MEMORANDUM

DISCUSSION:

Senate Bill 577 (2007) added Section 208.659 to the Revised Statutes of Missouri authorizing a revision to 13 CSR 70-4.090, thereby establishing the Uninsured Women’s Health Services program. The Centers for Medicare and Medicaid Services (CMS) approved an amendment to Missouri’s Section 1115 Waiver, authorizing the revision in December 2008. The CMS approval allows the Family Support Division to begin accepting applications and determining eligibility for the Uninsured Women’s Health Services (UWHS) program effectively immediately.

Through the UWHS program, Missouri provides women’s health services to uninsured women, from age 18 up to but not including age 55, with a family income less than or equal to 185% of the federal poverty level.

Women in the Uninsured Women’s Health Services program are eligible for the same services as women in the Extended Women’s Health Services (EWHS) program. These services are:

• Approved methods of contraception;
• Sexually transmitted disease testing and treatment, including pap tests and pelvic exams;
• Family planning, counseling, education on various methods of birth control; and
• Drugs, supplies, or devices related to the women’s health services described above, when they are prescribed by a physician or advanced practice nurse.

There is no cost sharing for UWHS coverage. Services are provided through fee-for-service through approved MO HealthNet providers in all areas of the state. UWHS coverage begins the first day of the month of application provided all eligibility factors are met. UWHS does not include prior quarter coverage. Coverage is date-specific for participants at the time of closing.

The Uninsured Women’s Health Services program manual has been added as Section 0927.000.00 of the Income Maintenance Manual. The eligibility requirements and procedures are outlined below. Eligibility determinations for UWHS are completed in FAMIS.

ELIGIBILITY REQUIREMENTS

A woman must meet the following criteria to be eligible for Uninsured Women’s Health Services:

1. Age;
2. Social Security Number;
3. Residence;
4. Citizenship and Alien Status;
5. Need;
6. Available Resources of less than $250,000;
7. Uninsured;
8. No access to employer-sponsored insurance; and
9. Ineligible for any other MO HealthNet program.

NOTE: MO HealthNet for Families (MHF) eligibility factors for the criteria listed above apply, unless otherwise noted. MHF eligibility factors not listed above (such as Assignment of Support Rights, Cooperation in Obtaining Support, etc.) do not apply to the Uninsured Women’s Health Services program.

Age

A woman must be age 18 and up to but not including age 55 to be eligible.

Social Security Number

This factor of eligibility applies to the female applicant. It does not apply to other persons who may be included in the assistance group (i.e. spouse of woman, dependent children). Follow the instructions outlined in Section 0905.010.05 for this eligibility factor.

While obtaining a social security number is not a factor of eligibility for other persons in the assistance group, the social security number should be requested as it may be needed to verify income.

Residence

This eligibility factor is the same as for MHF. Refer to Section 0905.010.25.

Citizenship and Alien Status

This eligibility factor is the same as for MHF. Refer to Section 0905.010.30.

Need

All MHF budgeting methodologies apply to UWHS except:

• Assistance grouping rules;
• The $50 child support disregard is not allowed;
• There is no stepparent deeming;
• SSI income of assistance group members is included.

Definitions of income and income exclusions are the same as for MHF unless otherwise stated.

A woman is eligible for UWHS healthcare coverage if the assistance group's net income does not exceed 185% of the federal poverty level (FPL) for the household size.

Mandatory assistance group members include:

• the woman;
• the spouse of the woman (if in the home).

NOTE: The father of an included optional child is mandatory, regardless of spousal status.

Optional assistance group members include:

• dependent children of the woman (including step-children).

NOTE: Do not include optional assistance group members whose income causes ineligibility.

Available Resources

A woman is ineligible for UWHS when she has available resources with a value of $250,000 or more. Available resources (defined in Temporary Assistance Manual, Sections 0205.005.05 through 0205.005.35) include any combination of the following:

1. real property,
2. personal property,
3. cash and securities, and
4. cash surrender value of life insurance policies (including money paid on revocable prepaid burial contracts) in excess of any exempt amount.

Uninsured

To be eligible for UWHS, a woman must be uninsured. Uninsured women are defined as women age eighteen (18) up to but not including fifty-five (55) years of age that do not have health insurance. Refer to Section 0920.020.05.10 for definition of health insurance. A woman covered by health insurance at the time UWHS eligibility is determined is ineligible, unless the insurance enrollment is already paid for by HIPP. There is no penalty for dropping insurance. A woman that is insured simply because the Health Insurance Premium Payment (HIPP) program is paying the premium will be treated as though she is uninsured.

No Access to Employer-Sponsored Insurance

In addition to being uninsured, the woman cannot have access to employer-sponsored health insurance (either through her employer or her spouse’s). Access to insurance available through employment includes group memberships or private company insurance enrollment options offered by the employer. Examples of group memberships that could offer health insurance are a union, professional organization, or trade association.

If the woman or her spouse fails to purchase the health insurance, she is ineligible as long as it is available. It is considered available even though there is a limited open enrollment period for which they need to wait. Affordability limits do not apply to this program.

Ineligible for Any Other MO HealthNet Program

A woman is ineligible for UWHS if she qualifies for any other MO HealthNet program on a non-spenddown basis. Explore eligibility for any Family Healthcare program (MO HealthNet for Families, MO HealthNet for Kids, and MO HealthNet for Pregnant Women) prior to exploring eligibility for UWHS. If the participant has an active MO HealthNet for Families (MHF) or MO HealthNet for Kids (MHK) case, explore eligibility for MO HealthNet for Families prior to exploring eligibility for UWHS by completing an add-a-person application. If ineligible for MO HealthNet for Families or any other full coverage program, explore eligibility for UWHS by registering a UWHS application and approve for UWHS if eligible on all UWHS eligibility factors. If the woman applies using the application for Family Healthcare programs, assume she is ineligible for MO HealthNet for the Aged, Blind, and Disabled (MHABD) unless she either indicates that she is disabled or receives Social Security disability or SSI benefits.

Examples:

Ms. Johnson meets all eligibility requirements for UWHS, but is receiving Extended Women’s Health Services (EWHS). Ms. Johnson is not eligible for UWHS as she is currently receiving MO HealthNet benefits under another program. NOTE: Ms. Johnson should be reviewed for UWHS eligibility prior to closing EWHS.

Ms. Smitt receives Social Security Disability of $650.00 per month, has resources under $1,000 and does not receive Medicare. She meets all other eligibility requirements for UWHS, but as she is disabled, she qualifies for MO HealthNet for the Aged, Blind and Disabled (MHABD) non-spenddown based on disability. Ms. Smitt is not eligible for UWHS as she qualifies for MHABD as non-spenddown.

Ms. Harmony is included on her children’s MO HealthNet for Kids case. Ms. Harmony submits a MO HealthNet for Kids, Pregnant Women, and Parents application on 1-2-09. Ms. Harmony is not pregnant, disabled, or blind. The eligibility specialist registers an add-a-person application for Family Healthcare (FAM in FAMIS) and an application for UWHS. If Ms. Harmony is determined ineligible for MO HealthNet for Families, eligibility for UWHS must be explored.

APPLICATION AND ELIGIBILITY PROCEDURES

Application Request

Effective immediately, when a women makes an application for Uninsured Women’s Health Services, register the application in FAMIS on the Application Request (REQUEST/FM0G) screen. Enter “MA” (Medical Assistance) in the Program Code field, and “WHS” (Uninsured Women’s Health) in the Sub Program Class field.

On the Application Detail (FM17) screen, enter the appropriate “Benefit Requested” code for each listed individual. DO NOT exclude (EX) a spouse, if in the home, or the father of any dependent child that is included.

Explore eligibility for UWHS anytime an application for Family Healthcare is received requesting coverage for an age-eligible woman by registering both a ‘FAM’ and ‘WHS’ application.

If an Internet application is received for a woman requesting coverage and the woman is not currently receiving benefits but is included on an active Family Healthcare case in FAMIS, explore eligibility for all MO HealthNet programs including UWHS. The application will not be able to be sent to FAMIS as the participant has an active case in FAMIS. The eligibility specialist must print and review the Application Summary (WB102) that displays on the Document Queue (FMVM or DOCQUE) screen in FAMIS. The applicant may wish to add-a-person and/or apply for MO HealthNet for Pregnant Women (MPW) or Uninsured Women’s Health Services (UWHS) program. If an application is needed, register the appropriate requested application (add-a-person, MPW, UWHS, or all) in FAMIS.

The MO HealthNet Application for Kids, Pregnant Women and Parents (IM-1UA) form is the application form used to apply for UWHS.

Applications must be completed in thirty (30) days.

Control Flow

Continue through the control flow, answering the technical and financial information screens standard for the Family Healthcare programs. In addition to the standard screens (Income, Social Security Number, Citizenship, etc.), eligibility specialists will need to fill out and/or obtain information for the following screens:

• Driver Questions:
  1. Does any person for whom you requested benefits have medical or hospital insurance or Medicare? – Fill out the insurance information requested on the next screen in the flow prompted by a “Yes” answer.
  2. Is health insurance available for any member of your family through an employer or group membership? – Fill out the information requested on the next screen in the flow prompted by a “Yes” answer.
• Resource Limit:
  1. The Net Worth (NETWORTH/FMH1) screen is being used for recording resources at this time. Document resources applicable to Temporary Assistance (TA) resource eligibility in the comment section of this screen, and record the applicable resource amount that is considered available.

Coding

The following codes have been assigned to the Uninsured Women’s Health Services program:

• FAMIS Medicaid Category – UWHS
• MO HealthNet Eligibility Code (ME Code) – 89

REINVESTIGATIONS

Reviews of UWHS EU’s are to be done annually. A review can be completed without the reinvestigation form, if all the information is obtained. For example, a review is completed by a Food Stamp application initial approval or recertification when all members of the UWHS Eligibility Unit are in the Food Stamp Eligibility Unit or by a Temporary Assistance application approval when all members of the UWHS Eligibility Unit are in the Temporary Assistance Eligibility Unit. For more information on entering a reinvestigation in FAMIS refer to the Completing a Temporary Assistance/Medical Assistance Reinvestigation in FAMIS User Guide.

The reinvestigation forms for MO HealthNet programs are in the process of being reviewed for content and use for multiple programs. The UWHS reinvestigation process is in development to be added to the FAMIS reinvestigation process used for the TA and Family Healthcare programs. Until this process is implemented in FAMIS, UWHS reinvestigations are to be processed manually. It is recommended to use the following forms for UWHS reinvestigations until further notice:

• Reinvestigation for Kids and Parents (IM-1U) – Recommended for women with dependents; or
• Medicaid Reinvestigation-Eligibility Statement (IM-2D) – Recommended for women without dependents.

EXPARTE PROCESS

Prior to discontinuing a participant’s coverage under UWHS, review the participant's possible eligibility under all MO HealthNet programs. Follow steps for an exparte review in MO HealthNet for Families Manual Sections 0905.025.16.05 - 0905.025.16.20.

Example:

Ms. Elrod reports that she is now insured and pregnant. Explore eligibility under MO HealthNet for Pregnant Women (MPW) prior to closing UWHS.

EXPLORING UWHS ELIGIBILITY FOR AGE-ELIGIBLE WOMEN WHEN NO LONGER ELIGIBLE FOR ANY OTHER MO HEALTHNET PROGRAM

When closing an age-eligible woman in any MHF/MHK/MHABD program, include reviewing eligibility for UWHS in the exparte process if the participant is no longer eligible for any other MO HealthNet program by registering a UWHS application and completing the controlled flow.

NOTE: A woman eligible for EWHS after the 60-day postpartum eligibility for MO HealthNet for Pregnant Women ends is to remain on EWHS as long as she remains eligible. Explore eligibility for UWHS prior to EWHS ending and transfer to UWHS if appropriate (using the exparte process).

NECESSARY ACTION:

• Effective immediately begin accepting applications for UWHS.
• Review this memorandum with appropriate staff.

LH/ER