| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | MO HEALTHNET FOR KIDS, PREGNANT WOMEN AND PARENTS INTERNET APPLICATION |
DISCUSSION:
Applications for MO HealthNet for Kids, Pregnant Women, and Parents may now be made via the Internet by visiting the Family Support Division's website at https://dss.mo.gov/mhk/appl.htm. The applicant may opt to complete the application on-line or download and print it to submit. The on-line application displays after selecting the “I Accept” statement below:
By selecting “I Accept” below, I have agreed to submit this application by electronic means. By signing this application electronically, I certify under penalty of perjury that all declarations made in this eligibility statement are true, accurate, and complete, to the best of my knowledge. I authorize insurers or employers to release any information on myself or my dependent(s) needed to determine eligibility for the HIPP program. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
By checking I Accept and typing my name in the “Signature/Affidavit” box on the form, I am electronically signing my application.
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(All Information is transmitted over a Secure network)
Selecting “I Accept” takes the applicant to the on-line application, which can be completed and then submitted on-line. Required sections that must be completed prior to submitting the application are:
- Section A containing name, address, and county of residence;
- Section B containing at least one household member; and
- The signature/affidavit and date section at the end of the application.
Once the application is submitted successfully, the applicant will receive a “Thank You” message to let him or her know that the application was accepted. The “Thank You” message includes generic information needed for an application, such as income verification, and requests the applicant send supporting documentation to the MO HealthNet Service Center in St. Joseph, Missouri.
The MO HealthNet Service Center staff is alerted by an e-mail that an Internet application has been submitted. The application can be opened through the database link provided in the e-mail. The application can be printed by selecting “View/Print Form” at the end of the application. The date of application is the date submitted by the applicant. This date will appear in the date applied field in the grey section titled, “For Office Use Only” on the IM-1UA application form.
Internet applications received by the MO HealthNet Service Center will be handled in the same manner as mail in applications currently received by the MO HealthNet Service Center, except that the date of application will be the date the application was submitted electronically. Applications that are to be forwarded to county offices for processing will be printed and registered in FAMIS prior to transferring to county offices. The printed copy of the application must be kept in the applicant's record. The eligibility specialist must follow-up with the applicant to complete missing information and to obtain needed documentation following policies used for mail in applications.
All Internet applications will have the county name (based upon the county code selected by the applicant), date, and a unique 10 digit number displayed in the date applied field in the grey section titled, “For Office Use Only” on the IM-1UA application form. For example, Cole012920081201023067, means that the applicant selected Cole County as his or her county of residence and that the application was submitted on January 29, 2008. The remainder of the number is a unique number assigned to that application.
NECESSARY ACTION:
- Review this memorandum with all appropriate staff.
- Accept and process Internet applications as instructed.