0840.000.00 Annual Renewals and Change in Circumstance

0840.015.05 Pre-closing Ex Parte Review

IM-45 May 3, 2023; IM-193 December 28, 2000

If a change in circumstance results in a determination of ineligibility for Non-MAGI MO HealthNet (MHN), ineligibility for all MHN categories must be established prior to taking action to close the case.  All available information must be carefully reviewed.  If potential eligibility exists under another category, continue MHN under the current MHN program while exploring other eligibility.

Do not ask the participant to provide new information that is available to the agency or to re-verify current case information.  In some situations, it may be necessary to obtain additional information from the participant to determine eligibility in another category.  Do not close while attempting to complete the new eligibility determination.

If the participant is determined eligible under another category, switch the individual to the appropriate category, a new application is not required.  Process both closing and approval actions on the same day in order to prevent any disruption in healthcare coverage.

If no other eligibility exists, initiate action to close the case by sending an Adverse Action Notice.  If a hearing is not requested, close the active MHN case after the Adverse Action Notice expires and notify the participant with an Action Notice.