Category: MoHealthNet Home

FROM: KIM EVANS, DIRECTOR

SUBJECT: MAGI MANUAL APPENDIX H UPDATE

MANUAL REVISION #
APPENDIX H

DISCUSSION:

MAGI Appendix H is updated. MO HealthNet Eligibility Codes (ME) Codes 07 (Foster Care), 36 (MHD IV-E Adopt-FFP Adoption Subsidy), and 56 (Adoption Subsidy) have been moved to the Newborn qualifying ME Codes side of Appendix H as they are Title XIX funded.

In addition, the appendix wording was corrected to show ME Code 83 as BCCT-PE and ME Code 84 as BCCT.

NECESSARY ACTION:

• Grant automatic newborn coverage to children born to women receiving (or retroactively eligible for) ME Codes 07, 36 and 56.
• Review this memorandum with appropriate staff.

KE/bl

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2023 MAGI COST OF LIVING ADJUSTMENT (COLA) FOR SSA/SSI INCOME

DISCUSSION:

Effective April 1, 2023, MAGI cases will be updated to reflect an 8.7% COLA for Social Security Administration (SSA) and Supplemental Security Income (SSI) participants.

Note: Due to the Continuous Eligibility Condition, no cases will have coverage closed or reduced to a lower level of care until an annual renewal has been completed.

Cases Adjusted

Cases that include income types Social Security Adult (disability or received off disabled/deceased spouse), Social Security Adult (retirement), Social Security Child (disability or received off disabled/deceased parent), and SSI are subject to an automatic increase of 8.7%. The eligibility system will end date the previous income and add a new piece of income evidence that reflects the adjusted income amount.

Cases That Did Not Adjust

Some cases will 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 will finalize the decision(s) and send out the appropriate notices. Adverse Action notices will not be acted upon until an annual renewal has been completed on the case.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/kg

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATE OF 1619 THRESHOLD AND INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY PENALTIES

MANUAL REVISION #
Appendix J
Appendix N

DISCUSSION:

The threshold amount established by the Social Security Administration (SSA) to determine eligibility under Section 1619 of the Social Security Act has increased to $4,134 effective January 1, 2023. Additional information regarding 1619 eligibility is available in manual section 0850.005.20 Financial Need.

The average private pay nursing care rate increased to $6,983 per month effective. For applications taken on or after April 1, 2023, use $6,983 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 and current 1619 threshold.

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/rnr

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2023 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, 2023, the Federal Poverty Level (FPL) income guidelines increase for all MAGI programs, including Presumptive Eligibility (PE).
MAGI cases will be adjusted on March 29, 2023 based on the new FPL income guidelines; however, due to the Continuous Eligibility Condition, no cases will have coverage closed or reduced to a lower level of care until an annual renewal has been completed.

Note: Change in circumstance or applications processed prior to April 1, 2023 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 earned income from a child to $12,950 based on the 2022 IRS Publication 501.

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

PRESUMPTIVE ELIGIBILITY

PE Manual Appendix A income standards are updated. These standards are effective from April 1, 2023 through March 31, 2024.

NECESSARY ACTION:

• Use the new FPL income guidelines beginning April 1, 2023.
• Review this memorandum with appropriate staff.

KE/kg

FROM: KIM EVANS, DIRECTOR

SUBJECT: CITIZENSHIP AND ALIEN STATUS SECTION OF THE BLIND PENSION (BP) MANUAL UPDATED

MANUAL REVISION #
0505.040.00

DISCUSSION:

An outdated link contained in manual section 0505.040.00 Citizenship and Alien Status in the BP Manual has been removed. Acceptable documentation for citizenship, and alien or immigrant status is the same for all MO HealthNet programs. Links were added to refer staff to the Family MO HealthNet (MAGI) manual sections below for acceptable documentation types.

• 1805.020.15 Documentation and Verification of Alien or Immigrant Status
• 1805.020.05.05 Documents to Verify Citizenship

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/mc

FROM: KIM EVANS, DIRECTOR

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

MANUAL REVISION #
Appendix J
Appendix K

DISCUSSION:

Effective April 1, 2023, 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)

On the weekend of March 11, 2023, 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 next annual review 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 MHABD Policy Manual is updated to include the change in FPL income limits. Appendix K is now named, MO HealthNet Eligibility for Non-MAGI Programs.

Income Standards
Appendix J in the MHABD Policy Manual is updated with the updated FPL income limits. Appendix J is now named, Non-MAGI Eligibility Standards.

All FPL income guidelines are effective from April 1, 2023 through March 31, 2024. 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:

• Begin using the new FPL income guidelines for eligibility determinations effective April 2023 and ongoing.
• Follow the staff user guides in FAMIS Resources to resolve conflicting actions related to FPL.
• Review this memorandum with appropriate staff.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATING TERMINOLOGY USED FOR MO HEALTHNET (MHN) PROGRAMS

DISCUSSION:

Programs that use Modified Adjusted Gross Income (MAGI) to determine eligibility for MHN are MAGI Programs. Policy that applies to MAGI Programs is listed on the Missouri Department of Social Services Manuals & Memos webpage under MAGI Manuals.

These programs include:

• MO HealthNet for Families
  • MO HealthNet for Families (MHF Adult, MHF Child)
  • MO HealthNet for Pregnant Women (MPW)
  • Show-Me Healthy Babies (SMHB)
  • MO HealthNet for Kids (MHK)
• Children’s Health Insurance Program (CHIP)
• Uninsured Women’s Health Services (UWHS)
• MO HealthNet Adult Expansion Group (AEG)
• Presumptive Eligibility (PE)

Programs that use other income counting methods to determine eligibility for MHN are Non-MAGI Programs. All Non-MAGI policy manuals are listed on the Missouri Department of Social Services Manuals & Memos webpage under Non-MAGI Manuals.

These programs include:

• MO HealthNet for the Aged, Blind, and Disabled Programs
  • MO HealthNet Non-Spend Down (MHNS)
  • MO HealthNet Spend Down (MHSD)
  • MO HealthNet Vendor (VENDOR)
  • Home and Community Based Waiver Services (HCB)
  • MO HealthNet for Disabled Children (MHDC)
  • Missouri’s Children with Developmental Disabilities Services Waiver Services (MOCDD)
  • Ticket to Work Health Assurance (TWHA)
  • Qualified Disabled Working Individuals (QDWI)
• Medicare Savings Programs (MSP)
  • Qualified Medicare Beneficiaries (QMB)
  • Specified Low-Income Medicare Beneficiaries (SLMB1)
  • Qualified Individuals (QI), also known as SLMB2
• Blind Pension (BP)
• Supplemental Aid to the Blind (SAB)
• Supplemental Nursing Care (SNC)
• Breast or Cervical Cancer Treatment (BCCT)

Some MO HealthNet programs follow guidelines in both and may be referenced by their program names, without regard to MAGI or Non-MAGI. These programs include:

• Emergency MO HealthNet Care for Ineligible Aliens (EMCIA)
  • The EMCIA Policy Manual is located under Other IM Manuals.
• Former Foster Care Youth (FFCY)
  • FFCY policy sections are located in the MAGI Policy Manual and in the MHABD Policy Manual.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: REVISION TO MAGI APPLICATION POLICY SECTIONS FOR ALL MO HEALTHNET (MHN) PROGRAMS

MANUAL REVISION #

DISCUSSION:

MHN applications submitted through the online application portal or through the Federally Facilitated Marketplace (FFM) are received as of the date they are submitted, regardless of whether the application is submitted outside of regular Family Support Division (FSD) business hours. This policy is located in the MAGI Family MO HealthNet Manual section, 1802.010.00 Requests for Benefits.

There has been no change to application date policy for MHN applications submitted in person, by mail, drop-off, or other electronic processes (myDSS Upload, email, or fax). Applications submitted by these methods use an application date of the date FSD received them. Applications submitted to FSD outside of regular business hours (after 5:00 PM, on weekends, or on holidays) use an application date of the next business day.

Revisions to additional MAGI manual sections simplified MHN application process policy.

1802.000.00 Applications, was updated to provide brief explanations and links to the other application policy sections.

1802.010.00 Requests for Benefits now includes policy information from the following obsoleted sections:

• 1802.010.10 Requests in Person
• 1802.010.20 Request by Mail
• 1802.010.30 On-line Application
• 1802.010.40 Request by Telephone
• 1802.010.50 Request for In Home Application
• 1802.010.60 Request Received Through Third Party
• 1802.010.70 MO HealthNet Requests at Federally Qualified Healthcare Centers (FQHC) and Disproportionate Share Hospitals (DSH)
• 1802.020.25 Main-in or Drop-off Application
• 1802.040.00 Dating the Application

Revisions were made to existing policy in MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual, section 0804.000.00 Application Processing to delete references to obsolete policies.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: UPDATED CHANGE REPORT (IM-145)

FORM REVISION #
IM-145
IM-145B obsolete

DISCUSSION:

The IM-145 has been updated and is to be used for all Family Support Division (FSD) programs.

Changes to the IM-145 include:

• Clearer fields for participant information.
• New fields for participants to close any FSD case for the household, or to remove a participant from an active case.
• Clearer field for participants to add a person to an active case.
• A new field for participants with an active MO HealthNet (MHN) case to request new or different MHN coverage.
• Clearer fields to report changes in child support expenses, dependent care expenses, and health insurance expenses.
• Updated language to allow the participant to sign with an electronic signature.

The revised IM-145 shows a revision date of 1/2023. All versions of the IM-145 with a different revision date are now obsolete. The obsolete forms may still be accepted as valid, but staff should begin using the revised form and encourage community partners to do the same.

Report a Change, online form on myDSS.mo.gov has been updated to reflect the revisions.

The IM-145 is updated in the public forms manual and the internal forms manual.

The Change Report (Income only) (IM-145B) form is now obsolete. Participants reporting change of income should use the IM-145 and only complete the necessary sections.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Begin using IM-145 with 1/2023 revision date immediately.
• Discard and destroy blank IM-145 forms with older revision dates.
• Discard and destroy blank IM-145B forms.
• Share with community partners and contacts.

KE/cj

FROM: KIM EVANS, DIRECTOR

SUBJECT: OBSOLETE FORMS USED TO TRANSITION GATEWAY TO BETTER HEALTH (GTBH) TO OTHER PROGRAMS

FORM REVISION #
IM-1U – obsolete
GTBH Transition Letter – obsolete

DISCUSSION:

The IM-1U and GTBH Transition Letter were created to transition GTBH participants to other MO HealthNet programs and are no longer to be used.

These forms were removed from the public and internal forms manuals:

• MO HealthNet Eligibility Review Form (IM-1U)
• Gateway to Better Health Transition Letter (GTBH Transition Letter)

Note: The MO HealthNet Review Form (IM-1U MAGI) and the MO HealthNet Eligibility Review Information (FA-402) are still valid forms and can be used by participants when a system generated form is not available.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Discard and recycle any obsolete forms.

KE/cj