Category: MoHealthNet Home

FROM: KIM EVANS, DIRECTOR

SUBJECT: MO HEALTHNET (MHN) POLICY CHANGES TO EXTEND POSTPARTUM COVERAGE TO 12 MONTHS

FORM REVISION #

IM-32MAGI

DISCUSSION:

Senate Bills 45 and 106, signed by Governor Parson on July 7, 2023 extend postpartum coverage to 12 months for women who have active Medicaid (including prior quarter) or Children’s Health Insurance Programs (CHIP) coverage when their pregnancy ends. The manual sections listed above are updated to reflect these changes. The changes included in this memorandum were effective July 7, 2023. Missouri’s State Plan Amendment (SPA) to implement these changes was approved by the Centers for Medicare and Medicaid Services (CMS) on November 14, 2023.

Note: This change to postpartum coverage does not apply to state funded programs such as Blind Pension (BP), Emergency MHN for Ineligible Aliens (EMCIA), Show-Me Healthy Babies (SMHB) individuals denied MO HealthNet for Pregnant Women (MPW) coverage due to an ineligible immigration status, and Uninsured Women’s Health Services (UWHS).

The following Family MO HealthNet (MAGI) manual sections are now obsolete:

• 1850.040.30 Coverage When Application Is Made After the Birth
• 1805.040.40 Extended Women’s Health Services
• 1850.040.40.10 Eligibility for Other MO HealthNet Programs
• 1850.040.40.30 Notification of Ineligibility for Extension Due to Insurance

The following sections have been added to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual:

• 0810.045.00 Pregnancy
• 0810.045.05 Postpartum

Appendix I and the IM-32MAGI have been updated to reflect a 12 month postpartum period.

Non-Pregnancy Levels of Care

Individuals receiving coverage under a non-pregnancy MHN level of care will not be moved to a pregnancy level of care unless they request that Family Support Division (FSD) do so.

Postpartum coverage for these individuals is granted within the MHN program they were on the date their pregnancy ended.

• Non-MAGI Spend Down and Ticket to Work Health Assurance (TWHA) – A pregnant individual under these programs will have continuous coverage from the first day they meet their Spend Down or pay their premium while pregnant through the end of the 12 month postpartum period.
• CHIP children – If it is not reported that a CHIP child is pregnant until after the pregnancy ends, the child will continue to be covered on the CHIP level of care they had on the date the pregnancy ended through their 12 month postpartum period. Pregnant and postpartum CHIP individuals are not required to pay a premium. However, if it is reported that a CHIP child is pregnant, they will be transitioned to MPW or SMHB for the remainder of their pregnancy through the end of the 12 month postpartum period.

NOTE: CHIP/SMHB individuals in their postpartum period who request to be moved to Title XIX level of coverage will not be able to regain eligibility under postpartum.

Prior Quarter

Individuals who apply for coverage after their pregnancy ends and are found eligible for prior quarter coverage, including the date the pregnancy ended, will be eligible for 12 months of postpartum coverage.

Extended Women’s Health Services (EWHS)

The EWHS program is discontinued with the implementation of 12 month postpartum. The UWHS program remains in place.

Annual Renewals

Annual renewals are not to be completed until the end of the 12 month postpartum period. An ex parte renewal will be attempted prior to sending a pre-populated renewal form to the participant.

System Updates

Updates are in progress in both eligibility systems to systematically grant 12 months of postpartum coverage. Review MEDES Resources, key word “Mitigation” for the manual process to follow on MAGI levels of care. The Non-MAGI manual process will be released in an email memorandum.

NECESSARY ACTION:

• Review MEDES Resources, key word “Mitigation” for the MAGI manual process to follow until system updates can be completed.
• Review this memorandum with appropriate staff.

KE/rc

FROM: KIM EVANS, DIRECTOR

SUBJECT: CONTINUOUS ELIGIBILITY FOR CHILDREN

DISCUSSION:

Effective January 1, 2024, Missouri is implementing Continuous Eligibility for Children (CEC) as directed in the Consolidated Appropriations Act, 2023. CEC allows continuous eligibility for 12 months for children ages 18 and under.

Eligibility may only be terminated prior to the end of the 12 month period if the child meets one of the following criteria:

• Turns 19,
• Ceases to be a resident of the State of Missouri,
• The child or child’s representative requests a voluntary termination of eligibility,
• The child dies, or
• Eligibility is erroneously granted at the most recent determination, redetermination, or renewal due to agency error or fraud, abuse, or perjury attributed to the child or child’s representative.

Policy updates will be released once the Centers for Medicare and Medicaid Services (CMS) has approved Missouri’s State Plan Amendment.

Note: Additional information on processing procedures is forthcoming.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vh

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2024 FAMILY MO HEALTHNET (MAGI) COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION (VA) AND RAILROAD (RR) INCOME

DISCUSSION:

Effective January 2024 VA and RR participants will receive a 3.2% COLA. System updates will be made the weekend of December 16, 2023.

Note: Annual renewals resumed for all MO HealthNet (MHN) programs on April 1, 2023. An annual renewal must be completed before a determination of ineligibility or lesser coverage can be made. The eligibility system will not reduce or end MHN coverage due to the COLA changes until an annual renewal has been completed for the case.

Cases Adjusted

Cases that include income types VA and/or RR benefits in the eligibility system are subject to an automatic increase of 3.2% for those income types. The eligibility system will end date the previous income and add a new piece of income evidence that reflects the adjusted income amount.

Note: Actions to reduce benefits will not be taken until an annual renewal has been completed.

Cases That Did Not Adjust

Some cases will not adjust during the 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: Adverse Action notices will not be issued until an annual renewal has been completed.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/vh

FROM: KIM EVANS, DIRECTOR

SUBJECT: QUALIFIED MEDICARE BENEFICIARY (QMB) AND SPECIFIED LOW-INCOME MEDICARE BENEFICIARY GROUP 1 (SLMB1) ENROLLMENT IS AUTOMATIC FOR MO HEALTHNET (MHN) PARTICIPANTS

MANUAL REVISION #

DISCUSSION:

Enrollment in QMB and SLMB1 is automatic for all eligible MHN participants. Eligibility for QMB and SLMB1 must be explored when processing an application for MHN coverage.

Explore eligibility for QMB and SLMB1 when completing annual renewals, changes in circumstance, or applications for other types of assistance. If the claimant does not already receive QMB or SLMB1 coverage and appears to be eligible, take actions to add QMB or SLMB1 coverage.

When a participant becomes eligible for QMB or SLMB1, the SMI premium is no longer an allowable deduction. This may cause an increase in spend down or cause a non-spend down participant to have a spend down. A participant may choose to close QMB or SLMB1 coverage. If the participant makes the request in person or by phone, explain the financial impact so the participant makes an informed decision.

Note: Medical expenses must be updated on the Medical Expense screen (MEDEXP/FMXA) in the eligibility system.

The following sections were added to the Family MO HealthNet (MAGI) Manual:

• 1805.065.00 Enrollment in Medicare Savings Programs (MSP)
• 1885.045.00 Participant Becomes Eligible for Medicare

The following section was added to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual:

• 0840.010.40 Participant Becomes Eligible for Medicare

The remaining MHABD Manual sections listed above are updated to reflect automatic enrollment policy, update general terminology and remove outdated processes.

Note: Continue to follow current processing procedures for Non-MAGI applications.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/sh

FROM: KIM EVANS, DIRECTOR

SUBJECT: MO HEALTHNET (MHN) COVERAGE FOR FORMER FOSTER CARE YOUTH (FFCY) INDIVIDUALS WHO AGED OUT OF CARE IN A STATE OTHER THAN MISSOURI

MANUAL REVISION #
0875.000.00
1805.050.00
1900.020.60

DISCUSSION:

Section 1002(a)(2) of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act became effective 1/1/2023 changing the way eligibility is determined for individuals who age out of foster care in a state other than Missouri. Eligibility for these individuals will be determined under different criteria based on when they reached the age of 18.

Individuals who turned 18 before January 1, 2023

• Are under age 26;
• Declare they were in foster care in a state other than Missouri for at least 6 months prior to aging out of care; and
• Must be found ineligible for MHN coverage in all other applicable mandatory eligibility groups prior to being approved for coverage under the FFCY program.

Individuals who turned 18 on or after January 1, 2023

• Are under age 26;
• Declare they were in foster care in a state other than Missouri at the time they turned 18;
• Are not required to be found ineligible for MHN coverage prior to being enrolled in FFCY coverage; and
• Are ineligible for FFCY coverage if they are already covered under a mandatory level of Medicaid through the state of Missouri.

System updates are in progress to determine eligibility for these individuals. Until system updates are completed, send an email to COLE.MHNPOLICY@dss.mo.gov with “Former foster care state other than Missouri” in the subject line if an application is received for one of these individuals.

FFCY eligibility for individuals who age out of foster care in Missouri will continue to be handled through Children’s Division’s (CD) eligibility system.

The Family MO HealthNet (MAGI) and Presumptive Eligibility (PE) Programs Manuals have been updated to reflect these changes.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/rc

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATED MODIFIED ADJUSTED GROSS INCOME (MAGI) VERIFICATION PLAN

MANUAL REVISION #
1800.005.00

DISCUSSION:

The Missouri MAGI Verification Plan has been updated and posted online with an implementation date of April 3, 2023. The MAGI verification plan is required to outline policies, processes and data sources used to determine MAGI eligibility.

Federal Regulations, 42 CFR 435.945(j) and 457.380(j), require state Medicaid and CHIP agencies to develop and maintain a MAGI State Eligibility Verification Plan. States are required to submit their verification plan to Centers for Medicare and Medicaid Services (CMS) who posts the plan on Medicaid.gov.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/rc