1820.000.00 Transitional MO HealthNet (TMH)

1820.030.10 Receipt of MHF in Three of Last Six Months

IM-19 February 7, 2018

Households must have been eligible and received MHF in at least three of the last six months immediately preceding the first month of MHF ineligibility. The household must have met all MHF eligibility criteria in the three months and been approved for MO HealthNet coverage on that basis.

NOTE: Because TMH can start on any given day of the month, partial months may be counted towards BOTH the 3 out of 6 required months of MHF AND the first month of TMH. For example, TMH begins on April 17th. April counts as a MHF month and a TMH month.

Months of prior quarter MHF may be included in the three months needed to establish eligibility for Transitional MO HealthNet. Households ineligible for MHF in the month of application due to the reasons in manual section 1820.030.00 Eligibility for Initial Six Months, but eligible for all three Prior Quarter months may receive Transitional MO HealthNet. In this situation, approve the application beginning MHF coverage at the earliest date eligibility existed in the prior quarter.

EXAMPLE 1: Mr. White applied for benefits on March 4th and requested Prior Quarter coverage. He started a new job on February 20th and received his first check on March 1st. After reviewing his income, Mr. White is not eligible for MHF coverage in March. Mr. White did not have any income in the months of December, January, and February, and is eligible for MHF in those months. Because he is eligible in at least three of the last six months, his household qualifies for TMH starting March 1st. Approve MHF beginning on December 1st.

Transitional MO HealthNet eligibility begins as soon as the adverse action period stating ineligibility for MHF expires.

EXAMPLE 2: On July 25th Ms. Green reported she went to work on July 21st. Ms. Green is a parent/caretaker relative whose earnings cause ineligibility for MHF. To stop MHF eligibility a 10-day adverse action notice is necessary. If Ms. Green received MHF in three months during the period of March through August, she is eligible for TMH. Change was reported July 25th and FSD mailed the adverse Action Notice the same day. The Adverse action period ends on August 4th. Ms. Green begins receiving TMH the day after the Adverse Action expires – August 5th.

EXAMPLE 3: Ms. Brown and her family have received MHF since April of the previous year. They were due for a review a year later in April. The review was attempted without contact with the participant. Income verification via electronic data was inconclusive and an IM-31A Request for Information was sent requesting income verification. Verification was not provided and MHF closed April 30th. Ms. Brown reapplied May 10 and provided the necessary income verification. Because she provided the verification within 30 days of the closing date we can reopen her original case and process it for TMH (refer to 1885.030.00 Reopening Closed Cases). No new application is necessary.

EXAMPLE 4: Mr. Blue and his family were placed on MHF in March. It is now August and Mr. Blue is reporting a job he started on April 2nd. The first day that Mr. Blue’s family could have received TMH coverage would be April 22 (Allowing 10-days from start of job to report change and 10-days for Adverse Action period). Since the family’s MHF coverage started in March and they would have moved to TMH in April, they do not meet the eligibility guideline of receiving MHF in three out of the last six months. The Blue family is not eligible for TMH. Complete an ex parte review of all household members.

NOTE: Each Prior Quarter month has its own independent evidence for the following:  Prior Quarter Income, Prior Quarter Deductions, and Prior Quarter Medical Bills.