Category: MoHealthNet Home

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 REQUIREMENT TO CERTIFY MAIL TO BLIND PENSION PARTICPANTS TEMPORARILY SUSPENDED

DISCUSSION:

The Department of Social Services (DSS) has suspended the requirement that correspondence between DSS and Blind Pension participants must be sent by certified mail.

This change will give the Family Support Division more flexibility in its communication system for the program, and will streamline communications with participants in light of the COVID-19 emergency. With more people sheltering in place throughout the state, suspending the certified mail requirement removes a barrier for participants in receiving their mail, and eliminates the requirement for the participant to sign the mail certification, which helps with social distancing.

The suspension is temporary and will end when the COVID-19 state of emergency ends.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/ad/vb

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  FILLABLE PDF VERSION OF THE APPLICATION FOR PRESUMPTIVE ELIGIBILITY (PE)

FORM REVISION: #09

PE-1SSL (PDF)

DISCUSSION:

The purpose of this memo is to introduce a fillable PDF version of the Application for Presumptive Eligibility (PE-1SSL).  This does not replace the paper version, but may be used instead by Qualified Entities.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/df

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  2020 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI MO HEALTHNET PROGRAMS

MANUAL REVISION #13 – 1805.030.20.20.05, 1840.010.15.05, 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 #8 – IM-4PRM

DISCUSSION:

Effective April 1, 2020, 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 Program (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.

Any cases in Annual Renewal status on April 1, 2020 will not receive the FPL update until the renewal is completed.

All other MAGI cases will be adjusted in April 2020 based on the new FPL income guidelines and notices sent.

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

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 may request 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.

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

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 2020 and later.
• Review this memorandum with appropriate staff.

KE/df                                                      

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  UPDATE TO INCOME INCLUDED AND EXCLUDED FOR MAGI PROGRAMS

MANUAL REVISION:#12 – 1805.030.20.10

DISCUSSION:

The purpose of this memorandum is to advise that MAGI manual section 1805.030.20.10 Income Excluded Under MAGI has been updated:

• An increase in the tax filer threshold for earned income from a child has increased to $12,200 based on the 2019 IRS Publication 501
• An increase in the tax filer threshold for unearned income from a child has increased to $1,100 based on the 2019 IRS Publication 501

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/df

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  2020 UPDATED PRESUMPTIVE ELIGIBILITY INCOME GUIDELINES

MANUAL REVISION #11 – APPENDIX A (1900.000.00)

DISCUSION:

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, 2020 through March 31, 2021. 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:  UPDATE OF POVERTY INCOME GUIDELINES FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS

MANUAL REVISION #09 – 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, 2020, 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 07, 2020, MO HealthNet for the Aged, Blind and Disabled programs in FAMIS with income eligibility based on the federal poverty level will be adjusted. This memorandum includes information on:

• PREMIUM REFUNDS
• REQUEST FOR HEARING/CONTINUED BENEFITS
• 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.

REQUEST FOR HEARING/CONTINUED BENEFITS

Any participant receiving an FA-420 MO HealthNet Adverse Action Notice may request a hearing on the mass adjustment action.  

If a participant receiving an FA-420 requests a hearing on the adjustment within ten days from the date of the notice, the participant may request benefits be continued at the level received before the FPL adjustment, until the hearing decision is made. Staff should inform the participant if continued benefits are issued and the agency is determined to be correct, a claim will be established for any overpayment.

Refer to the “FAMIS Changes Due to the Federal Poverty Level Adjustments” for eligibility system processes to allow continued MO HealthNet benefits at the same level of care prior to the FPL adjustment when a hearing decision is pending.  The “FAMIS Changes Due to the Federal Poverty Level Adjustments” will also provide information regarding specific cases in FAMIS the FPL mass adjustment is unable to systematically adjust. 

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, 2020 through March 31, 2021

MHABD AB Income standards effective April 01, 2020 through March 31, 2021

Blind Pension sighted spouse income maximum effective April 01, 2020 through March 31, 2021

QDWI income standards effective April 01, 2020 through March 31, 2021 

QMB income standards effective April 01, 2020 through March 31, 2021

SLMB1 income standards effective April 01, 2020 through March 31, 2021

SLMB2 income standards effective April 01, 2020 through March 31, 2021

TWHA Premiums for Single Cases

TWHA Premiums for Couple Cases

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

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

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines effective for April 2020 and later.
• Follow the FPL FAMIS Guide to resolve conflicting actions.
• Review this memorandum with appropriate staff.

KE/vm      

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 MO HealthNet (MHN) Coverage for Positive COVID-19 Diagnosis

DISCUSSION:

FSD will provide MO HealthNet coverage for individuals between the ages of 19 and 64 who have a positive COVID-19 diagnosis and meet current MHABD eligibility guidelines, including income and resources. 

Applications for individuals who have a positive COVID-19 diagnosis will be accepted on a signed IM-1MA application form.   

• To expedite the process, applications for individuals who have a positive COVID-19 diagnosis can be submitted to FSD.COVIDAPPS@dss.mo.gov.
• Submitting verification of the COVID-19 diagnosis with the application will allow for expedited processing. Verification of a positive COVID-19 diagnosis includes, but is not limited to, a letter signed by the physician, lab results, discharge summary, or hospital records that clearly state the diagnosis.
  • NOTE: FSD must accept fillable applications from hospitals, providers, friends and/or family with an electronic signature that includes a statement from the applicant who is quarantined and wishing to apply for Missouri Medicaid. 

If eligible, COVID-19 MHN coverage will begin the first day of the month of application in which a positive COVID-19 was performed and the determination of disability will be authorized for 90 days and reassessed moving forward.  To authorize coverage for the month of a test completed prior to the month of application, indicate a request for prior quarter coverage on the REQUEST/FM0G screen and entering the date of the diagnosis on the DISABLED/FMMX screen with the COV code.  When entering an approval ensure that only the appropriate months are authorized.

• Additional information will be released when available regarding participants that continue to have a positive COVID-19 diagnosis at the end of the 90 day time period.
• This coverage will remain in effect until the health emergency ends or the individual is no longer considered disabled whichever occurs last.

NOTE:  Utilize prior quarter as needed for medical services that are related to a positive COVID-19 test but not prior to February 1, 2020.  System updates allow for coverage based on a COVID-19 diagnosis to be authorized back to March 1, 2020.  When applicable, staff must use the Worker Initiated Budget Calculation screen in order to authorize coverage for February 2020.

Processing applications:

An application for COVID-19 coverage must be registered in the same manner as an MHABD-PTD application.  These applications are a high priority.    

• Use the standard income and resource limits for the MHABD-PTD program.
• Verification of a positive COVID-19 diagnosis is required.
• To be eligible, individuals must be between the ages of 19 and 64.
• Accept self-attestation of income and resources unless questionable, with the exception of trusts and annuities. Trusts and annuities must still be submitted to the Program and Policy unit for interpretation.
• Staff must explore all avenues available to FSD to verify citizenship and identity before requesting verification from the participant.
• The COVID-19 diagnosis will be captured in FAMIS on the DISABLED/FMMX screen using code “COV.”
  • The begin date is the date of the test that resulted in a positive COVID-19 diagnosis.
  • Only enter hard copy verification of the COV code if the individual is within the designated age range and has a positive COVID-19 diagnosis.
• Coverage will be displayed as Spend Down or Non-Spend Down coverage. A new ME code will not be created for this program and coverage will show as ME 13.  If staff need to identify that coverage was authorized due to a positive COVID-19 test, this information can be located by checking the DISABLED/FMMX screen, or reviewing the technical details screen associated with the authorization. 
• Programming is being completed to add specific information to the approval notice sent to eligible individuals who have a positive COVID-19 diagnosis.
• Enter a comment on the Eligibility Unit Member Role (EUMEMROL/FM3Z) screen with label “COVID-19 Application” on every case approved for coverage due to positive diagnosis.
• Include a comment on each income or resource entry that is verified with self-attestation with label “COVID-19 Self-Attestation” on every case approved for coverage due to positive diagnosis. The body of the comment should include the following statement:  “Self-attestation accepted as verification due to special circumstances.  42 CFR §435.952(c)(3)”

NOTE:  MAGI coverage should be explored if coverage could be offered through Family MHN programs

Questions regarding the entry of COVID-19 MHN coverage may be sent via email to Cole.MHNPolicy@dss.mo.gov.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/rr/vb

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 VERIFICATIONS FOR FAMILY HEALTHCARE PROGRAMS (MAGI)           

DISCUSSION:

On March 13, 2020 a national health emergency was declared in response to COVID-19.  This allows The Centers for Medicare and Medicaid Services (CMS) to approve waivers for states to have all points of eligibility temporarily waived with the exceptions of citizenship and identity. 

If an applicant has already provided documentation, use what was provided as verification.  Ensure all electronic sources are utilized when available.

When an applicant has not provided verification and the information is not able to be verified by electronic sources, follow these instructions:

• For income: reasonable compatibility does not need to be run. Accept self-attestation of income.
• For tax-filing status: if tax-filing status is blank on an application – the client must be contacted. If contact cannot be made, a manual Request for Information (IM-31A) must be sent and tracked.  The participant is still able to verbally provide their tax-filing status without submitting documentation. 
• For citizenship and identity: see 020.05.05 Documents to Verify Citizenship for a list of acceptable documents.
• Reasonable opportunity: Allow reasonable opportunity for applicants requesting benefits who do not have citizenship documents/proof of qualified immigrant status or a social security number (SSN) at the time of application.
  • When an SSN is not provided at application – attempt to contact the participant. If the applicant has indicated they have applied for an SSN, accept self-attestation of SSN application.  If the applicant indicates they have NOT applied for an SSN, allow reasonable opportunity on a good faith effort as individuals may not be able to go to a Social Security office at this time.
  • If a participant does not provide verification they have applied for a birth certificate – allow reasonable opportunity on a good faith effort as individuals may not be able to apply for a birth certificate at this time.

NECESSARY ACTION:

• Follow above instructions starting immediately.
• Review this memorandum with appropriate staff.
• If MEDES system will not accept self-attestation as a verification item-use “Other documentation, verified by caseworker.”
• In addition to the comment regarding the application, leave an additional comment with the label COVID-19 to state, “Self-attestation accepted as verification due to special circumstances. 42 CFR 435.952(c)(3).”
  • Note: Copy and paste the above label for comments.

KE/al

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  COVID-19 EMERGENCY MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED VERIFICATION REQUIREMENT CHANGES

DISCUSSION:

This memorandum will introduce temporary changes to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) verification requirements due to the COVID-19 emergency.

For the duration of the emergency, MHABD programs will accept self-attestation for all verification requirements, except:

• positive COVID-19 diagnosis,
• ID,
• Citizenship,
• trusts and/or annuities.

NOTE:  Trusts and annuities must be submitted per normal procedures to Program and Policy for review.  Please note in the title of the Request for Interpretation of Policy (IM-14) if the review is for household that includes a COVID-19 positive participant.

SNAP is not making the same change to verification requirements at this time. 

FAMIS is an integrated system, meaning that changes made for one program will have an impact on the other programs. 

• FAMIS will continue to mail Request for Verification (FA-325) notices to participants, as they are still needed for other programs.
• System changes are in place that will prevent the closing of MHABD cases for any reason, including but not limited to failure to provide verification, or excess resources.  

Staff will enter the collateral contact (CC) verification code to indicate they are accepting self-attestation on MHABD cases.  Using CC may cause SNAP or other programs to complete, this is acceptable.

• Enter a comment on the Eligibility Unit Member Role (EUMEMROL/FM3Z) screen with label “COVID-19” on every case approved for coverage or continued due to positive diagnosis.
• Enter a comment on the each income or resource that is verified with self-attestation with label “COVID-19” and copy the following as the comment body: “Self-attestation accepted as verification due to special circumstances. 42 CFR 435.952(c)(3).”

When/if further verification is received staff should enter that information and complete and eligibility determination (EDRES).

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Do not require verification for MHABD cases, except for trusts and annuities.

KE/vb/rr

FROM:  KIM EVANS, DIRECTOR

SUBJECT:  FORMS ADDED TO IM FORMS MANUAL TO VERIFY VETERAN’S ADMINISTRATION (VA) INCOME FOR VENDOR PARTICIPANTS

FORM REVISION #07 – FA-312 VA Vendor, FA-313 VA Vendor Letter

DISCUSSION:

When a participant is receiving VA income and enters a vendor facility, their income may or may not change depending on what type of VA income they are receiving.

Regional Nursing Home offices can send a release form to the participant to sign so that staff may contact VA directly to verify any changes in income that occurred due to the participant entering a vendor facility.

Forms were added to the IM Forms Manual to assist staff with collecting this information. Veterans Administration Verification (Vendor) form (FA-312 VA Vendor) is the release form for the participant to sign. VA Letter (FA-313 VA Vendor Letter) is available for staff to send to the participant to request the signed release and explain why FSD needs to contact VA.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj