who is applying for MO HealthNet. The IM-6AR was signed by Aaron 7 months ago. The IM-6AR was not submitted within 90 days of the date Aaron signed it, therefore, it is not a valid IM-6AR.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/ers

IM-64 UPDATE TO THIRD PARTY LIABILITY (TPL) SECTION IN THE FAMILY MO HEALTHNET (MAGI) AND MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) MANUALS

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATE TO THIRD PARTY LIABILITY (TPL) SECTION IN THE FAMILY MO HEALTHNET (MAGI) AND MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) MANUALS

MANUAL REVISION #
0880.020.00
1805.045.00

 

DISCUSSION:

Third Party Liability (TPL) policy has been updated. Updates include the addition of examples and the following clarification:

Uninsured status is an eligibility factor for certain types of coverage, such as Children’s Health Insurance Programs (CHIP). To determine eligibility for one of these coverage types, insured status cannot be questionable. Obtain and document information or clarification to explain insured status before determining eligibility.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/ers

IM-63 INTRODUCING AGED, BLIND, AND DISABLED SUPPLEMENT (IM-1ABDS) AND OBSOLETING APPLICATION FOR MO HEALTHNET (MEDICAID) (IM-1MA)

FROM: KIM EVANS, DIRECTOR

SUBJECT: INTRODUCING AGED, BLIND, AND DISABLED SUPPLEMENT (IM-1ABDS) AND OBSOLETING APPLICATION FOR MO HEALTHNET (MEDICAID) (IM-1MA)

FORM REVISION #
IM-1ABDS
IM-1ABDS (SPANISH)
IM-1ABDS (LP)

 

DISCUSSION:

The Aged, Blind, and Disabled Supplement (IM-1ABDS) has been created for use with the Application for Health Coverage & Help Paying Costs (IM-1SSL) which is currently used for Family MO HealthNet (MAGI) programs. The Aged, Blind, and Disabled Supplement (IM-1ABDS) collects program specific information and asset information for the MO HealthNet for the Aged, Blind and Disabled (MHABD) programs. Spanish and Large Print forms are also available. This change simplifies the application process for participants who want to apply for Medicaid benefits and provides Family Support Division (FSD) with the information to explore all potential Medicaid coverage.

Effective July 6, 2021 when a participant applies for MO HealthNet (MHN), they must complete the IM-1SSL to collect address, household members, income, and other basic MHN eligibility information. If the participant is disabled, blind, over the age of 65, or in need of long-term care, then they will also complete the IM-1ABDS to collect information regarding program specific questions, assets, and other expenses required for the MHABD programs.

The IM-1ABDS CANNOT be accepted as an application without the signed IM-1SSL. If an IM-1ABDS is received without a signed application, FSD staff must contact the participant to advise that they did not submit a valid application and provide information about applying online or by phone, or offer to mail an application to the participant. The application date is the date a signed IM-1SSL is received.

Staff should complete the IM-1ABDS if the required information cannot be collected from the participant by phone or in person.

The IM-1ABDS CAN be used by a participant to request a referral for an active MAGI participant who is requesting MHABD benefits. Staff must follow current procedures for exploring MHABD coverage.

As of 7/6/2021, the IM-1MA is obsolete and should not be distributed by FSD staff. Unused applications should be discarded and the IM-1SSL and IM-1ABDS should be used for all MHABD applicants. Staff who work with community partners and other stakeholders should advise of the new application process.

FSD will honor IM-1MA’s received between 7/6/2021 and 12/31/2021 as applications. An IM-1MA received prior to 12/31/2021 MUST be processed as a valid application.

NOTE: If an IM-1MA is received after 12/31/21, FSD staff must send an IM-1SSL and IM-1ABDS to the participant. If the IM-1SSL is returned, the date of application would be the date the IM-1MA was first received.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • FSD staff should address any questions or concerns regarding this change through normal supervisory channels.
  • FSD staff should order IM-1ABDS forms from the e-store.
  • Access and print IM-1SSL and IM-1ABDS form from DSS Forms Manual.
  • Discard any unused IM-1MA forms.

 

KE/cj

IM-62 2021 PRESUMPTIVE ELIGIBILITY (PE) INCOME GUIDELINES CONTINUED

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  2021 PRESUMPTIVE ELIGIBILITY (PE) INCOME GUIDELINES CONTINUED

MANUAL REVISION #
APPENDIX A (1900.000.00)

 

DISCUSSION:

The PE Appendix A which posted April 1, 2021 has been extended through March 31, 2022. The attached Appendix A, found in the Presumptive Eligibility Manual, is effective from July 1, 2021 through March 31, 2022.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/df

IM-61 APPOINTING AN AUTHORIZED REPRESENTATIVE (IM-6AR) LARGE PRINT AND SPANISH TRANSLATION FORMS ADDED TO THE FORMS MANUALS

FROM: KIM EVANS, DIRECTOR

SUBJECT: APPOINTING AN AUTHORIZED REPRESENTATIVE (IM-6AR) LARGE PRINT AND SPANISH TRANSLATION FORMS ADDED TO THE FORMS MANUALS

FORM REVISION #
IM-6AR LP
IM-6AR SPANISH

 

DISCUSSION:

The IM-6AR with a revision date of 11/2019 has been converted to large print (IM-6AR LP) and translated into Spanish (IM-6AR Spanish). Both versions of the form are now available in the Department of Social Services (DSS) Forms Manual and the Income Maintenance (IM) Forms Manual.

This is NOT a new revision and no information has changed on the English version.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/cj

IM-56 RESTRICTED ACCOUNTS SECTION ADDED TO THE DECEMBER 1973 ELIGIBILITY REQUIREMENTS MANUAL

FROM: KIM EVANS, DIRECTOR

SUBJECT: RESTRICTED ACCOUNTS SECTION ADDED TO THE DECEMBER 1973 ELIGIBILITY REQUIREMENTS MANUAL

MANUAL REVISION #
1025.015.18

 

DISCUSSION:

The Restricted Accounts section (1025.015.18) has been added to the December 1973 Eligibility Requirements manual. This section provides guidance to help staff determine whether or not a restricted account must be considered as a resource for MO HealthNet for the Aged, Blind, and Disabled programs.

If after review of this policy, staff are still unclear about how funds in a restricted account are evaluated, please submit for review by Program & Policy before a determination is made. Staff should submit a Request for Interpretation of Policy (IM-14) through normal supervisory channels and include all relevant information with the IM-14.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/vm

IM-55 FEDERAL NOTICE REQUIREMENT FOR MO HEALTHNET (MHN) PROGRAMS

FROM: KIM EVANS, DIRECTOR

SUBJECT: FEDERAL NOTICE REQUIREMENT FOR MO HEALTHNET (MHN) PROGRAMS

MANUAL REVISION #
0130.005.05.30 Federal Notice Requirements

FORM REVISION #
IM-4 MULTI LANGUAGE INTERPRETER SERVICES
IM-4 MHN NON-DISCRIMINATION ENGLISH VERSION
IM-4 MHN NON-DISCRIMINATION SPANISH VERSION

 

DISCUSSION:

The Family Support Division (FSD) is introducing a new policy section, 0130.005.05.30 Federal Notice Requirements . This section is located within the Legal Aspects chapter of the General Info Manual under 0130.005.05 Availability of Information. Two new forms have been created, the IM-4 Multi Language Interpreter Services (IM-4 MLIS) and the IM-4 MHN Non-Discrimination (IM-4 MHND) (in English and Spanish).

Federal Regulation 45CFR 92.101-92.105, requires FSD to provide information about language services available to Medicaid participants. FSD will send the IM-4 Multi Language Interpreter Services (IM-4 MLIS) when notices and forms are sent to the participant in connection with their MO HealthNet eligibility.

Federal Regulation 45 CFR 92.1-92.6, requires FSD to provide information regarding prohibiting discrimination under any health program or activity receiving Federal financial assistance. The IM-4 MHN Non-Discrimination (IM-4 MHND) English and Spanish forms and the IM-4 Multi Language Interpreter Services (IM-4 MLIS) forms were created and are located in the Forms Manual.

Beginning June 1, 2021, FSD will systematically send an informational notice, the IM-4 Multi Language Interpreter Services (IM-4 MLIS), in addition to notices and forms sent from the eligibility systems. Additionally, FSD is systematically adding the Non-Discrimination statement, in both English and Spanish, to all Annual Reviews.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Staff will mail the appropriate form with MO HealthNet Applications, MO HealthNet Reviews, and MO HealthNet notices that are sent outside the system.
  • MEDES will NOT show that the IM-4 MLIS or the IM-4 MHND were sent.

KE/mc

IM-51 REVISION TO 2021 UPDATED PRESUMPTIVE ELIGIBILITY (PE) INCOME GUIDELINES

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  REVISION TO 2021 UPDATED PRESUMPTIVE ELIGIBILITY (PE) INCOME GUIDELINES

MANUAL REVISION #
APPENDIX A (1900.000.00)

 

DISCUSSION:

Revisions have been made to PE Appendix A, PE Income Standards, previously posted in Memo IM-#26 on April 2, 2021. The guidelines listed for children ages 1 through 18 have been adjusted and the attached Appendix A, found in the Presumptive Eligibility Manual, is effective from April 1, 2021 through June 30, 2021.

 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

 

KE/df

IM-50 COMPACT OF FREE ASSOCIATION POLICY UPDATES FOR MO HEALTHNET FOR THE AGED, BLIND AND DISABLED (MHABD) AND FAMILY MO HEALTHNET (MAGI) PROGRAMS

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COMPACT OF FREE ASSOCIATION POLICY UPDATES FOR MO HEALTHNET FOR THE AGED, BLIND AND DISABLED (MHABD) AND FAMILY MO HEALTHNET (MAGI) PROGRAMS

MANUAL REVISION #

1010.010.00

1805.020.10.20

 

DISCUSSION:

Citizens of the Federated States of Micronesia, Republic of Palau, and Republic of the Marshall Islands have signed a Compact of Free Association (COFA) with the United States which allows them to enter and leave the United States at will.

As of 12/27/2020, in accordance with section 208 of the federal Consolidated Appropriations Act, 2021, these individuals are eligible to receive MO HealthNet benefits without applying for immigrant status with the United States Citizenship and Immigration Service (USCIS- formerly Immigration and Naturalization Service). These individuals are considered Qualified Noncitizens and are eligible for MHABD and MAGI as long as all other eligibility requirements have been met.

COFA policy only applies to Title XIX funded Medicaid programs which includes but is not limited to: MO HealthNet Non-Spend Down (MHNS), MO HealthNet Spend Down (MHSD), MO HealthNet for Families (MHF) and MO HealthNet for Pregnant Women (MPW). Children’s Health Insurance Programs (CHIP) are funded through Title XXI and therefore are excluded from COFA policy.

Note: Please refer to Appendix H ME Codes Chart for a list of programs and their Title or Funding Source.

 

MHABD Programs

The eligibility system has been updated as of 05/02/2021 to allow new status codes on the NONCITZN/FMML screen for individuals from the Federated States of Micronesia (MCR), Republic of Palau (PAL), and Republic of the Marshall Islands (MAR).

Note: Only application dates of 12/27/2020 or after are eligible and coverage will begin no earlier than 12/27/2020. If processing an application that should include eligibility from 12/27/2020-12/31/2020, send to MHN Program & Policy COLE.MHNPOLICY@dss.mo.gov for review.                                                                                                                                                                                         

 

MAGI Programs

Eligibility system updates have not been completed.  Continue to use guidance issued in E-MAIL Memo #19 for COFA MAGI applicants.

For more information refer to U.S. Citizenship and Immigration Services.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

KE/nw