Family MO HealthNet (MAGI) Manual

1840.030.10 Failure to Pay Notice

IM-#153, November 30, 2017

The Failure to Pay Notice is sent to participants whose premium payment is not received by the due date noted on the Recurring Invoice. The Failure to Pay Notice states that premium payment is past due and gives the participant an additional 20 days for the payment to be received before coverage is ended.

The Failure to Pay Notice allows participants an opportunity to show that their income or household size has changed prior to ending coverage due to failure to pay a premium. Participants are informed that they must contact the Family Support Division (FSD) Information Center within ten days of the date of the notice to report changes in income and/or household size. If a participant reports one or both of these changes, the FSD must take the following steps:

  • Enter reported information into MEDES immediately. MEDES will run an eligibility determination to determine if there is a change in level of care or premium amount.
  • Inform the participant to contact the MO HealthNet Stakeholder Services Unit (formerly the Premium Collections Unit) at 1-800-392-2161 regarding their outstanding invoice.

EXAMPLE: Mr. Thompson’s child, Mike, has been receiving SCHIP premium coverage, CHIP74. He fails to pay the Recurring Invoice sent April 1. Mr. Thompson is mailed a Failure to Pay Notice on April 15 stating he is being given an additional twenty (20) days to pay his premium, due now by May 5. Mr. Thompson notifies the FSD on April 18 that Mike’s earned income decreased by $50. The eligibility specialist (ES) verifies the change in income through requested verification and enters the adjusted income with a budget month of April. The eligibility specialist informs the participant to contact the MO HealthNet Stakeholder Services Unit for information regarding the outstanding invoice.