IM-21 March 5, 2008, IM-#83 August 2, 2005, IM-04 January 12, 2001 Changes in income and household composition may cause a family to change to a different eligibility group. The following are the procedures to use when a change in eligibility is reported or discovered.
From no premium to premium (LOC Q (MC+100, MC+133, or MC+185 in FAMIS) or LOC 1 (CHIP0 in FAMIS) to LOC 2 (CHIP73 or CHIP74 in FAMIS) or LOC 3 (CHIP75 IN FAMIS)).An Adverse Action (FA410) must be sent to notify the participant of the requirement to pay a premium. The Adverse Action informs the participant that current non-premium level of care will end and a premium payment is required to continue to receive MO HealthNet coverage.Once the Adverse Action (FA410) expires, the Action Notice (FA450) is sent. The Action Notice states coverage continues for 60 days, and that a premium payment is required to receive coverage past the 60th day. If the premium is not received by the end of the 60-day period, coverage in the non-premium LOC ends and eligibility for premium coverage is closed.
From premium to no premium (LOC 2 (CHIP73 or CHIP74 in FAMIS) or LOC 3 (CHIP75 in FAMIS) to LOC Q (MC+100, MC+133, or MC+185 in FAMIS) or LOC 1 (CHIP0 in FAMIS)). When a change is entered into the FAMIS system which results in a change from premium to non premium, FAMIS will change the individual to the appropriate level or care. The eligibility date for the non-premium level of care starts the first of the month of non-premium eligibility. Any refund of premiums will be determined by MO HealthNet Division.
Other level of care changes. Any time there is a change in the level of care, an Action Notice (FA450) it sent to notify the family of the effect of the change. An Adverse Action (FA410) is not required when the LOC changes from a non-premium level of care to another non-premium level (example: family�s income increases, changing child from MC+133 to CHIP0).