Family MO HealthNet (MAGI) Manual

1880.020.00 RECONSIDERATION PERIOD

IM-#137, November 20, 2017

As provided in 42 CFR 435.916(C)(ii), allow submission of the pre-populated Annual Renewal Form (IM-1U) up to 90 days after termination of eligibility.

The reconsideration period allows cases that closed for failure to return the IM-1U to be reopened when the IM-1U is received within 90 days after the case has already closed.

Allow the reconsideration period if the individual fails to return the Annual Renewal form but provides all information required to complete the Annual Renewal by phone, online, in-person, or through the mail within the 90 day reconsideration period.

Follow normal procedures when information or clarification is required. When additional information is required, send a Request for Information Notice (IM-31A), to request the further information or clarification.

The reconsideration period is treated in two different manners:

    1. When the IM-1U is received within 30 days of the case closing:
      • Reopen the case; refer to the MAGI Policy manual section 1885.030.00 Reopening Closed Cases.
      • Process the IM-1U.
      • If found eligible, there will be no lapse in coverage.
        • The certification period is extended for another 12 months.
      • If found ineligible, send the appropriate notices; the Adverse Action Notice (IM-80) followed by the Change Notice (IM-33C)
    2. When the IM-1U is received the 31st – the 90th day after the case has closed:
      • Use the IM-1U in place of a new application.
      • The date the IM-1U is received is used as the application date.

NOTE: If there is a lapse in coverage and the individual attests to unpaid medical bills, explore eligibility in the Prior Quarter (PQ) months; refer to 1830.020.00 Prior Quarter.

EXAMPLE: Audrey’s MHN Annual Renewal could not be completed automatically and she was sent a pre-populated IM-1U. Audrey failed to reply to the IM-1U and her case closed. Audrey returned the IM-1U 60 days after the case closed. Further income clarification was required to complete the application. The IM-31A was sent allowing 10 days to return the clarifying information. Audrey responded to the request for information. Eligibility was explored for current month and ongoing. Audrey attested to having medical bills from July, therefore eligibility was also explored for the PQ. Audrey was found eligible. She was sent an Approval Notice (IM-33A) for current and ongoing months and an Approval Notice for Prior Quarter (IM-33APQ) for prior quarter months.

NOTE: If additional information is required, only request information needed to renew eligibility. Review and use current information in the case record and electronic data sources before requiring the individual to provide information for the Annual Renewal.

EXAMPLE: In November Katrina’s case closed for failure to provide requested information to complete the Annual Renewal. Katrina responded to the IM-1U 85 days after the case closed. Additional clarification is required to confirm Katrina’s attested income. A Request for Information (IM-31A) was sent to request clarification of income. Katrina failed to provide income clarification by the end of the 10 day timeframe. Katrina’s application was rejected and a Rejection Notice (IM-33R) was sent. An ex-parte is not completed to explore eligibility for other MHN programs since Katrina failed to respond to the request for information. The case was closed and the IM-1U was treated as a new application.

If the pre-populated Annual Renewal form is received more than 90 days after the case closed, do not use the Annual Renewal form in place of an application. The individual must reapply through normal application procedures. Notify the individual how to reapply by sending the, Letter for IM-1U’s Returned After 90-Days.