When individuals age out of a MAGI MO HealthNet (MHN) based program, an ex-parte review must be completed to explore eligibility for other MO HealthNet MAGI programs.
NOTE: When an individual ages out of a MHN program, eligibility ends on the individual’s birthday. Coverage does not extend to the end of the month. For eligibility and coverage begin and end dates refer to the Family Healthcare Processing, Eligibility and Coverage Dates table.
Section 1902 of the Social Security Act provides that at the age of 65 all participants age out of MAGI MO HealthNet Programs (MHN), unless otherwise indicated by the specific MHN program policy.
- MO HealthNet for Families (MHF) Child – 19 years old
- MO HealthNet for Families (MHF) Adult – 65 years old
- MO HealthNet for Adult Expansion Group (AEG) – 65 years old
- MO HealthNet for Kids (MHK) – 19 years old
- MO HealthNet for Kids under 1 (MHK under 1) – 1 year old
- MO HealthNet for Newborns – 1 year old
- Show Me Healthy Babies Newborns – 1 year old
- Uninsured Women’s Health Services (UWHS) – 56 years old
Section 208.040 RSMo states to be eligible for MO HealthNet for Families (MHF), a child must be under the age of 19 years. However, the child must be a high school student and expected to graduate high school, for the child to receive MHF between the ages of 18 and 19. This is also known as the MHF Student Extension.
NOTE: FSD has 45 days to complete the CIC from the date the change is reported. FSD must input the change, send the adverse action notices (IM-80PRE and the IM-80) as necessary, and the action notice all within the 45 day timeframe. If the child is found not to be a high school student, by the child’s 18th birthday an ex-parte review is completed to explore potential eligibility for other MHN programs. Student status is verified by self-attestation unless questionable.
When a child does not meet the MHF Student Extension and is no longer eligible for MHF, and there are no other MHF eligible children in the parent/caretaker’s household, the parent/caretaker is no longer eligible for MHF. When the student meets the extension criteria, the parent/caretaker can continue to receive MHF during the extension period.
EXAMPLE: Annie’s household consists of herself and her mother, Joann. Both Annie and Joann have MHF coverage. Annie graduated high school early, at age 17. Since Annie is not a high school student when she turns 18, an ex-parte review is completed. It is found that Annie is eligible for MO HealthNet for Kids (MHK). Joann no longer has an eligible child in the home and therefore cannot receive MHF. Joann’s eligibility is explored under AEG.
NOTE: The MHF Student Extension only applies to MO HealthNet for Families (MHF). A child can receive MO HealthNet for Kids (MHK) until the age of 19 without meeting a student status requirement.
EXAMPLE: John is currently receiving AEG and he is turning 65 years old in 60 days. Eligibility will be explored for non-MAGI coverage, MO HealthNet for the Aged, Blind, and Disabled, before closing AEG coverage.
EXAMPLE: Jill is currently receiving MHK and she is turning 19 years old in 20 days. Eligibility will be explored for AEG before closing MHK.
NOTE: If Jill is claiming a disability, receiving SSI, or receiving SSDI eligibility for non-MAGI coverage (MHABD) will be concurrently determined.