Family MO HealthNet (MAGI) Manual – Table of Contents

1820.050.30 Loss of TMH Eligibility after First Six Months

IM-#111, July 25, 2019, IM-#19, February 07, 2018

If the first quarterly report is not received by the 21st day of the 4th month of TMH eligibility, an ex parte review will be completed to evaluate eligibility under other MO HealthNet (MHN) programs.

The certification period will extend depending on what initial form of verification was used to move the participants from MHF to TMH:

  • When client statement (MHF to TMH verification in MEDES) is used, the certification period will extend out 60 days after the initial 6 months of TMH.  Coverage will be granted based on income level and other case evidence.
  • When another form of verification is used, the certification period will extend for a full 12 months (6 months added to the initial 6 month TMH period).  Coverage will be granted based on income level and other case evidence.

If any children on TMH are now eligible for a non-premium level of care, the coverage will be granted and an action notice will be generated to the head of household on the case.

If any children on TMH are now eligible for a premium level of care above 196% FPL, CHIP coverage will be granted following the adverse action period and 60 day transition period after the initial TMH period has ended. If children on TMH are found eligible for a premium level of care below 196% FPL (CHIP 73), they will remain on TMH while coverage for the parent(s) is suspended.