- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- REVISED AUTOMATIC WITHDRAWAL FORMS FOR MO HEALTHNET FOR AGED, BLIND AND DISABLED-SPEND DOWN (MHABD-SD) AND TICKET TO WORK HEALTH ASSURANCE (TWHA) PROGRAMS, AND CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)
DISCUSSION:
The MO HealthNet Division Automatic Withdrawal Forms for MO HealthNet for Aged, Blind and Disabled Spend Down and Ticket to Work Programs, and MO HealthNet Children's Health Insurance Program (CHIP) have been revised. Revisions include:
- A place was added for bank account holder's signature.
- The words "IMPORTANT" and "CASE NUMBER" are bolded.
Eligibility specialists should encourage applicants and participants of MO HealthNet programs, Ticket to Work, Spend Down, and CHIP, to take advantage of the opportunity to simplify payments by electing to begin automatic withdrawal of the monthly premium or spend down amount.
Obtain the applicable automatic withdrawal form from the following links to provide to participants:
For Ticket to Work Health Assurance (TWHA) Program: https://dss.mo.gov/mhd/participants/pdf/ttw-ha.pdf
For MO HealthNet for Aged, Blind and Disabled-Spend Down Program: https://dss.mo.gov/mhd/participants/pdf/awa-spenddown.pdf
For MO HealthNet Children's Health Insurance Program (CHIP): https://dss.mo.gov/mhd/participants/pdf/awa-mc.pdf
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Provide an automatic withdrawal form to individuals at initial application, annual review, and interim contacts when applicable.
- Begin using revised forms immediately.
AC/VB