0745.000.00 Annual Renewals and Change in Circumstance

0745.030.05 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 SP-Only and SSI-SP, ineligibility for all MO HealthNet (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 MHN category, change the case address if necessary, and continue MHN under the conversion case number (type of assistance A, E, or F) as a level of care T while exploring the other eligibility. Action may be taken to discontinue the cash grant while not affecting the MHN eligibility.

Do not ask the participant to provide new information that is available to the agency or to re-verify current case information. Obtain additional information from the participant if needed 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 transactions on the same day in order to prevent any disruption in healthcare coverage.

If the category the participant is eligible is MHN Spend Down send an Adverse Action Notice notifying the participant they will become Spend Down the month after the Adverse Action expires. After the Adverse Action expires, register an MHN Spend Down application, and:

  1. Close the SP-Only or SSI-SP case at the end of the current month.
  2. Approve the MHN Spend Down case with a Title XIX begin date of the first day of the next month.
  3. Send the participant a Notice of Approval for Medical Assistance Spenddown. If no other eligibility exists, initiate Adverse Action to close the case by sending an Adverse Action Notice. If a hearing is not requested, close the case once the action expires and notify the participant in writing confirming the closing.