As provided in 42 CFR 435.916(d), when information is received regarding changes in the individual’s circumstances (CiC) that may affect eligibility, re-determine eligibility for MAGI Family MO HealthNet (MHN).
CiC’s that may impact the Level of Care (LOC) will prompt a floating renewal. If the CiC does not change the LOC but could have because of the type of change, the floating renewal should be completed. CiC’s that prompt a floating renewal include:
- Income Change
- Household Composition Change
NOTE: A change that does not impact the LOC, such as an address change, will not prompt a floating renewal.
A floating renewal will be completed at a CiC mentioned above, when:
- There is enough information provided by the participant, and/or
- There is enough information available to the agency through electronic and other sources to complete the renewal.
The system will reset the certification period when a CiC completes a floating renewal. The certification period is extended from the date the CiC is finalized for another 12 calendar months.
Floating renewals can only occur at CiC when there is enough information present to complete the renewal without requiring information from the individual. If there is not enough information available to FSD through the CiC, case record, electronic data source, or any other reliable source, a floating renewal will not be completed.
EXAMPLE: Katherine’s certification period ends June 30th. On March 15th Katherine reported she changed employers and will have an increase in income but did not provide any documentation. A review of electronic data sources confirmed Katherine’s change in employment and her income is Reasonably Compatible with her statement. Katherine’s income is the only income for the MAGI household. There is enough information to complete a floating renewal. The renewal is completed and the certification period is extended another 12 months from the date the CiC is finalized. Katherine will receive the 10 day Adverse Action Notice (IM-80) if the LOC decreases, and a Change Notice (IM-33C).
EXAMPLE: Eva’s certification period ends December 31st. On September 2nd Eva reported a new address. A review of the case shows that there were no changes in income or household composition. Eva’s CiC to change her address does not include a change in the LOC for Eva’s household. The CiC to update the household’s address is processed. The certification period is not renewed at this time. Eva’s case will be renewed at the end of her original certification period, December 31st.
If eligibility exists, under the same or a new LOC, a new 12 month certification period will begin. The new certification is effective as of the first of the month that the change(s) take effect.
EXAMPLE: On June 27th Charlene applied for MPW. She reported that her employment at Wal-Mart ended May 7th. Charlene submitted her separation letter from Wal-Mart and her last pay check dated May 31st. Her two children, Ruby and Max, currently receive CHIP 0 with a certification period of November 1, 2017 to October 31, 2018. Since the change of income can be confirmed and the changes were applied to the case, Ruby and Max’s level of care changed to MO HealthNet for Families (MHF). The certification period is reset as June 1, 2018 to May 31, 2019. Charlene is sent the Change Notice (IM-33C).
If a CiC is received during the annual renewal process but the IM-1U has not been signed and returned, a qualifying CiC may still complete the annual renewal. Follow the floating renewal guidelines of this section to complete the renewal. The policy for completing floating renewals does not change regardless of when a CiC falls in the certification period.
EXAMPLE: Josh’s certification period was set to end August 31st. The case could not be renewed automatically. The manual IM-1U was generated by the system 55 days prior to the end of the certification period with the auto renew failure. On August 8th Josh called to report a new residential address for the household. Josh’s case record indicates income from XYZ Employer. More information is needed about Josh’s income to complete the renewal. Since the CiC did not include income information, additional information regarding his income was not requested. Josh did not return the IM-1U, and the case closed. Josh was provided a 10 day Adverse Action Notice (IM-80) period. After the adverse action period expired, Josh was sent a Change Notice (IM-33C) notifying him the case has been closed for failure to complete the annual renewal.
EXAMPLE: Sue Ann’s certification period was set to end August 31st. The case could not be renewed automatically. The manual IM-1U was triggered. On August 8th Sue Ann reported she was laid off July 10th and now receives $260 in unemployment each week. She did not sign or return the IM-1U. A review of IMES confirmed Sue Ann’s statement. There were no other outstanding eligibility criteria needed to complete an eligibility renewal. The annual renewal was completed and the certification period extended for another 12 months. Sue Ann’s LOC remained the same. She was sent a Change Notice (IM-33C) notifying her the case has been renewed.
When an individual or household is determined ineligible based on eligibility criteria, complete an ex-parte review to determine eligibility for other MHN categories. Refer to MAGI Policy manual 1890.000.00 EX PARTE REVIEW PROCESS.
NOTE: If the case closes for failure to return the renewal form or failure to cooperate by providing requested information, an ex-parte is not completed.