Family MO HealthNet (MAGI) Manual

1820.030.40 Untimely Report Of Income Change Resulting in Ineligibility for MHF

IM-#19, February 07, 2018

The start date for TMH will always be calculated as the date the coverage should have begun (NOT the date of discovery).

When the change is reported/discovered before the 21st day of the fourth month of Transitional MO HealthNet eligibility, enter the income change as reported by the participant and MEDES will take the appropriate action.

EXAMPLE 1: Ms. Black and her family have been on MO HealthNet for Families since September. It is now the following June and Ms. Black just reported that she started a job on March 24th. We cannot affect her coverage for the month of March. Using March 24th as our starting point, allowing ten (10) days for Ms. Black to report the change, ten (10) days for FSD to process the information, and another ten (10) days for an adverse action, the first date that Ms. Black’s family could receive TMH coverage would be April 23rd. April counts as her first month of TMH.

When the change is reported/discovered after the 21st day of the fourth month but before the end of the sixth month of Transitional MO HealthNet eligibility, complete a closing transaction providing Transitional MO HealthNet for the first six months only. DO NOT give or send the parent/caretaker relative a quarterly report form. The due date passed and the caretaker cannot be eligible for the second six months. Explore eligibility for other MO HealthNet programs.

EXAMPLE 2: Ms. Orange and her family were placed on MHF 12 months ago (in February). It is now January and Ms. Orange is reporting a job she started on August 12th. Using August 12th as our starting point, allowing ten (10) days for Ms. Orange to report the change, ten (10) days for FSD to process the information, and another ten days for an adverse action, the first date that Ms. Orange’s family could receive TMH coverage would be September 11th. January would count as her fifth month of TMH. Since Ms. Orange did not report her income until after the first quarterly report would have been due (by the 21st day of the 4th month/December 21st), her household is only eligible for the first six months of coverage and no extended coverage.

p>When the change is reported/discovered after the end of the sixth month of Transitional MO HealthNet eligibility, follow appropriate closing procedures on the MHF case and do not transfer to Transitional MO HealthNet. Enter a complete comment in MEDES explaining why TMH was not entered into system. Explore eligibility for other MO HealthNet programs prior to closing the MHF case.

EXAMPLE: Ms. Crane and her family have received MHF for 9 months. Ms. Crane started a new job on January 20th; however, she did not report the new income to FSD until after August 3rd. Using January 20th as our starting point, allowing ten (10) days for Ms. Crane to report the change, ten (10) days for FSD to process the information, and another ten (10) days for an adverse action, the first month that Ms. Crane’s family could have received TMH coverage beginning February 19th. August would count as her seventh month of TMH. This income was reported after the sixth month (July) of possible TMH eligibility. Follow standard procedure and complete an ex parte review on all household members.