Family MO HealthNet (MAGI) Manual

1800.000.00 Family MO HealthNet Programs

• 1800.005.00 Legal Basis

1801.000.00 Authorized Representative(s) for MO HealthNet

• 1801.005.00 Legal Basis
• 1801.010.00 Appointing an Authorized Representative
  • 1801.010.10 Appointing an Authorized Representative in a Household With Multiple Adults
  • 1801.010.20 Appointing Another Adult Member of the Household as an Authorized Representative
• 1801.020.00 Duration of Appointment of Representative
• 1801.030.00 Revoking an Authorized Representative Appointment

1802.000.00 Applications

• 1802.005.00 Legal Basis
• 1802.010.00 Requests for Benefits
  • 1802.010.10 Request in Person obsolete
  • 1802.010.20 Request by Mail obsolete
  • 1802.010.30 Online Application obsolete
  • 1802.010.40 Request by Telephone obsolete
  • 1802.010.50 Request for In-Home Application obsolete
  • 1802.010.60 Request Received Through Third Party obsolete
  • 1802.010.70 MO HealthNet Requests at Federally Qualified Healthcare Centers (FQHC) and Disproportionate Share Hospitals (DSH) obsolete
  • 1802.010.80 Specialized Application Procedures
    • 1802.010.80.05 Adding a Person to an Existing Application
    • 1802.010.80.10 Applications on a Closed Case
    • 1802.010.80.15 MO HealthNet Applications for Incarcerated Individuals
• 1802.020.00 Signing the Application
  • 1802.020.05 Application With No Signature
  • 1802.020.10 Signing by Mark
  • 1802.020.15 Electronic Signature
  • 1802.020.20 Telephonic Signature
  • 1802.020.25 Mail-In or Drop-Off Application obsolete
  • 1802.020.30 Signing by an Authorized Representative
  • 1802.020.35 Signing by a Relative
  • 1802.020.40 Signing by a Legal Guardian or Conservator
  • 1802.020.45 Signing on Behalf of a Deceased Participant
    • 1802.020.45.05 Death After Application
    • 1802.020.45.10 Application for Deceased Persons
    • 1802.020.45.15 Absence From the Home at Application
• 1802.030.00 Filer Consent
• 1802.040.00 Dating the Application obsolete
• 1802.050.00 Application Timeframes
  • 1802.050.10 Cancel Rejections

1805.000.00 Eligibility and Verification

• 1805.000.02 Federal Hub Calls
• 1805.000.05 Reasonable Opportunity (RO)
  • 1805.000.05.05 Reapplication After 90-Day Reasonable Opportunity obsolete
• 1805.005.00 Resident of Missouri
• 1805.010.00 Age and Date of Birth
• 1805.015.00 Social Security Number (SSN)
  • 1805.015.05 Failure to Complete an SSN Application or Furnish an SSN
• 1805.020.00 Citizenship and Immigrant Status
  • 1805.020.05 Citizenship
    • 1805.020.05.05 Documents to Verify Citizenship
  • 1805.020.10 Qualified Immigrant
    • 1805.020.10.05 Qualified Immigrants Entering Prior to 8/22/96
    • 1805.020.10.10 Qualified Immigrants Entering After 8/22/96
      • 1805.020.10.10.05 Qualified Immigrants With No Waiting Period
      • 1805.020.10.10.10 Qualified Immigrants With a Five-Year Period of Ineligibility
    • 1805.020.10.15 Non-qualified Immigrants
    • 1805.020.10.20 Citizens of the Federated States of Micronesia, Republic of Palau, and Republic of the Marshall Islands
  • 1805.020.15 Documentation and Verification of Alien or Immigrant Status
• 1805.025.00 Pregnancy
• 1805.030.00 Modified Adjusted Gross Income (MAGI) Methodology
  • 1805.030.05 Income Evidence
  • 1805.030.10 MAGI Household Composition
    • 1805.030.10.05 Legal Basis
    • 1805.030.10.07 Relationships
    • 1805.030.10.10 MAGI Household Composition for Tax Filers
    • 1805.030.10.15 MAGI Household Composition for Tax Non-filers
    • 1805.030.10.20 Exceptions to MAGI Household Composition
      • 1805.030.10.20.05 Joint Custody
    • 1805.030.10.25 Caretaker Relatives
  • 1805.030.15 Reasonable Compatibility
    • 1805.030.15.10 Reasonable Compatibility (RC) With More Than One Income in the Household
  • 1805.030.20 Income, Deductions, and the Five Percent (5%) Disregard
    • 1805.030.20.05 Income Included Under MAGI
    • 1805.030.20.10 Income Excluded Under MAGI
    • 1805.030.20.15 Allowable Deductions
    • 1805.030.20.20 Five Percent Disregard – Legal Basis
      • 1805.030.20.20.05 Calculation of the Five Percent Disregard
  • 1805.030.25 Determining MAGI
    • 1805.030.25.05 Projection of MAGI
    • 1805.030.25.10 Patterns of Income
    • 1805.030.25.15 Specific Types of Income
• 1805.035.00 Adding Income Comments to Evidence
• 1805.040.00 Cooperation in Pursuit of Medical Support
  • 1805.040.05 Referral to FSD-CS
  • 1805.040.10 Notice/Good Cause for Refusal to Cooperate
    • 1805.040.10.05 Areas of Cooperation
    • 1805.040.10.10 Refusal to Cooperate/Claiming Good Cause
    • 1805.040.10.15 Good Cause Defined
      • 1805.040.10.15.05 Determining Good Cause
      • 1805.040.10.15.10 Types of Evidence to Support Good Cause
    • 1805.040.10.20 Sanctions for Non-cooperation
    • 1805.040.10.25 Cooperation and Referral to Child Support When Adding Children to an Active Case
• 1805.045.00 Third Party Liability (TPL)
• 1805.050.00 Former Foster Care Youth (FFCY)
• 1805.060.00 Managed Care and Medicare
• 1805.065.00 Enrollment in Medicare Savings Programs (MSP)
• 1805.070.00 Continuous Eligibility for Children (CEC)

1810.000.00 MO HealthNet for Families (MHF)

• 1810.010.00 Legal Basis
• 1810.020.00 Eligibility Requirements
  • 1810.020.10 Income Maximums/Need
  • 1810.020.20 Construction of MAGI Household for MHF
    • 1810.020.20.10 Relationship of Child to Parent or Caretaker Relative
    • 1810.020.20.20 Eligibility for 18-Year-Olds
• 1810.030.00 Begin and End Dates for Coverage
  • 1810.030.10 Prior Quarter (PQ)
  • 1810.030.20 Transitional MO HealthNet
• 1810.040.00 Healthcare Coverage

1820.000.00 Transitional MO HealthNet (TMH)

• 1820.010.00 Legal Basis
• 1820.015.00 TMH Definitions
• 1820.020.00 Cooperation in Pursuit of Medical Support (TMH)
• 1820.030.00 Eligibility for Initial Six Months
  • 1820.030.10 Receipt of MHF in Three of Last Six Months
  • 1820.030.20 Notification of Initial TMH Eligibility
  • 1820.030.30 Ineligibility in First Six Months
  • 1820.030.40 Untimely Report of Income Change Resulting in Ineligibility for MHF
  • 1820.030.50 Untimely Agency Action on Change
  • 1820.030.60 Eligible Household Member Leaves Household
• 1820.040.00 Eligibility During the Second Six Month Period
  • 1820.040.10 Budgeting for Income Eligibility
• 1820.050.00 Quarterly Report Requirements
  • 1820.050.10 Quarterly Report Completeness
  • 1820.050.20 Good Cause for Failure to Return Quarterly Report
  • 1820.050.30 Loss of TMH Eligibility After First Six Months
    • 1820.050.30.10 Reinstatement of TMH Eligibility for Six Month Closings
  • 1820.050.40 Suspended TMH Eligibility in Second Six Month Period
    • 1820.050.40.10 Reinstatement of Individuals Suspended on TMH
• 1820.060.00 Ex Parte Review When TMH Ends
  • 1820.060.10 Ex Parte Review Results
    • 1820.060.10.10 Administrative Hearings

1830.000.00 MO HealthNet for Kids (MHK) – Non-CHIP Coverage

• 1830.005.00 Legal Basis
• 1830.010.00 Eligibility Requirements
  • 1830.010.05 Income Maximums/Need
    • 1830.010.05.05 Budget Procedure
  • 1830.010.10 Referral to Family Support Division – Child Support (FSD-CS)
• 1830.015.00 Healthcare Coverage Begin and End Dates
• 1830.020.00 Prior Quarter (PQ)

1840.000.00 MO HealthNet Children’s Health Insurance Program (CHIP)

• 1840.005.00 Legal Basis (CHIP)
• 1840.010.00 Eligibility Requirements
  • 1840.010.05 Need
  • 1840.010.10 Uninsured
    • 1840.010.10.05 HIPP Effect on Uninsured Status
  • 1840.010.15 Access to Affordable Health Insurance
    • 1840.010.15.05 Affordable Insurance Definition
    • 1840.010.15.08 Affordability Test
    • 1840.010.15.10 Employer-Sponsored Insurance
    • 1840.010.15.12 State Employee Health Insurance
    • 1840.010.15.15 Private Insurance
    • 1840.010.15.20 Special Healthcare Needs
• 1840.015.00 Begin and End Dates for CHIP Coverage
• 1840.020.00 Interim Changes
  • 1840.020.05 From No Premium to Premium
  • 1840.020.10 From Premium to No Premium
  • 1840.020.15 Other Level of Care Changes
  • 1840.020.20 Adding a Person
• 1840.025.00 Payment of Premium
  • 1840.025.05 Failure to Pay Initial Premium
  • 1840.025.10 Failure to Pay Premium After Coverage Begins
• 1840.030.00 MO HealthNet Division Notices for Non-payment of Premium
  • 1840.030.05 Initial and Recurring Invoices
  • 1840.030.10 Failure to Pay Notice
  • 1840.030.15 Notice of Case Action
  • 1840.030.20 Closing Letter

1850.000.00 MO HealthNet for Pregnant Women (MPW)

• 1850.010.00 Legal Basis
• 1850.020.00 Eligibility Requirements
  • 1850.020.10 Pregnant
  • 1850.020.20 Income Maximum/Need
    • 1850.020.20.10 Income Limits
• 1850.030.00 Prior Quarter (PQ) and Month of Application Eligibility
• 1850.040.00 Healthcare Coverage
  • 1850.040.10 Continuous Eligibility for Pregnant Women
  • 1850.040.20 Postpartum Coverage
    • 1850.040.20.10 Correction of Postpartum Ending Date
  • 1850.040.30 Coverage When Application Is Made After the Birth obsolete
  • 1850.040.40 Extended Women’s Health Services obsolete
    • 1850.040.40.10 Eligibility for Other MO HealthNet Programs obsolete
    • 1850.040.40.20 No Longer in Need of Family Planning Services obsolete
    • 1850.040.40.30 Notification of Ineligibility for Extension Due to Insurance obsolete
• 1850.050.00 Annual Renewals

1855.000.00 Show-Me Healthy Babies (SMHB)

• 1855.010.00 Legal Basis
• 1855.020.00 Eligibility
  • 1855.020.10 Unborn Child
  • 1855.020.20 Resident of Missouri
  • 1855.020.30 Need
  • 1855.020.40 Uninsured
  • 1855.020.50 Employer-Sponsored Insurance
  • 1855.020.60 Private Insurance
  • 1855.020.70 Ineligible for Any Other MO HealthNet Programs
  • 1855.020.80 Application Processing Timeframe
• 1855.030.00 Healthcare Coverage
  • 1855.030.05 Coverage for the Child After Birth
  • 1855.030.10 Labor and Delivery Coverage for the Mother
  • 1855.030.15 Coverage for the Mother After Birth of the Child

1860.000.00 Newborn – Automatic MO HealthNet Eligibility

• 1860.005.00 Legal Basis
• 1860.010.00 Eligibility
  • 1860.010.05 Adding the Newborn
  • 1860.010.10 Assignment of DCN
  • 1860.010.15 Verification of Birth
  • 1860.010.20 Eligibility Dates
• 1860.015.00 Newborn’s Effect on the Eligibility of Other Household Members’ MO HealthNet
• 1860.020.00 Reinvestigations

1865.000.00 Adult Expansion Group (AEG)

• 1865.010.00 Legal Basis
• 1865.020.00 Eligibility Requirements
• 1865.030.00 Begin and End Dates for Coverage
  • 1865.030.10 Prior Quarter (PQ)
• 1865.040.00 Interim Changes for Adult Expansion Group (AEG)
  • 1865.040.10 Choice of Adult Expansion Group (AEG)
• 1865.050.00 Healthcare Coverage

1870.000.00 Uninsured Women’s Health Services Program (UWHS)

• 1870.005.00 Legal Basis
• 1870.010.00 Eligibility Requirements (UWHS)
  • 1870.010.05 Age (UWHS)
  • 1870.010.10 Social Security Number (UWHS)
  • 1870.010.15 Residence (UWHS)
  • 1870.010.20 Citizenship and Alien Status (UWHS)
  • 1870.010.25 Need (UWHS)
    • 1870.010.25.05 Income Limits (UWHS)
    • 1870.010.25.10 Household (UWHS)
  • 1870.010.30 Uninsured (UWHS)
    • 1870.010.30.05 HIPP Effect on Uninsured Status (UWHS)
    • 1870.010.30.10 Health Insurance Definition (UWHS)
  • 1870.010.35 No Access to Employer-Sponsored Insurance (UWHS)
  • 1870.010.40 Ineligible for Any Other MO HealthNet Program (UWHS)
• 1870.015.00 Healthcare Coverage (UWHS)
  • 1870.015.05 UWHS HealthCare Coverage End Date
• 1870.020.00 Prompt Disposition (UWHS)
• 1870.025.00 Annual Renewals (UWHS)
• 1870.030.00 Ex Parte Process
• 1870.035.00 Exploring UWHS Eligibility for Age Eligible Women When No Longer Eligible for Any Other MO HealthNet Program

1880.000.00 Annual Renewals

• 1880.005.00 Pre-populated Annual Renewal Form
• 1880.010.00 Floating Renewal obsolete
• 1880.015.00 Children’s Health Insurance Program (CHIP) Annual Renewal
• 1880.020.00 Reconsideration Period
• 1880.025.00 Annual Renewal Case Action Notifications

1885.000.00 Change in Circumstance

• 1885.005.00 Age Out
• 1885.010.00 Adding a Person
• 1885.015.00 Removing a Person
• 1885.020.00 Returned Mail
• 1885.025.00 Moved Out of State
• 1885.030.00 Reopening Closed Cases
• 1885.035.00 Away From Home
• 1885.040.00 Suspension of MAGI Benefits for Incarcerated Individuals
• 1885.045.00 Participant Becomes Eligible for Medicare

1890.000.00 Ex Parte Review Process

• 1890.010.00 Pre-closing Actions
  • 1890.010.10 Eligibility Exists Under Another Category
  • 1890.010.20 No Other Eligibility Exists

1895.000.00 Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE)

• 1895.005.00 Unwinding the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE)
• 1895.010.00 Transition Period