| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | JULIA M. VS. SCOTT COURT ORDER |
DISCUSSION:
On July 9, 2007, a Court Order for injunctive relief was issued in the Julia M. vs. Scott case. This lawsuit was brought on behalf of all children residing in Missouri and who are receiving or who will receive MC+ health coverage and are required to pay a premium under Section 208.640 RSMo. Julia M. sought a Court Order to enjoin the Department of Social Services (DSS) to notify all MC+ recipients who are disenrolled from MC+ health coverage for failure to pay premium of their rights to appeal prior to disenrollment and to provide opportunity for continued enrollment and benefits pending a hearing. The Court granted Julia M.'s motion for preliminary injunction.
Actions taken for non-payment of premium are automated. Therefore, there is no change to the way Family Support Division (FSD) staff handle a MC+ premium case at this time. This memorandum is for informational purposes only.
Effective July 9, 2007, MC+ premium cases cannot close or have healthcare benefits terminate for failure to pay an invoice for active recipients. DSS must:
- Notify the recipient of his/her right to a hearing ten days prior to benefits terminating due to failure to pay the premium, and
- Continue recipient's healthcare coverage pending the outcome of a hearing if requested by the recipient.
The Court Order applies to recipients who fail to pay a recurring invoice as well as recipients who fail to pay an initial invoice sent out when changing from a non-premium to premium level of care. The Court Order does not apply to individuals whose application is approved for MC+ premium and fail to pay the initial invoice. Individuals who do not pay an initial invoice following approval of MC+ will continue to have cases closed following current practices.
The Division of Medical Services (DMS) is currently revising the notices sent to recipients who fail to pay premiums. Until the notice is revised and ready for use, MC+ health benefits will not be terminated for non-payment of premium. FSD staff will be informed when the notice is revised.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.