MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual – Table of Contents

0840.005.05 RECONSIDERATION PERIOD

IM-#63 November 27, 2018

Per 42 CFR 435.916(C)(ii), allow submission of the Annual Review Form (FA-402) up to 90 days after termination of eligibility.

The reconsideration period allows cases that closed for failure to return the (FA-402) to be reopened when the (FA-402) is received within 90 days from the date the closing action is completed in FAMIS.

NOTE: The 90 day reconsideration period is calculated from the date the case closes in FAMIS, and not the date MO HealthNet coverage ends.

Follow normal procedures when information or clarification is needed. When additional information is needed, send a Request for Information Notice (FA-325) to request the information or clarification.

The reconsideration period is treated in two different manners:

    1. When the (FA-402) is received within 30 days of the action to close the case:

The certification period is extended for another 12 months.

      • If found ineligible, send the appropriate notices: the Adverse Action Notice (IM-80) or system generated (FA-420), followed by the Adult MO HealthNet Benefit Action Notice (FA-460).

 

  1. When the (FA-402) is received the 31st through the 90th day from the closing date in FAMIS:
    • Use the (FA-402) as a new application. Do not require the household to complete an application form.
    • The date the (FA-402) is received is used as the application date.

If there is a lapse in coverage and the individual attests to unpaid medical bills, explore eligibility in the Prior Quarter (PQ) months; refer to 0810.015.00 Prior Quarter Coverage.

Note: If additional information is required, only request information needed to renew eligibility. Review and use current information in the case record and electronic data sources before requiring the individual to provide information for the Annual Review.

If the (FA-402) Annual Review form is received more than 90 days after the case closed, do not use the Annual Review form in place of an application. The individual must reapply through normal application procedures. Notify the individual how to reapply by sending the, Letter for (FA-402) Returned After 90-Days.