IM-94 June 30, 2022; IM-153 November 30, 2017; IM-09 January 22, 2015
MO HealthNet (MHN) eligibility and coverage for children in the No-Cost group (CHIP 4M, CHIP 71, and CHIP 72) begins with the first day of the month of application or first day of the month in which eligibility is met.
For children in the Reduced Premium group (CHIP 73 and CHIP 74), MHN eligibility begins on the date of application, or first day of the month determined eligible. Coverage begins on the date of application or first day of the month determined eligible, or the date the premium is paid, whichever is later.
For eligible children in the Full Premium group (CHIP75), eligibility and coverage can begin no earlier than 30 days from the date of application, or on the date the premium is paid, whichever is later. For eligible (CHIP 75) premium group children determined to have special healthcare needs, eligibility begins on the date of application and coverage begins on the date of application or the date the premium is paid, whichever is later. The exception to the 30-day begin date only applies to the children with special healthcare needs; other children in the household who do not have a special healthcare need are subject to the 30-day begin date from the date of application.
EXAMPLE: Mrs. Wilson applies for MHN for her one child, Jan, on September 1. She meets all eligibility requirements for the Full Premium Group (CHIP 75). Mrs. Wilson attests that Jan has special healthcare needs. Staff approve the case September 10. As Jan has special healthcare needs, she is not subject to the 30-day begin date; eligibility begins September 1.
An invoice is mailed to Mrs. Wilson on September 11, the day after the approval. Mrs. Wilson’s payment is received by the MO HealthNet Division (MHD) Stakeholder Services Unit on September 15. Jan’s coverage begins September 15.
MHN coverage for all CHIP children is date specific at the time of closing. If a participant becomes ineligible, send an adverse action notice prior to closing. Close the coverage on the first business day following the expiration of the adverse action.
Children in the non-premium group are eligible for prior quarter coverage. Children in the CHIP 73, 74, or 75 groups are not eligible for prior quarter coverage.