The Notice of Case Action is sent to participants whose premium payment is not received by the due date noted on the Failure to Pay Notices. This notice states that the participant’s premium payment has not been received, and that coverage will end in ten (10) days. Participants are informed that coverage may continue if a hearing is requested within ten (10) days.
If a participant requests a hearing due to a CHIP Premium child losing eligibility, 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 a premium, the FSD eligibility specialist accepts the client’s request for a hearing and completes 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 case record in the Virtual File Room. FSD staff must not tell the participant that they must contact the MO HealthNet Division’s (MHD’s) Stakeholder Services Unit (formerly the Premium Collections Unit) to request the hearing.
MHD’s Stakeholder 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 and/or eligibility. MHD will file the claim for any MO HealthNet coverage received 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 premium.