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

0840.010.20 CHANGE TO MA-WD PREMIUM

IM-78 June 28, 2002

When a change occurs resulting in an active Medicaid claimant going to the Medical Assistance for Working Disabled (MA-WD) premium group, the change is effective the first day of the second month following the date change is entered in the IMU5 system.  This allows the claimant to have uninterrupted coverage, if the premium is paid timely.  If the premium is not paid at the end of the month following the worker enters the change to MA-WD premium the claimant will not have Medicaid coverage until a premium is paid.

When changing an active MA-WD non-premium or MA non-spend down case to the MA-WD premium group, use the following procedure:

  1. Send the claimant an Advance Notice of Adverse Action (IM-80).
  2. When the IM-80 expires, enter the change in the IMU5 system with a Title XIX begin date of the first day of the second month following the date change is entered.  For example, if the change is entered on any date in July enter September 1 as the Title XIX begin date for the premium level of care/reason code.
  3. When the change is entered in the system send a Notice of Case Action (IM-33) to notify the claimant of the change.
  4. The day after the change is entered DMS will send the claimant an initial invoice for the first month of premium group coverage.

The system will not allow a case to change directly from spend down to MA-WD premium.  When an active spend down case needs to change to the MA-WD premium group, it is necessary to enter the IMU5 changing the case to MA-WD non-premium one day and the next day enter it as premium case.  This allows the system to take the case out of spend down coverage into the MA-WD program without adding an additional month of spend down coverage.  DO NOT CLOSE A spend down CASE AND REGISTER A NEW APPLICATION TO CHANGE THE CASE TO MA-WD PREMIUM. Use the following procedure to change a case from MA spend down to MA-WD premium:

  1. Record the date the spend down claimant reports having earned income.  Consider this a request for MA-WD (a new application form is not required).  The date of request is used as the application date when determining the earliest possible Medicaid (Title XIX) eligibility begin date under MA-WD.
  2. Determine the claimant’s eligibility for MA-WD, and record the basis for the determination.  The claimant can be determined eligible for MA-WD in the prior quarter, if employed in those months.
  3. Change the case MA-WD non-premium in the IMU5 system.  Enter a Title XIX begin date of the first day of the first month in which the claimant employed or the first day of the prior quarter, whichever is later.
  4. The next day change the case to MA-WD premium.  Enter a Title XIX begin date of the first day of the second month following the date change is entered.
  5. Send the claimant an MA-WD approval letter informing them of the MA-WD approval and the first month they are required to pay a premium.
  6. The day after the change to MA-WD premium is entered DMS will send the claimant an initial invoice for the first month of premium group coverage.