Family MO HealthNet (MAGI)

1820.050.40 Suspended TMH Eligibility in Second Six Month Period

IM-#111, July 25, 2019, IM-#52, March 25, 2019, IM-#19, February 07, 2018

If the second quarterly report is not returned by the 21st day of the 7th month, the coverage of parents/caretaker relatives is suspended on the 1st day of the 8th month.

If the third quarterly report is not returned by the 21st day of the 10th month, the coverage of parents/caretaker relatives is suspended on the 1st day of the 11th month.

In both situations:

  • An adverse action is sent 10 days prior to the suspension.
  • An ex parte is completed by the system and the child(ren) move to the next level of care, if eligible, based on existing evidence.
  • Coverage of parents/caretaker relatives remains suspended until the last day of the 12th month.

    EXCEPTION: If a change is reported making a parent/caretaker relative eligible for another level of care, move the parent/caretaker relative to the appropriate level of care avoiding interruption in coverage when possible.

    Example:  Mark’s TMH coverage is currently suspended.  He begins receiving Social Security Disability during the suspension.  An MHABD application is completed and he is moved to that level of care.

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 after the 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.

An ex parte is completed by the system and an annual renewal will be generated if the household goes to the end of the 12th month of TMH.