MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual

0840.010.00 Changes in Circumstances

IM-04 January 11, 2024; IM-01 January 3, 2023; IM-113 July 17, 2020; IM-121 September 11, 2017

Participants of Non-MAGI programs are required to report changes in circumstance affecting eligibility factors within ten calendar days of the change. Any necessary action resulting from a change must be taken within ten calendar days of the date the participant reports the change. If the change in circumstance results in any change to eligibility, such as a change in level of coverage, change in spend down or premium amount, or ineligibility, Family Support Division (FSD) must notify the participant.

NOTE: While the date of the change is usually considered as the date that the change happened, when the change is obtaining employment or a change in rate of pay, the change date is considered to be the date of the first paycheck or first paycheck with the changed rate of pay.

If the action results in increased coverage or a better benefit, it shall be effective the month of the report. If the system does not adjust coverage for the appropriate months, staff should complete necessary actions to ensure that the correct coverage is authorized for those months.

NOTE: If the change is not reported within ten calendar days and would result in an increase in coverage, the change is effective the month of report, not the month in which the change actually occurred.

Coverage Options

There are circumstances when eligibility for more than one Non-MAGI coverage type exists.  This commonly occurs between the Spend Down, Ticket to Work, and Specified Low-Income Medicare Beneficiary – Group 2 (SLMB2) programs. 

Decisions regarding coverage options must be made by the participant or their Authorized Representative. Some of these changes can cause a significant cost difference for the participant. It is the responsibility of FSD staff to contact the participant to discuss their coverage options, and record the participant’s coverage choice in the eligibility system.  If the participant does not respond to a Request for Contact letter within ten days, FSD staff will enter a decision based on the level of coverage currently being received, past coverage history, or the lowest cost option. FSD must document in the eligibility system any attempts to contact the participant and support for the coverage option authorized. The participant must be sent the appropriate adverse action and action notices including the option to appeal the decision.

If the participant is requesting to be switched to another program, either a different Non-MAGI program or a MAGI program, do not require a new application and complete an eligibility determination as an ex parte (which means without contacting the participant), if possible. See 0840.015.05 Pre-closing Ex Parte Review.

EXCEPTION: A signed MO HealthNet Application Addendum: Request to Add Cash Benefits (IM-1MAC) is required to apply for Supplemental Nursing Care (SNC), Supplemental Aid to the Blind (SAB), or Blind Pension (BP). See 0804.025.00 MO HealthNet Application Concurrent With MHABD Cash Programs.

Adverse Actions

An Advance Notice of Adverse Action is required before any adverse action can be taken. Refer to 0130.015.10 Advance Notice of Adverse Action Required and 0130.015.20 Exceptions to Advance Notice of Adverse Action for additional information. 

The following are examples of case outcomes that would require an Advance Notice of Adverse Action (this list is not all-inclusive):

  • Change in level of care from vendor to non-vendor
  • Change from non-Spend Down to Spend Down
  • Increase in spend down amount
  • Increase in TWHA premium
  • Change that results in ineligibility for all types of MO HealthNet coverage

Pre-Closing Reviews

When a change in circumstance results in the participant no longer being eligible for Non-MAGI coverage, a review must be completed to explore eligibility for other MO HealthNet programs. Complete this pre-closing review as an ex parte (which means without contacting the participant), if possible. Review Non-MAGI manual section 0840.015.05 Pre-closing Ex Parte Review for additional information.