Category: MoHealthNet Home

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  2021 FAMILY MO HEALTHNET (MAGI) COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION (VA) AND RAILROAD (RR) INCOME

DISCUSSION:

The purpose of this memorandum is to inform staff that VA and RR participants received a 1.3% COLA for MAGI programs effective January 2021.

NOTE: The Families First Coronavirus Response Action of 2020 (FFCRA) requires that MO HealthNet (MHN) coverage for individuals be maintained at the same level or better for the duration of the COVID-19 Public Health Emergency (PHE).  The eligibility system will not reduce or end MHN coverage due to the COLA changes until the PHE has ended.

Cases Adjusted

Cases that include income types VA and/or RR benefits in the eligibility system were subject to an automatic increase of 1.3% 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. 

NOTE: Actions to reduce benefits will not be taken until the COVID-19 PHE has ended.

Cases That Did Not Adjust

Some cases did 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 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 a 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 an 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.

NOTE: Adverse Action notices will not be issued until the COVID-19 PHE has ended.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/kg

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  2021 UPDATED PRESUMPTIVE ELIGIBILITY INCOME GUIDELINES

MANUAL REVISION #

APPENDIX A (1900.000.00)

DISCUSSION:

The purpose of this memorandum is to update the income guidelines for Presumptive Eligibility due to the increase in the Federal Poverty Level (FPL). These guidelines are effective from April 1, 2021 through March 31, 2022. Appendix A, found in the Presumptive Eligibility Manual has been updated to reflect the new FPL. 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/df                                              

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  2021 UPDATE OF POVERTY INCOME GUIDELINES FOR FAMILY MO HEALTHNET (MAGI) PROGRAMS

MANUAL REVISION #

1805.030.20.10

1800.000.00 APPENDIX A

1800.000.00 APPENDIX B

1800.000.00 APPENDIX D

1800.000.00 APPENDIX E

1800.000.00 APPENDIX I

FORM REVISION #

IM-4PRM                    

DISCUSSION:

Effective April 1, 2021, the Federal Poverty Level (FPL) income guidelines are increased for:

• MO HealthNet for Kids (MHK);
• Children’s Health Insurance Program (CHIP);
• MO HealthNet for Pregnant Women (MPW);
• Show-Me Healthy Babies (SMHB);
• Uninsured Women’s Health Services (UWHS); and
• All Presumptive Eligibility programs:
  • Temporary MO HealthNet During Pregnancy (TEMP);
  • Show-Me Health Babies Presumptive Eligibility (SMHB-PE);
  • Presumptive Eligibility for Children (PC); and
  • Presumptive Eligibility for Parents/Caretaker Relatives (MHF-PE).

NOTE: New poverty income guidelines for Presumptive Eligibility programs will be provided to Qualified Entities by Income Maintenance Program and Policy.

MAGI cases will be adjusted in April 2021 based on the new FPL income guidelines; however, due to the Public Health Emergency (PHE), no cases will have coverage closed or reduced to a lower level of care due to FPL adjustments until after the PHE has ended. 

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.

REQUEST FOR HEARING/CONTINUED BENEFITS

After the PHE expires, any household receiving an IM-80 Adverse Action Notice may request a hearing on the adjustment action within 10 days from the date of the notice.

If a household receiving an IM-80 Adverse Action Notice requests a hearing on the adjustment within 10 days of the notice, the household benefits continue at the level before the FPL adjustment until the hearing decision is made. Staff should inform the household that if continued benefits are issued and the agency is determined to be correct, a claim will be established for any overpayment.

MAGI MANUAL, 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 earned income from a child to $12,400 based on the 2020 IRS Publication 501.

NOTE: The tax filer threshold for unearned income from a child has not increased and remains the same.

The internet pages MHK/MHF/TA Income Chart and Do Your Children Need Health Coverage are updated to include the change in FPL income limits.

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines effective for April 2021 and later.
• Review this memorandum with appropriate staff.

KE/al

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  MILEAGE EXPENSE RATE INCREASE

MANUAL REVISION #

APPENDIX J

DISCUSSION:

The state mileage rate used to calculate expenses for Income Maintenance Programs will increase to $0.43 effective April 1, 2021.

A Memorandum for DSS Employees was issued by the Human Resource Center announcing the same change to employee mileage reimbursement rates, often used on monthly expense reports. The increased rate for employee mileage reimbursement is effective March 1, 2021.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vb

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  HOME AND COMMUNITY BASED SERVICES (HCB) REFERRAL UPDATE

MANUAL REVISION #

0820.030.10.05

DISCUSSION:

The purpose of this memorandum is to introduce a clarification added to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual.

Section 0820.030.10.05 has been updated to clarify that a Home and Community Based (HCB) referral is not needed when the participant is eligible for MHABD Non-Spend Down (MHNS).

MHNS provides the same coverage as HCB.

Refer to the HCB vs HCBS chart for further clarification of coverage and eligibility for HCB which requires a referral to DHSS versus HCBS services provided under non-spend down or spend down coverage.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Do not submit an IM-54A for an individual who is eligible for MHNS.

KE/vb

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  INCARCERATION REPORTED BY ACCURINT FOR GOVERNMENT ELIGIBILITY (AFGE)

FORM REVISION #

Information Notice-Regarding an Action Taken on your Case (IM-50AfGE)

DISCUSSION:

The Accurint for Government Eligibility (AfGE) portal provides information regarding incarceration in more than 30 states.  AfGE may be used for the MO HealthNet for the Aged, Blind, and Disabled (MHABD) and Family MO HealthNet (MAGI) programs at the time of application and at annual renewal.

Refer to the AfGE User Guide for instructions on how and when to access incarceration information available in the AfGE portal.

Continue to follow the policies and procedures discussed in the following memos:

• IM-11 Introduction of Suspension of MO HealthNet Benefits for Incarcerated Participants for All MO HealthNet Programs, dated February 17, 2020
• IM-12 Introduction of New Forms for Suspended MO HealthNet (MHN) Benefits for Incarcerated Participants, dated February 19, 2021
• Email Memo-7 System Changes in FAMIS to End Food Stamps (FS), Temporary Assistance (TA), and Child Care (CC) Benefits when MO HealthNet for the Aged, Blind, and Disabled (MHABD) is Suspended Due to Incarceration, dated March 29, 2020

The Suspending MO HealthNet Participants (IM-150) form must be completed using the information gathered from the AfGE portal.  The form and AfGE printout must be sent in one attachment via email to MHNJailsandDOCReport@ip.sp.mo.gov.  The AfGE results must also be stored in the participant’s electronic file in the Electronic Content Management (ECM) system.  Sending the document to the SharePoint address does not automatically add the document to the electronic file in the ECM.

Incarceration information provided by the AfGE portal is subject to Fair Credit Reporting Act (FCRA) requirements.  Staff must have the appropriate FCRA authorization prior to searching the AfGE portal for incarceration information.  Information regarding proper authorization to review FCRA sources is available in the Electronic Verification System section of the General Information manual. 

 NOTE:  Individuals who are not applying for or receiving MO HealthNet coverage must sign an Authorization for Verification (IM-6EVS) form before their information can be accessed in the AfGE portal.  This includes spouses who are not requesting coverage on the MHABD case and parents who are not requesting coverage on the MAGI case. 

In order to notify the participant of a negative action taken on their case due to information reported by AfGE, staff must include an IM-50AfGE Information Notice-Regarding an Action Taken on your Case with the notices regarding the suspension of MO HealthNet benefits.  This form provides notification for the participants MO HealthNet case as well as any additional cases such as TA, CC, or the Supplemental Nutrition Assistance Program (SNAP). 

Questions must be sent through normal supervisory channels to the MHN Program and Policy Unit at COLE.MHNPolicy@dss.mo.gov.  If a case specific policy clearance is needed, the Request for Interpretation of Policy (IM-14) process should be utilized.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/rr/kg

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  UPDATE TO MO HEALTHNET GATEWAY TO BETTER HEALTH APPLICATION

FORM REVISION #

IM-1MAGW

DISCUSSION:

The MO HealthNet Gateway to Better Health Application has been updated to reflect the 2021 Substantial Gainful Activity (SGA) income maximum of $1310.00. 

Use this updated version effective immediately and discard all previous versions. 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  UPDATE OF POVERTY INCOME GUIDELINES FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED PROGRAMS

MANUAL REVISION #

Appendix J, Adult Standards Chart
Appendix K, MO HealthNet Aged, Blind, and Disabled Program Descriptions
Appendix L, Aged, Blind, Disabled Income Chart
Appendix M, Medicare Cost Savings Program

DISCUSSION:

Effective April 1, 2021, the Federal Poverty Level (FPL) income guidelines increase for the following programs: MO HealthNet for the Aged, Blind and Disabled (MHABD) Spend Down and Non-Spend Down, Ticket to Work Health Assurance (TWHA), Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB and SLMB-2), Qualified Disabled Working Individuals (QDWI), MO HealthNet for Disabled Children (MHDC) and Gateway to Better Health programs (GTBH).  The Blind Pension (BP) spousal support income maximum has also increased with the FPL.   

On the weekend of March 06, 2021, MHABD programs with income eligibility based on the federal poverty level will be adjusted. This memorandum includes information on:

• PREMIUM REFUNDS
• INCOME CHARTS AND PROGRAM DESCRIPTIONS

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.

INCOME CHARTS

Income charts are no longer being updated in each manual section, but instead will be updated in the Appendices.  For historical purposes, the income standards listed below will be included in the FPL memo:

MHABD OAA/PTD income standards effective April 01, 2021 through March 31, 2022

MHABD AB income standards effective April 01, 2021 through March 31, 2022

Blind Pension sighted spouse income maximum effective April 01, 2021 through March 31, 2022

QDWI income standards effective April 01, 2021 through March 31, 2022 

QMB income standards effective April 01, 2021 through March 31, 2022

SLMB1 income standards effective April 01, 2021 through March 31, 2022

SLMB2 income standards effective April 01, 2021 through March 31, 2022

TWHA Premiums for Single Cases effective April 01, 2021 through March 31, 2022

TWHA Premiums for Couple Cases effective April 01, 2021 through March 31, 2022

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

The MHABD Standards Chart, MHABD Program Descriptions, MHABD Income Chart, and the Medicare Cost Savings Programs (QMB and SLMB) internet pages are updated in Appendices J, K, L, and M in the MHABD Manual to include the change in FPL income limits.

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines effective for April 2021 and later.
• Follow the FPL FAMIS Guide to resolve conflicting actions.
• Review this memorandum with appropriate staff.

KE/vm      

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 purpose of this memorandum is to inform staff that the average private pay nursing care rate will increase to $6,588 per month on April 1, 2021.  For applications taken on or after April 1, 2021, use $6,588 to determine the number of months of ineligibility for vendor level services.

The current average private pay nursing care rate can be found on Appendix J.

The historical values for average private pay nursing care rates are listed on Appendix N.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Use $6,588 as the average private pay rate effective for applications on or after April 1, 2021.

KE/vb                                              

FROM:  KIM EVANS, DIRECTOR

SUBJECT:   CLARIFICATION OF THE QUALIFIED INCOME TRUST (QIT) TRUSTEE REQUIREMENTS FOR PARTICIPANTS OF THE HOME AND COMMUNITY BASED (HCB) AND MISSOURI’S CHILDREN WITH DEVELOPMENTAL DISABILITIES (MOCDD) WAIVER PROGRAMS        

MANUAL REVISION # 

1025.015.04.01.02

DISCUSSION:

The purpose of this memorandum is to inform staff of clarification added to the QIT section 1025.015.04.01.02 of the December 1973 Eligibility Requirements manual related to a participant’s selection of a trustee when a QIT is established. 

Under 42 USC 1396p(d)(4)(B), participants who meet all other eligibility requirements for the HCB and MOCDD programs (except for income), will become eligible to receive waiver services when the participant creates a QIT and deposits the portion of his/her income that is over the income maximum standard for HCB or MOCDD. That portion of a participant’s income deposited into the QIT is excluded from the HCB or MOCDD budget.  Any gains on income held in the QIT are also excluded for HCB and MOCDD. 

During the process of establishing a QIT, the participant is required to select a trustee for administration of the trust.  Clarification has been added to the manual explaining the requirement for the participant to select a trustee for the proper administration of his/her QIT, but the participant is not required to select a trustee who is bonded.  It is assumed by the Family Support Division the participant will select a trustee based on who he/she feels most confident will protect assets held in the QIT, and one who will follow guidelines established for how funds may be distributed to the participant from the QIT.

See the Qualified Income Trusts section 1025.015.04.01.02 under “Deposits and Distributions from the QIT” for information about QIT distribution requirements. Staff must continue to follow the instructions in this section when funds from a QIT have been misused or mishandled.  This policy applies whether or not the trustee of the QIT is bonded.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vm