IM-22 April 11, 2024; IM-25 March 23, 2023; IM-94 June 30, 2022; IM-151 November 29, 2017; IM-90 July 11, 2017
Per 42 CFR 435.916, applicants/participants must be able to report a change in circumstance (CiC) online, by telephone, by mail, in person or through other electronic means.
A CiC may be received from different sources:
- Applicant/Participant
- Third party
- Electronic data sources
Change in Circumstance
Per 42 CFR 435.912, a CiC is a redetermination of eligibility. When a CiC occurs that could potentially affect eligibility, households have ten (10) calendar days to report the change to the Family Support Division (FSD). FSD must process the reported change and provide the household with notification of the change within 10 days of the change taking effect on the case.
Note: Households are required to report changes timely. However, children in their Continuous Eligibility for Children (CEC) period must not be closed or changed to a lesser level of care during the CEC period. Refer to 1805.070.00 Continuous Eligibility for Children for allowable closing reasons.
For changes reported timely, within 10 days of the date the change occurred, the action is taken from the date the change occurred. If the change is reported non-timely, more than 10 days after the change occurred, action is taken from the date reported.
Note: Do not take away coverage that has already been given; a claim should be established when necessary. When reported untimely, Children’s Health Insurance Program (CHIP) refunds are not issued.
Exception: Newborns born to a woman eligible for Title XIX MO HealthNet (MHN) coverage at the date of the child’s birth receive coverage back to the date of birth. This applies regardless if the birth of the child was reported timely or untimely. If there is an individual(s) in the household whose eligibility is impacted due to the birth of the child, the changes are taken as of the report date whether the birth was reported timely or untimely. See 1860.010.00 Eligibility.
Example: Darlene’s employment at the local factory ended in November 15. She reported the change on April 28. Since the change was not reported timely, it will be effective as of the report date, April 28. With the change in Darlene’s income, her children’s coverage will change from CHIP 74 to MO HealthNet for Kids (MHK). Since the change was not reported timely she will not be issued a refund for the CHIP payments from December through April. MHK coverage for Darlene’s children will begin May 1.
Example: Ginger gave birth to Jacob on June 1. Ginger was receiving coverage under a Title XIX MHN program on the date the child was born. The hospital where Jacob was born reported his birth to FSD on June 2. Ginger’s other son, Adam age 5 is currently receiving CHIP 74. FSD processed the CiC on June 7 to add Jacob to Ginger’s household. By adding Jacob to the household, Adam’s MHN coverage changed to MHK. Jacob is eligible for Newborn coverage effective with his date of birth, June 1. The change in Adam’s coverage is effective with the date of the change, not the report date, because the CiC was reported timely.
Example: Mary gave birth to Riley on February 18. Mary was receiving coverage under a Title XIX MHN program on the date Riley was born. Riley’s birth was reported to FSD on May 10. Mary has two other children, Zach (age 7) and Sam (age 3). Zach and Sam have both been receiving CHIP 75 MHN coverage since December. When FSD processed the CiC to add Riley to the household on May 15, adding Riley to the household caused Zach and Sam’s coverage to change from CHIP 75 to CHIP 74. The CiC (Riley’s birth) was not reported timely, so the MHN level of coverage change for Zach and Sam is effective as of the report date, May 10. Riley is eligible for Newborn coverage effective February 18, his date of birth.
Voluntary Closing
Voluntary closings are only acted upon when a request to close a MHN case is received from the head of household, spouse, or Authorized Representative. Do not accept the request to voluntarily close a case from a minor child of the household who is not the head of the household, or from any other persons or sources outside of the household.
- When the head of household, spouse, or the Authorized Representative provides a written request to close their MHN case, take action to close the case. An adverse action period is not required since the request was provided in writing. Send an action notice to notify the household the case has been closed.
- When the request to voluntarily terminate coverage for a specific individual or for the entire household comes from someone other than the head of the household, provide a 10 day adverse action period by sending an adverse action notice.
- If the request to close a MHN case is received verbally, provide a 10 day adverse action period by sending the household an adverse action notice. When the adverse action expires send the household an action notice, to notify the household the case has been closed.
Example: Matilda is the head of the household for herself, her spouse Tyler, and their child Dominick. Tyler submitted in writing that he has moved out of the house and would like MHN benefits closed for himself only. Since Tyler is not the head of the household, Matilda is sent the 10 day adverse action notice. Once the adverse action period expires, Tyler’s MHN benefits in Matilda’s household hold are closed and she is sent an action notice.
An individual cannot receive MHN benefits in another household until benefits have completely closed in the original household.
Note: Households are required to report changes timely. However, children in their CEC period must not be closed or changed to a lesser level of care during their CEC period. If changes reported negatively impact the household, actions can only be applied to those 19 years of age and older. Refer to 1805.070.00 Continuous Eligibility for Children (CEC).