Family Healthcare (FAMIS) Manual

0927.010.45 Ineligible for Any Other MO HealthNet Program (UWHS)

IM#-8 February 03, 2011, IM-#70 November 19, 2010,   IM-#74 September 25, 2009,   IM-#1 January 07, 2009

A woman is ineligible for UWHS if she qualifies for any other MO HealthNet program. Explore eligibility for any Family Healthcare program (MO HealthNet for Families, MO HealthNet for Kids, and MO HealthNet for Pregnant Women) prior to exploring eligibility for UWHS. If the participant has an active MO HealthNet for Families (MHF) or MO HealthNet for Kids (MHK) case, explore eligibility for MO HealthNet for Families prior to exploring eligibility for UWHS by completing an add-a-person application. If ineligible for MO HealthNet for Families or any other full coverage program, explore eligibility for UWHS by registering a UWHS application and approve for UWHS if eligible on all UWHS eligibility factors. FAMIS automatically registers a UWHS application if found ineligible for any MO HealthNet program in the FAMIS system. If the woman applies using the application for Family Healthcare programs, assume she is ineligible for MO HealthNet for the Aged, Blind, and Disabled (MHABD) unless she either indicates that she is disabled or receives Social Security disability or SSI benefits.

Examples:

Ms. Johnson meets all eligibility requirements for UWHS, but is receiving Extended Women’s Health Services (EWHS). Ms. Johnson is not eligible for UWHS as she is currently receiving MO HealthNet benefits under another program. NOTE: Ms. Johnson should be reviewed for UWHS eligibility prior to closing EWHS. FAMIS registers a UWHS application in the eleventh month of EWHS coverage to explore eligibility for UWHS.

Ms. Smitt receives Social Security Disability of $650.00 per month, has resources under $1,000 and does not receive Medicare. She meets all other eligibility requirements for UWHS, but as she is disabled, she qualifies for MO HealthNet for the Aged, Blind and Disabled (MHABD) based on disability. Ms. Smitt is not eligible for UWHS as she qualifies for MHABD.

Ms. Warren receives Social Security Disability of $1,000 per month, has resources under $1,000 and does not receive Medicare. She meets all other eligibility requirements for UWHS, but as she is disabled, she qualifies for MO HealthNet for the Aged, Blind and Disabled (MHABD) based on disability. Ms. Warren is not eligible for UWHS as she qualifies for MHABD on a spenddown basis. If Ms. Warren fails to purchase the spenddown coverage, she is ineligible as long as it is available. It is considered available even though she may not choose to pay her premium.

Ms. Harmony is included on her children’s MO HealthNet for Kids case. Ms. Harmony submits a MO HealthNet for Kids, Pregnant Women, and Parents application on 1-2-09. Ms. Harmony is not pregnant, disabled, or blind. The eligibility specialist registers an add-a-person application for Family Healthcare (FAM in FAMIS) and an application for UWHS. If Ms. Harmony is determined ineligible for MO HealthNet for Families, eligibility for UWHS must be explored.