1865.000.00 Adult Expansion Group (AEG)

1865.040.10 Choice of Adult Expansion Group (AEG)

IM-#95 September 21, 2021

Choice at Application

When an applicant submits a MO HealthNet (MHN) application, Family Support Division (FSD) will conduct a concurrent eligibility determination using MAGI and non-MAGI methodology if the following is reported:

  • Aged 19-64
  • Report a disability, blindness, breast/cervical cancer diagnosis, and/or SSDI
  • Not receiving SSI, and
  • Not enrolled in/entitled to Medicare Part A or B

Once FSD has determined eligibility under MAGI and non-MAGI methodology, the participant is given a choice of programs if found eligible for AEG and for a non-mandatory MO HealthNet for the Aged, Blind, and Disabled (MHABD) program (i.e. Spend Down, Blind Pension, etc.).

  • Notify the applicant of eligibility for both AEG and the non-mandatory MHABD program and they must choose between the two programs.
  • The applicant has 10 days to notify FSD staff of the program choice.
    • If the applicant chooses to remain on AEG then the MAGI case will remain open.
    • If the applicant chooses the non-mandatory MHABD program then FSD will take the action to transfer from AEG coverage to MHABD.
      • FSD will need to send and observe an Adverse Action period if the choice is made verbally (not in writing).
    • If the applicant does not notify FSD within 10 days, the applicant will remain enrolled in AEG.
      • If the applicant notifies FSD, at a later date, of a request to transfer to the non-mandatory MHABD program, FSD staff will explore transitioning the individual to the other program.

NOTE: MAGI determinations are likely to be completed before non-MAGI determinations, therefore, the participant will be enrolled in AEG while the non-MAGI determination is pending. Refer to Appendix K for a full listing of mandatory and non-mandatory programs.

Examples for Receipt of a New Application

Adam, 55 years old, is in need of healthcare coverage, is not claiming a disability and not currently receiving SSI or SSDI. Adam submits an MHN application. Only determine eligibility under MAGI based methodology.

John, 42 years old, is in need of healthcare coverage and is currently receiving SSI. John submits an MHN application. Only determine eligibility under non-MAGI based methodology. The receipt of SSI makes John ineligible for AEG.

Lisa, 28 years old, is in need of healthcare coverage. Lisa is claiming a disability, not currently receiving SSI or SSDI and submits an MHN application. Determine eligibility using MAGI and non-MAGI based methodologies.

Examples of Concurrent Eligibility Determinations at Application

Matt, 36 years old, applies for MHN and is determined eligible for AEG. Matt is claiming a disability, so eligibility is explored for MHABD at the same time as AEG. Matt does not receive SSI or SSDI so his information has been sent to the Medical Review Team (MRT). After the MRT review is complete, Matt is determined eligible for MHABD Spend Down. Matt must be given a choice of programs before granting MHABD Spend Down coverage. Matt chooses MHABD Spend Down by writing a letter, and action to transfer from AEG coverage to MHABD Spend Down is taken the same day.

Note: If the participant verbally chooses to transfer to a non-mandatory MHABD program from AEG, then send and observe a 10-day adverse action period before closing the AEG coverage and moving the participant to the non-mandatory MHABD program. If the participant is eligible for a mandatory MHABD program, the AEG participant would NOT be given a program choice and would be given an adverse action period of 10 days.

Bobby, 27 years old, applies for MHN and claims a disability. Bobby is determined eligible for AEG while his eligibility determination is pending with MRT. Bobby fails to return the information needed for MRT to make a determination; however, this does not affect his AEG eligibility. Since Bobby is already receiving AEG, he will remain on this program.

 

Choice at Annual Review/Renewal

When a participant submits an MHN Annual Review/Renewal form, FSD will conduct a concurrent eligibility determination using MAGI and non-MAGI methodology if the following applies to the participant:

  • Aged 19-64
  • Report a disability, blindness, breast/cervical cancer diagnosis, and/or SSDI
  • Not receiving SSI
  • Not enrolled in/entitled to Medicare Part A or Part B

Once FSD has determined eligibility under MAGI and non-MAGI methodology, the participant is given a choice if eligible for both AEG and a non-mandatory MHABD program.

  • Notify the participant of eligibility for both AEG and the non-MAGI, non-mandatory coverage and that they must choose between the two programs.
  • The participant has 10 days to notify FSD staff of the coverage choice.
    • If the participant is receiving AEG coverage and chooses to remain on AEG then coverage will not be changed.
    • If the participant is receiving MHABD coverage and chooses to remain on MHABD then the coverage will not be changed.
    • If the participant is receiving AEG coverage and chooses the non-mandatory MHABD program then FSD will take action the same day if the choice is made in writing.
    • If the participant is receiving AEG coverage and chooses the non-mandatory MHABD program then FSD will send and observe an adverse action period of 10 days for the AEG program before transferring to MHABD if the choice is not in writing.
    • If the participant is receiving MHABD coverage and chooses to receive AEG coverage then FSD will take action the same day if the choice is made in writing.
    • If the participant is receiving MHABD coverage and chooses to receive AEG coverage then FSD will send and observe an adverse action period of 10 days for the MHABD program before transferring to AEG if the choice is not in writing.
    • If the participant does not notify FSD of the choice within 10 days, program coverage will not change from the current program level that he/she is receiving prior to the review and remains eligible for.

Examples for Receipt of an Annual Review/Renewal

John, 57 years old, is currently receiving MHABD and receives SSI. John submits an Annual Review for MHN. Only determine continued eligibility under non-MAGI based methodology. The receipt of SSI makes John ineligible for AEG.

Mark, 60 years old, currently receives MHABD Spend Down, does not receive SSI and is not entitled to or enrolled in Medicare. Mark submits an Annual Review for MHN. Explore eligibility under MAGI and non-MAGI based methodologies.

Example of Concurrent Eligibility Determinations at Annual Review/Renewal

Penny, 52 years old, currently receives AEG coverage and has returned an Annual Renewal. Penny is not receiving SSI or enrolled/entitled to Medicare, but is claiming a disability. Eligibility must be explored for MAGI and non-MAGI programs. Penny remains eligible for AEG and is determined eligible for MHABD Spend Down. Penny must be given a choice before granting MHABD Spend Down. Penny chooses MHABD Spend Down by calling, so an adverse action of 10 days is observed for the AEG coverage and then Penny is transferred to MHABD Spend Down.

Note: If Penny had not reported a disability, only continued coverage for AEG would be explored.