Family Healthcare (FAMIS) Manual

0905.000.00 Medical Assistance for Families (MAF)

• 0905.005.00 Legal Basis (MAF) 
• 0905.010.00 Eligibility Requirements (MAF)
  • 0905.010.05 Social Security Number (SSN)
    • 0905.010.05.05 Failure to Complete an SSN Application or Furnish an SSN 
  • 0905.010.10 Age of Child (MAF) 
  • 0905.010.15 Relationship of Caretaker to Child (MAF) 
  • 0905.010.20 Child Living in the Home of Caretaker (MAF) 
  • 0905.010.25 Residence (MAF) 
  • 0905.010.30 Citizenship and Alien Status (MAF)
    • 0905.010.30.05 Qualified Alien (MAF) 
    • 0905.010.30.10 Qualified Aliens Entering Prior to 8/22/96 
    • 0905.010.30.15 Qualified Aliens Entering After 8/22/96
      • 0905.010.30.15.05 Iraq and Afghan Special Immigrants 12/30/08 
      • 0905.010.30.15.10 Eligibility 12/30/08 
      • 0905.010.30.15.15 Verification 12/30/08 
      • 0905.010.30.15.20 FAMIS Entry 12/30/08 
      • 0905.010.30.20 Non-qualified Alien (MAF) 
      • 0905.010.30.25 Documentation and Verification of Citizen or Alien Status 
  • 0905.010.35 Assignment of Medical Support (MAF) 
  • 0905.010.40 Cooperation in Pursuit of Medical Support (MAF)
    • 0905.010.40.05 Referral to DCSE (MAF) 
    • 0905.010.40.10 Cooperation and Referrals When Adding Children (MAF) 
• 0905.012.00 Need (MAF)
  • 0905.012.05 Dependent Child (MAF) 
  • 0905.012.10 Assistance Group (MAF)
    • 0905.012.10.05 Assistance Group Mandatory Persons Include: 
    • 0905.012.10.10 Assistance Group Mandatory Exclusions (MAF) 
    • 0905.012.10.15 Assistance Group Optional Inclusions (MAF) 
  • 0905.012.15 Minor Parent Assistance Group Provision (MAF) 
  • 0905.012.20 Deeming Income From a Minor Parent’s Parent (MAF) 
  • 0905.012.25 Non-parent Caretaker Relative (MAF) 
  • 0905.012.30 Legal Guardian (MAF) 
  • 0905.012.35 Stepparent Cases (MAF) 
  • 0905.012.40 Eighteen-Year-Olds Not Attending School  (MAF) 
  • 0905.012.45 SSI Children (MAF) 
  • 0905.012.50 Child Support Disregard 
  • 0905.012.55 Need Standard 
    • 0905.012.55.05 Gross Income Limit 
    • 0905.012.55.10 Eligibility Based on Need 
    • 0905.012.55.15 Net Income Limit Test 
  • 0905.012.60 Income 
    • 0905.012.60.05 Sources of Earned and Unearned Income 
    • 0905.012.60.10 Computing Income 
    • 0905.012.60.15 Patterns of Income Examples 
    • 0905.012.60.20 Treatment of Specific Types of Income 
  • 0905.012.65 Overhead Expenses of Producing Income 
  • 0905.012.70 Earned Income Disregards
    • 0905.012.70.05 Standard Work Exemption 
    • 0905.012.70.10 $30 Plus 1/3 of Earned Income Disregard 
    • 0905.012.70.15 $30 Earned Income Disregard 
    • 0905.012.70.20 Child/Incapacitated Parent Care Costs 
    • 0905.012.70.25 State Payment of Child Care Costs 
  • 0905.012.75 Income Excluded 
    • 0905.012.75.05 Gain or Benefit Not in the Form of Money 
    • 0905.012.75.10 Earnings of Children and Parents Under Age 19 
    • 0905.012.75.12 Ricky Ray Hemophilia Fund 
    • 0905.012.75.15 Supplementary Assistance 
    • 0905.012.75.20 Volunteer Income 
    • 0905.012.75.25 Loans/Grants/Scholarships 
    • 0905.012.75.30 Indian or Alaskan Native Payments 
    • 0905.012.75.35 Governmental Payment 
    • 0905.012.75.40 Other Income 
    • 0905.012.75.45 Income From Job Corps 
    • 0905.012.75.50 Budgeting Job Corps Income 
    • 0905.012.75.55 Portion of a Veteran’s Pension Designated for Aid and Attendance
    • 0905.012.75.60 Benefits designated for a Veteran’s Dependent
    • 0905.012.75.65 Portion of a Veteran’s Pension Paid for Unusual Medical Expenses
    • 0905.012.75.70 VA Homebound Allowances
  • 0905.012.80 Social Security Cost of Living Adjustment (COLA) Disregard 
• 0905.015.00 MC+ Healthcare Coverage (MAF)
  • 0905.015.05 Prior Quarter (MAF)
    • 0905.015.05.05 Prior Quarter (MAF Pregnant Women) 
  • 0905.015.10 MC+ Healthcare Coverage End Date on Closings
• 0905.020.00 Prompt Disposition (MAF)
• 0905.025.00 Reviews and Interim Contacts (MAF)
  • 0905.025.01 Annual Review (MAF) 
  • 0905.025.05 Combination MAF and Temporary Assistance Cases
  • 0905.025.10 Earned Income Closings (MAF)
  • 0905.025.15 Voluntary Withdrawals
  • 0905.025.16 MAF / MC+ Closing Review Procedures
    • 0905.025.16.05 Ex Parte Review
    • 0905.025.16.10 Pre-closing Review
    • 0905.025.16.15 Eligibility Exists Under Another Category
    • 0905.025.16.20 No Other Eligibility Exists
  • 0905.025.20 Adding a Person (MAF) 
• 0905.030.00 Location of Case Records

0910.000.00 Transitional Medical Assistance (TMA)

• 0910.005.00 Legal Basis (TMA)
• 0910.010.00 Eligibility for Initial Six Months (TMA)
  • 0910.010.05 Receipt of MAF in Three of Last Six Months (TMA)
  • 0910.010.10 Eligible Family Members (TMA)
  • 0910.010.15 Caretaker Relative (TMA)
  • 0910.010.20 Notification of Initial TMA Eligibility
• 0910.015.00 Eligibility During First Six Months (TMA)
• 0910.020.00 Eligibility During the Second Six Month Period (TMA)
• 0910.025.00 Quarterly Report Requirements (TMA)
  • 0910.025.05 Quarterly Report Completeness (TMA)
  • 0910.025.10 Good Cause for Failure to Return Quarterly Report (TMA)
• 0910.030.00 Budgeting for Income Eligibility (TMA)
  • 0910.030.05 Income Eligibility For ETMA 
• 0910.035.00 Eligibility for Additional Household Members (TMA)
• 0910.040.00 Cooperation in Pursuit of Medical Support (TMA)
• 0910.045.00 Untimely Report of or Action on Change (TMA)
  • 0910.045.05 Change Not Reported Timely (TMA)
  • 0910.045.10 Change Not Acted Upon Timely (TMA)
• 0910.050.00 Eligibility for Other MC+ Programs When TMA Ends
  • 0910.050.05 Loss of TMA Eligibility After Six Months
    • 0910.050.05.05 Reinstatement of TMA Eligibility for Six Month Closings
  • 0910.050.10 Suspended TMA Eligibility
    • 0910.050.10.05 Reinstatement of Individuals Suspended on TMA
  • 0910.050.15 Ex Parte Review
    • 0910.050.15.05 Action Necessary for 12 Month Closings
    • 0910.050.15.10 Action Necessary for 6 Month Closings
  • 0910.050.20 Pre-closing Review
    • 0910.050.20.05 No Response From Client
    • 0910.050.20.10 Response From Client
    • 0910.050.20.15 Eligibility Established for Another Category
    • 0910.050.20.20 Ineligible for Another Category
    • 0910.050.20.25 Appeals
• 0910.055.00 Extended Transitional Medical Assistance (ETMA)
  • 0910.055.05 Completion of the Initial 12 Months of TMA (ETMA)
  • 0910.055.10 Employment (ETMA)
  • 0910.055.15 Uninsured (ETMA)
  • 0910.055.20 Income (ETMA)
  • 0910.055.25 Eligible Child in the Home (ETMA)
  • 0910.055.30 MC+ Healthcare Coverage (ETMA)
  • 0910.055.35 System Changes (ETMA)
  • 0910.055.40 Notification of Extension (ETMA)
  • 0910.055.45 Notification of Ineligibility for Extension (ETMA)
  • 0910.055.50 Children on TMA Cases Being Extended (ETMA)
  • 0910.055.55 Children on TMA Cases Not Being Extended (ETMA)

0915.000.00 Extended MAF on Support Closings

• 0915.005.00 Eligibility (Extended MAF Support Closings)
  • 0915.005.05 Assistance Group for Support Closings 
  • 0915.005.10 Individual Eligible for MC+ (Extended MAF Support Closings)  
• 0915.010.00 Four Month Extension of Support Closings
• 0915.015.00 Notification Requirements on MAF Support Closings
• 0915.020.00 Case Becomes MAF Eligible

0920.000.00 MC+ for Children (MHK)

• 0920.005.00 Legal Basis (MHK)
• 0920.010.00 Eligibility Requirements (MHK)
  • 0920.010.05 Social Security Number (MHK) 
  • 0920.010.10 Age of Child (MHK) 
  • 0920.010.15 Residence (MHK) 
  • 0920.010.20 Citizenship and Alien Status (MHK) 
  • 0920.010.25 Assignment of Medical Support (MHK) 
  • 0920.010.30 Cooperation in Pursuit of Medical Support (MHK)
    • 0920.010.30.05 Referral to DCSE (MHK) 
    • 0920.010.30.10 Cooperation and Referrals When Adding Children (MHK) 
  • 0920.010.35 Need (MHK)
    • 0920.010.35.05 Assistance Group (MHK) 
    • 0920.010.35.10 SSI/SAB Income (MHK) 
    • 0920.010.35.15 Budget Procedure MC+ NOM-CHIP (MHK) 
    • 0920.010.35.20 Social Security Cost of Living Adjustment (COLA) Disregard 
• 0920.015.00 Healthcare Coverage for Non Chip Children
  • 0920.015.05 Prior Quarter (Non-CHIP) 
  • 0920.015.10 MC+ Healthcare Coverage End Date on Closings (Non-CHIP)
• 0920.020.00 MC+ Eligibility for Chip Children (MHK)
  • 0920.020.05 Uninsured (MO HealthNet for Kids)
    • 0920.020.05.05 HIPP Effect on Uninsured Status (MHK) 
    • 0920.020.05.10 Health Insurance Definition (MO HealthNet for Kids) 
    • 0920.020.05.15 Good Cause for Dropping Insurance 
    • 0920.020.05.20 Special Healthcare Needs Exception for CHIP 
  • 0920.020.10 Access to Affordable Health Insurance
    • 0920.020.10.05 Affordable Insurance Definition 
    • 0920.020.10.10 Employer Sponsored Insurance 
    • 0920.020.10.15 Private Insurance 
  • 0920.020.15 Payment of Premium
    • 0920.020.15.05 Failure to Pay Premium After Coverage Begins 
    • 0920.020.15.10 Failure to Pay Initial Premium 
  • 0920.020.20 Income Limits for CHIP Children 
  • 0920.020.25 Net Worth 
  • 0920.020.30 MC+ Healthcare Coverage for CHIP Children
    • 0920.020.30.05 Restrictions on Healthcare Services (CHIP) 
    • 0920.020.30.10 MC+ Healthcare Coverage End Date on Closings (Chip)
• 0920.025.00 MC+ Uninsured Custodial Parents
  • 0920.025.30 MC+ Healthcare Coverage for Custodial Parents
    • 0920.025.30.05 Restrictions on Healthcare Services (CP) 
• 0920.030.00 Application Procedures (MHK)
  • 0920.030.05 Levels of Care (MHK) 
  • 0920.030.10 Premium Group Special Procedures 
  • 0920.030.15 Prompt Disposition (MHK) 
• 0920.035.00 Reviews (MHK) 
• 0920.040.00 Interim Changes (MHK)
  • 0920.040.05 Adding a Person (MHK) 
• 0920.045.00 Notices and Closings for Non-payment or Premium

0925.000.00 MC+ for Pregnant Women (MPW)

• 0925.005.00 Legal Basis (MPW) 
• 0925.010.00 Eligibility Requirements (MPW)
  • 0925.010.05 Pregnancy 
  • 0925.010.10 Social Security Number (MPW) 
  • 0925.010.15 Residence (MPW) 
  • 0925.010.20 Citizenship and Alien Status (MPW) 
  • 0925.010.25 Need (MPW)
    • 0925.010.25.05 Income Limits (MPW) 
    • 0925.010.25.10 Assistance Group (MPW) 
    • 0925.010.25.15 SSI/SAB Income (MPW) 
    • 0925.010.25.20 Social Security Cost of Living Adjustment (COLA) Disregard 
• 0925.020.00 MHW Healthcare Coverage
  • 0925.020.05 Prior Quarter (MPW) 
  • 0925.020.10 Postpartum Coverage
    • 0925.020.10.05 Correction of Postpartum Ending Date
  • 0925.020.15 Coverage When Application Is Made After the Birth (MPW) 
• 0925.025.00 Continuous Eligibility for Pregnant Women
  • 0925.025.05 Pregnant Women Losing Eligibility for Other MC+ Programs 
• 0925.030.00 Dual Eligibility General Relief and MPW
• 0925.035.00 Identifying the Type of MPW Assistance
• 0925.040.00 Priority/Reinvestigations (MPW) 
• 0925.045.00 Case Management Services
• 0925.050.00 Extended Women’s Health Services (EWHS)
  • 0925.050.05 Covered Women’s Health Services (EWHS) 
  • 0925.050.10 Eligibility for Other MO HealthNet Programs (EWHS) 
  • 0925.050.15 No Longer in Need of Family Planning Services 
  • 0925.050.20 System Processes (EWHS)
    • 0925.050.20.05 Notification of Extension (EWHS) 
    • 0925.050.20.10 Notification of Ineligibility for Extension Due to Insurance (EWHS)

0927.000.00 Uninsured Women’s Health Services Program (UWHS)  

• 0927.005.00 Legal Basis
• 0927.010.00 Eligibility Requirements (UWHS)
  • 0927.010.05 Age (UWHS) 
  • 0927.010.10 Social Security Number (UWHS) 
  • 0927.010.15 Residence (UWHS) 
  • 0927.010.20 Citizenship and Alien Status (UWHS) 
  • 0927.010.25 Need (UWHS)
    • 0927.010.25.05 Income Limits (UWHS) 
    • 0927.010.25.10 Assistance Group (UWHS) 
    • 0927.010.25.15 Need Standard 
    • 0927.010.25.20 Eligibility Based on Need 
    • 0927.010.25.25 Net Income Limit Test 
  • 0927.010.30 Available Resources (UWHS)
    • 0927.010.30.05 Real Property 
    • 0927.010.30.10 Personal Property 
    • 0927.010.30.15 Cash and Securities 
    • 0927.010.30.20 Life Insurance, Prepaid Burials and Burial Funds 
  • 0927.010.35 Uninsured (UWHS)
    • 0927.010.35.05 HIPP Effect on Uninsured Status (UWHS) 
    • 0927.010.35.10 Health Insurance Definition (UWHS) 
  • 0927.010.40 No Access to Employer Sponsored Insurance (UWHS) 
  • 0927.010.45 Ineligible for Any Other MO HealthNet Program (UWHS) 
• 0927.015.00 Healthcare Coverage (UWHS)
  • 0927.015.05 UWHA Healthcare Coverage End Date
• 0927.020.00 Prompt Disposition (UWHS) 
• 0927.025.00 Reinvestigations (UWHS) 
• 0927.030.00 Ex Parte Process
• 0927.035.00 Exploring UWHS Eligibility for Age Eligible Women When No Longer Eligible for Any Other MO HealthNet Program 

0930.000.00 Newborn Children Automatic MC+ Eligibility 

• 0930.005.00 Legal Basis (Newborns) 
• 0930.010.00 Eligibility (Newborns)
  • 0930.010.05 Notification of Birth (Newborns) 
  • 0930.010.10 Assignment of DCN 
  • 0930.010.15 Verification of Birth
  • 0930.010.20 Approve the Child With Appropriate Level of Care 
  • 0930.010.25 Eligibility Dates 
• 0930.015.00 Procedures After Child Added (NEWBORNS)
  • 0930.015.05 Newborn’s Eligibility for Other Programs 
• 0930.020.00 Reinvestigations (NEWBORNS) 
• 0930.025.00 Case Management Services

0935.000.00 MC+ for Uninsured Non-custodial Parents (NCP)

• 0935.005.00 Legal Basis (NCP)
• 0935.010.00 Eligibility Requirements (NCP)
  • 0935.010.05 Uninsured (NCP)
  • 0935.010.10 Income (NCP)
  • 0935.010.15 Child Support Is Current (NCP)
  • 0935.010.20 Social Security Number (NCP)
  • 0935.010.25 Residence (NCP)
  • 0935.010.30 Citizenship/Alien Status (NCP)
• 0935.015.00 Twenty-Four Month Limit (NCP)
• 0935.020.00 NCP Healthcare Coverage
  • 0935.020.05 Restrictions on Healthcare Services (NCP)
• 0935.025.00 Applications Procedures (NCP)
  • 0935.025.05 IMU5 System Entries (NCP)
  • 0935.025.10 Prompt Disposition (NCP)
• 0935.030.00 Reviews (NCP)
• 0935.035.00 Interim Changes (NCP)

0940.000.00 MC+ for Parents’ Fair Share Participants (PFS)

• 0940.005.00 Legal Basis (PFS)
• 0940.010.00 Eligibility Requirements (PFS)
  • 0940.010.05 Uninsured (PFS)
  • 0940.010.10 Participating in Parents’ Fair Share
  • 0940.010.15 Social Security Number (PFS)
  • 0940.010.20 Residence (PFS)
  • 0940.010.25 Citizenship/Alien Status (PFS)
• 0940.015.00 PFS Healthcare Coverage
  • 0940.015.05 Restrictions on Healthcare Services (PFS)
• 0940.020.00 Applications Procedures (PFS)
  • 0940.020.05 IMU5 System Entries (PFS)
  • 0940.020.10 Prompt Disposition (PFS)
• 0940.025.00 Changes on Active Cases (PFS)

0945.000.00 Temporary Medicaid During Pregnancy (TEMP) Program  

• 0945.005.00 Legal Basis and Overview
• 0945.010.00 Qualified Provider
• 0945.015.00 FSD Count Office Responsibility
• 0945.020.00 Temp Forms
• 0945.025.00 ITMP System
• 0945.030.00 ITMP Interaction With IM System
• 0945.035.00 Hearing Rights
• 0945.040.00 Restriction of Medicaid Benefits for Temp Recipients
• 0945.045.00 Newborns Not Eligible Under Temp
• 0945.050.00 Beginning Eligibility Date Prior Quarter Coverage
• 0945.055.00 Responsibility for Training Qualified Providers

0950.000.00 Presumptive Eligibility (PE) for Children Program

• 0950.005.00 Legal Basis and Overview
• 0950.010.00 Qualified Entity
  • 0950.010.05 Qualified Entity Responsibilities
    • 0950.010.05.05 QE Responsibility When Children Found Presumptively Eligible
    • 0950.010.05.10 QE Responsibility When Children Are Not Found Presumptively Eligible 
• 0950.015.00 MO Health net Service Center Responsibilities
• 0950.020.00 FSD County Office Responsibilities
  • 0950.020.05 Responsibility for Training Qualified Providers
  • 0950.020.10 Courtesy Applications
• 0950.030.00 Entering Presumptive Eligibility Determinations
  • 0950.030.05 Presumptively Eligible
  • 0950.030.10 Presumptively Ineligible 
• 0950.040.00 Effect of MO HealthNet Eligibility Decision
• 0950.050.00 Presumptive Eligibility for Children Forms
• 0950.060.00 Hearing Rights 
• 0950.070.00 MO HealthNet Benefits for Presumptively Eligible Children
• 0950.080.00 No Automatic Newborn Coverage
• 0950.090.00 Beginning Eligibility Date Prior Quarter Coverage

0955.000.00 Medical Assistance for Children in Care (MACC)

• 0955.005.00 Eligibility Requirements (MACC)
  • 0955.005.05 Institutional Care and Living Arrangements (MACC)
  • 0955.005.10 Financial Need (MACC)
  • 0955.005.15 DMH/DYS/Juvenile Court Financial Responsibility
  • 0955.005.20 Resources (MACC)
  • 0955.005.25 Residence (MACC)
  • 0955.005.30 Citizenship and Alien Status (MACC)
  • 0955.005.35 Social Security Number (MACC)
  • 0955.005.40 Age (MACC)
  • 0955.005.45 Relationship of Payee to Child (MACC)
• 0955.010.00 Medicaid Coverage (MACC)
  • 0955.010.05 Prior Quarter (MACC)
  • 0955.010.15 Early Periodic Screening, Diagnosis, and Treatment (EPSDT)
• 0955.015.00 Application Procedures (MACC)
  • 0955.015.05 Prompt Disposition (MACC)
  • 0955.015.10 Initial Application Processing (MACC)
  • 0955.015.15 Children From Active Cases Transferring to MACC
• 0955.020.00 Participants Leaving and Eligible Living Arrangements