0855.000.00 Ticket to Work Health Assurance (TWHA) Program

0855.005.45 Premium Payment

IM-22 April 11, 2024; IM-106 December 28, 2023; IM-49 March 21, 2019; IM-30 April 19, 2018; IM-30 March 29, 2017; IM-26 May 9, 2016; IM-22 March 20, 2015; IM-17 March 21, 2014; IM-26 March 11, 2013; IM-20 March 13, 2012; IM-16 March 14, 2011; IM-13 March 5, 2009; IM-22 March 7, 2008; IM-77 August 28, 2007; IM-26 March 23, 2007

A participant whose income exceeds 100% of the Federal Poverty Level (FPL) must pay a monthly premium to participate in the TWHA program. TWHA premium amounts are based on a formula specified by state statute and are adjusted annually effective April 1.

On new approvals, participants in the premium group must select the beginning date of coverage, which may be as early as the first month of the prior quarter (if otherwise eligible) but no later than the month following approval. When approving the case, the selected beginning date is entered as the beginning date of eligibility. Thus, staff must discuss with the participant the amount of the premium, how premium payments received will be applied, and have the participant select the month they want coverage to begin.

Note: If a participant is not in the premium group, coverage should begin on the first day of the first month the participant is eligible. Refer to Sections 0810.005.00 MO HealthNet Non-Spend Down Coverage and 0810.015.00 Prior Quarter (PQ) Coverage.

Refer to MHABD Appendix J for current TWHA premium amounts.

Continuous Eligibility for Children (CEC)

Continuous eligibility of participants under the age of 19 must be applied to children who are eligible for MO HealthNet TWHA Coverage.

  • The TWHA premium must be paid monthly for the child to receive payment of medical claims.
  • Eligibility begins at approval.
  • MO HealthNet Division (MHD) determines coverage being active if TWHA premium is paid each month.
  • Increasing the TWHA premium amount is not allowed during the CEC period.
  • Decreasing the TWHA premium amount is allowed during the CEC period.

Note: Refer to section 1805.070.00 Continuous Eligibility for Children (CEC) in the MAGI Manual.