Gateway to Better Health Manual

1600.030.05 EX PARTE REVIEW

IM-80 May 17, 2019

Under 42 CFR 435.909, prior to stopping a participant’s coverage under most MO HealtNet categories, with the exception of closure for failure to cooperate, it is mandatory to explore eligibility under other MO HealthNet programs. Changes such as address, pregnancy, income, age, disability, or blindness may allow a participant to move from one MO HealthNet program to another without a new application. This process of exploring eligibility under another MO HealthNet program is called ex parte review.

Complete an ex parte review without requiring an application from the participant unless:

  • Eligibility is being explored for MAGI programs; and
  • there is no active MAGI case for the household.

42 CFR 435.907 specifies that participants moving from non-MAGI to MAGI programs may use new applications or supplemental forms to capture necessary information.

Note:  Do NOT explore eligibility for an MHABD cash grant program without a new,  signed application.

Because MAGI and Non-MAGI programs have different eligibility and verification requirements, participants may be required to submit additional paperwork.  Use the data sources listed in 1805.000.00 ELIGIBILITY AND VERIFICATION whenever possible to verify eligibility criteria.

Move the participant to the MO HealthNet benefits with the highest level of care for which they qualify.  When ending eligibility in one category and approving another, take necessary steps to prevent a disruption in healthcare coverage.