1840.000.00 MO HealthNet Children’s Health Insurance Program (CHIP)

1840.030.15 Notice of Case Action

IM-22 April 11, 2024; IM-153 November 30, 2017

MHD will send notice of case action to participants whose initial premium payment is not received by the due date noted on the notice.

If a participant requests a hearing due to an initial premium, the eligibility specialist must determine whether the reason for the hearing request is due to a case action taken by FSD or due to non-payment of a premium. If the request appears to be due to non-payment of an initial premium, FSD staff accept the client’s request for a hearing and complete an IM-87 Hearing Request form. The IM-87 must be faxed to the MO HealthNet Hearings Unit at 573-526-2471 on the date of the request. Scan the original IM-87 to the participant’s electronic case record. FSD staff must not tell the participant that they must contact the MO HealthNet Division’s (MHD’s) Constituent Services Unit (formerly the Premium Collections Unit) to request the hearing.

MHD’s Constituent Services Unit will continue to provide coverage for the child(ren) affected by the hearing request. There will be no affect to FSD eligibility. MHD will essentially be holding the close action for failure to pay a premium. If the participant loses the hearing, MHD will send the closing action to close coverage. MHD may file a claim for any MO HealthNet coverage that the participant’s child(ren) was not eligible to receive.

Note: Do not put a hold on the CHIP case due to a hearing requested because of non-payment of initial premium.

Note: Failure to pay a premium is not a valid closing reason for children who are in their Continuous Eligibility for Children (CEC) period. Refer to 1805.070.00 Continuous Eligibility for Children (CEC)