IM-30 April 2, 2021; IM-115 August 6, 2019; IM-98 July 3, 2019
MO HealthNet for the Aged, Blind, or Disabled (MHABD) cases may be reopened or cancel closed under the following circumstances:
- When the case was closed in error, such as:
- Incorrect data entry; or
- Information was received by FSD in a timely manner, but not entered into the eligibility system in time to stop the case closing.
- When the participant provides ALL missing information that caused the case to close within 30 days of the date the closing action is complete.
This information may include, but is not limited to:
- income information
- real or personal property information
NOTE: The closing action is considered complete on the date the case closed, not the date that coverage ends. For some MHABD programs a case may close on a particular date with coverage continuing through the end of the month or the end of the following month. The action notice will notify the participant of the date the case closed, and the date the coverage ends.
EXAMPLE: Mr. Smith has active MO HealthNet for the Aged, Blind, and Disabled (MHABD) Spend Down coverage and reports he has gotten married and his spouse has earned income. Mr. Smith provides verification of his marriage, but does not provide income verification. FSD staff is unable to verify the income using sources available to FSD and sends a Request for Information Notice requesting income verification. Mr. Smith fails to submit the information in ten days, and an adverse action notice is sent. No response is received from Mr. or Mrs. Smith. The adverse action expires and the case closes on May 25th with coverage continuing through June 30th.
On June 2nd, seven days after the closing is completed, Mr. Smith submits one paystub, but does not provide the pay frequency bi-weekly or twice monthly. Staff makes a comment in the eligibility system regarding the information provided, but does NOT reopen the case since the pay frequency is unknown and still outstanding.
On June 14th, twenty days after the closing is completed, Mr. Smith submits the additional paystubs which verify the frequency of pay. Staff makes a comment in the eligibility system regarding the wage information received and takes action to reopen the case now that FSD has received all outstanding verification.
If the outstanding verification had not been provided until June 25th, thirty-one days after the case closed, the closing could not have been canceled. Mr. Smith’s coverage would still end on June 30th.
NOTE: When reopening a case due to the annual review or during the 90-day reconsideration period, refer to MHABD manual section 0840.005.05 Reconsideration Period.
If the case closed due to verification that was not provided during a request to add a person who is requesting coverage or to add a category of coverage to an active MHABD case and that verification is later provided, in addition to pursuing a cancel closing of the case, ensure that the request for coverage continues to be processed if information was provided within the appropriate cancel rejection timeframes. Policy regarding canceling a rejection can be found in MHABD manual section 0804.020.00 Canceling a Rejection.
Add a person requests in which the individual being added is not requesting coverage are considered a change in circumstance. If the case closes, the cancel closing policy would apply.
Adding a category of coverage follows the application processing time frames in the cancel rejection policy. Changing a category of coverage is considered a change in circumstance and if the case closes, the cancel closing policy would apply.
Examples of applications adding a category of coverage include, but are not limited to:
- Adding QMB or SLMB1 – a new signed application form is not required,
NOTE: Staff must NOT register an add a category request in the eligibility system when a request to add QMB/SLMB coverage has been requested.
- Adding Blind Pension (BP) or Supplemental Aid to the Blind (SAB) – a new signed application form is required.
NOTE: Staff MUST register an add a category request in the eligibility system when a request to add BP or SAB coverage has been requested.
Examples of changing a category of coverage include, but are not limited to:
- MHABD Spend Down or Non-Spend Down to Ticket to Work
- MHABD Spend Down or Non-Spend Down to vendor
- MHABD Spend Down to SLMB2
The MO HealthNet Division (MHD) Stakeholder Services Unit (formerly the Premium Collections Unit) must be notified when a MHABD Spend Down or Ticket to Work (TWHA) case is reopened for any reason.
The MHD Medicare Buy-In Unit must be notified when a QMB/SLMB case is reopened for any reason. Refer to the MHABD Cancel Close/Cancel Reject Chart for the current procedure for reopening Spend Down, TWHA, and QMB/SLMB cases.