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:
- Third party
- Electronic data sources
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.
EXAMPLE: Joe and his son, George, are active MO HealthNet for Families (MHF). Lula, George’s mother moved in with Joe and George on March 5th. Joe is required to report the change by March 15th; FSD will process the CiC and provide Joe with all necessary adverse action notices and action notice within 45 days from March 15th (the date the change was reported).
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.
EXAMPLE: Darlene’s employment at the local factory ended in November 15, 2021. Darlene was laid off due to low work demand. Darlene failed to report this information to FSD timely. She reported the change on April 28, 2022. The change will be effective as of the report date, April 28, 2022. Darlene’s two children are on CHIP 73. With the change in Darlene’s income her children are eligible for 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 2021 through April 2022. MHK coverage for Darlene’s two children will begin May 1st. Send an action notice to notify the household of the changes applied to the case. An adverse action period is not required as this is a better level of coverage and therefore a positive change.
EXAMPLE: Ginger gave birth to her child, Jacob, on June 1st. 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 2nd. Ginger has another child at home, Adam age 5, of whom she is the custodial parent. Adam is currently receiving CHIP 74. FSD processed the CiC on June 7th to add Jacob to Ginger’s household, which impacted Adam’s coverage. 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 1st. The change in Adam’s coverage is effective with the date of the change, not the report date, because the CiC was reported timely. Send an action notice to notify the household of the changes applied to the case. An adverse action period is not required as this is a better level of coverage and therefore a positive change.
EXAMPLE: Mary gave birth to her child, Riley, on February 18th. 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 10th. Mary is married to Stewart and they have two other children, Zach (7) and Sam (3). Zach and Sam have both been receiving CHIP 75 MHN coverage since December. FSD processed the CiC to add Riley to the household on May 15th. 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, and the MHN level of coverage change for Zach and Sam is effective as of the report date, May 10th. Riley is eligible for Newborn coverage effective February 18th, his date of birth. Send an action notice to notify the household of the changes applied to the case. An adverse action period is not required as this is a better level of coverage and therefore a positive change.
Voluntary closings are only acted upon when a request to close a MHN case is received from a responsible member of the household 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 an individual provides FSD with 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.
- 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.
- 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.
EXAMPLE: Matilda is the head of the household for herself, her spouse Tyler, and their child Dominick. Tyler submitted in writing that he 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.
NOTE: An individual cannot receive MHN benefits in another household until benefits have completely closed in the original household.