Family MO HealthNet (MAGI) Manual

1890.000.00 Ex Parte Review Process

IM-04 January 11, 2024; IM-105 December 22, 2023; IM-109 August 9, 2017; IM-29 March 29, 2017

Under 42 CFR 435.916, before stopping a participant’s coverage under most MO HealthNet (MHN) categories and for most reasons, it is mandatory for Family Support Division (FSD) to explore possible eligibility under all other MHN programs.

Eligibility criteria or changes in circumstance such as pregnancy, income, age, or household composition may allow a participant to move from one MHN program to another without a new application. If the individual claims a disability, is blind, or age 65 or older, explore eligibility for Non-MAGI programs also.

This pre-closing review must be completed ex parte (which means without contacting the participant), if possible. However, if there is information that suggests eligibility for another program but eligibility cannot be determined during the ex parte review, FSD must attempt to contact the participant and collect additional information before closing the participant’s coverage.

When determining eligibility under another category:  

  • Do not ask the participant to provide information that is available to FSD, or to re-verify current case information.
  • Use all available data sources to verify eligibility criteria.
  • Move the participant to the MHN benefits with the highest level of care for which they qualify, or if they are eligible for multiple programs, you must notify the participant and allow them to make a choice.
  • Do not end current coverage before approval in another category or until the participant is determined ineligible for all MHN programs.
  • If ending eligibility from one eligibility system and approving in another, close the active benefits and then the next day approve the new benefits to prevent any disruption in healthcare coverage.
  • Use the Aged, Blind, and Disabled Supplement (IM-1ABDS), if needed, to explore eligibility for Non-MAGI programs, if a participant is aged 65 years or older, disabled, or blind. Non-MAGI programs have different program eligibility and verification requirements than MAGI programs. 

NOTE: If the participant remains eligible for the current MHN program, but requests to be switched to another program, complete an eligibility determination as an ex parte review, if possible.

The following programs are time limited and will not generate Adverse Action Notices at the end of their time period:

  • Newborn (up to, but not including one (1) year of age)
  • Transitional MO HealthNet (maximum of twelve (12) months)

Households are informed of the coverage timeframes at the point of approval.  When coverage for these programs ends, a review for other eligibility is required. If no other eligibility exists when closing these cases, FSD staff must send an appropriate manual notice.