Family MO HealthNet (MAGI) Manual

1805.000.00 Eligibility and Verification

IM-80 June 11, 2020; IM-95 July 13, 2017; IM-30 May 17, 2016; IM-97 November 9, 2015; IM-125 December 31, 2013

All Family MO HealthNet applicants/participants must meet and provide information regarding the following eligibility requirements under 13 CSR 40-7.015:

NOTE: Refer to Appendix A – MAGI Income With 5% of FPL Included and CHIP Premium Amounts for the individual Family MO HealthNet program income guidelines which include the five percent (5%) of FPL disregard.

NOTERSMo 208.215 states that MO HealthNet is the payer of last resort.

13 CSR 40-7.040 states the Family Support Division (FSD) must verify all eligibility factors through available means, including information obtained through:

  • Electronic data sources
  • An applicant’s/participant’s statement
  • Other information the FSD has obtained

Except where the law requires other procedures, the FSD may accept a participant’s statement of information needed to determine the eligibility of an individual for MO HealthNet without requiring further proof from the individual, unless the FSD has information not reasonably compatible with the statement. For additional information, refer to 1805.030.15 Reasonable Compatibility.

If verification cannot be obtained by the FSD through electronic data sources or if the information is not reasonably compatible with collected information, the FSD must ask for any additional information by sending a Request for Information (IM-31A) to the participant.

The participant must provide the required verification within ten (10) days from the date that the FSD requests the information in writing. A participant may request additional time to provide the information. The additional time shall be granted if the participant is making a reasonable effort to obtain the information.

NOTE: Only one IM-31A is required to be sent.

If a participant fails to provide the requested verification within ten (10) days from the date of the written request or fails to obtain additional time to provide the information, the division must:

  • Reject the application; or
  • Issue an adverse action notice to the participant notifying them that their coverage will terminate ten (10) days from the date of the adverse action notice.

    NOTE: Do not reject or close a case for failure to provide complete information regarding Third Party Liability. Refer to 1805.045.00 Third Party Liability (TPL).

Comments on the case must support all information requested and additional time granted.

The FSD will only accept an applicant’s/participant’s statement from the following:

  • The applicant/participant
  • Adults in the applicant’s household
  • An appointed authorized representative or someone legally acting on behalf of the applicant/participant when the applicant/participant is a minor or incapacitated

NOTE: Verification of Social Security Number (SSN), Identity, Citizenship, Immigrant status, and Income are required by law.

Comments on the case must support what was used to verify eligibility factors.