Hearings Manual

0130.020.100.10 Reversals of MO HealthNet Eligibility

If the case involves MO HealthNet eligibility that was incorrectly closed or denied, the Decision or Order will contain the following statements:  “In addition, Claimant may be eligible for reimbursement of paid MO HealthNet covered medical services provided from the date the case was rejected or closed to the date this Decision was signed.  Agency is instructed to explore eligibility for such reimbursement with Claimant.”

To explore EU reimbursement of paid medical services, when it is determined by a hearing decision (including an amended hearing decision), or a FSD witness or supervisory decision that MO HealthNet benefits were incorrectly denied: 

  • Complete Section A of the Request for Recipient Medicaid Reimbursement (IM-64) form indicating the period of MO HealthNet eligibility.
  • Send the EU a letter with a copy of the IM-64 requesting they provide information and sign in Section A, and return the form within ten days. If the IM-64 is not returned, the FSD takes no further action.
  • If the EU responds with a “NO” to the question of Section A IM-64, send the form to the MO HealthNet Division.  This completes the EU reimbursement process.
  • If the EU has made payment for medical services during the dates indicated in Section A, complete Section B of the IM-64.
  • If the FSD response in Section B is “NO”, send the IM-64 to the MO HealthNet Division.  This completes the EU reimbursement process.
  • If the EU is determined eligible (Section B is “YES”) for the period in Section A, complete Section C and submit the form to the MO HealthNet Division.
  • The MO HealthNet Division contacts the EU and provides additional procedures for obtaining reimbursement.
  • The MO HealthNet Division notifies the FSD by a copy of the EU letter if the request for EU MO HealthNet reimbursement is denied.