Family MO HealthNet (MAGI) Manual – Table of Contents

1880.025.00 ANNUAL RENEWAL CASE ACTION NOTIFICATIONS

IM-#137, November 20, 2017

A redetermination is made and case action notices are sent within 10 days of receiving the necessary information to determine continued eligibility.

    • If the redetermination produces no change or a higher level of care –
      • Send an Action Notice (IM-33) notifying the individual of the action taken on their case as a result of the annual renewal redetermination.
    • If the redetermination produces a lower level of care –
      • Send an Adverse Action Notice (IM-80) notifying the individual 10 days prior to the change taking effect;
      • Once the 10-day Adverse Action period expires, take action on the case; and
      • Send an Action Notice (IM-33) notifying the individual of the action taken on their case as a result of the annual renewal redetermination.
    • If the redetermination produces an outcome of ineligibility –
      • Send a Pre-Closing Notice (IM-80PRE) notifying the individual that in 10 days the agency will start the action to close the case if we do not hear from them. There are no hearing rights on the Pre-Closing Notice (IM-80PRE).
      • Once the Pre-Closing Notice (IM-80PRE) expires, send an Adverse Action Notice (IM-80) notifying the individual 10 days that the agency will take action to close.

NOTE: An Pre-Closing Notice (IM-80PRE) is not required when the individual’s case is closing for failure to respond to the Request for Information (IM-31A).

    • Once the Adverse Action Notice (IM-80) period expires, take action on the case, and
    • Send an Action Notice (IM-33) notifying the individual of the action taken on their case as a result of the annual renewal redetermination.

When the annual renewal determination produces a result of ineligible for reasons other than failure to cooperate, it is necessary to evaluate eligibility for a different MHN category prior to taking action to close the case. If it is determined the individual is not eligible for any other MHN program, the individual’s information is sent to the Federally Facilitated Marketplace (FFM) for an eligibility determination.

NOTE: An ex-parte review is not required when the case is closed for failure to respond to the IM-1U or failure to provide requested information.

When the disability flag is marked, the system will make a referral task to MO HealthNet for the Aged, Blind and Disabled (MHABD). The case will remain open until a decision is made on the MHABD case. When approved or denied for MHABD, the MAGI the Eligibility Specialist must manually close the MAGI case.