- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- MO HEALTHNET SINGLE STREAMLINED ADDITION (IM-1ADP)
- FORMS MANUAL REVISION #23
DISCUSSION:
The purpose of this memorandum is to introduce an attachment for the MO HealthNet Single Streamlined Application (IM-1SSL). The IM-1SSL asks questions about person 1 and person 2. The two-page MO HealthNet Single Streamlined Addition (IM-1ADP) is a generic form for additional people. For applicants with more than two individuals in the MAGI household, the IM-1ADP form allows applicants to answer the same questions as the IM-1SSL for additional people, and relieves confusion of having multiple "Person 2" forms.
The IM-1ADP allows applicants to write a number at the top of the form, in the box next to the "Step 2: PERSON 
". This is to assist eligibility specialists in determining the number of individuals in each MAGI household.
When giving the IM-1SSL to an applicant, ask if there are more than two people including them, their spouse/partner, and children or other family members who live with them, and/or anyone on their same federal income tax return if they file a return. If the applicant states yes, provide the applicant with the appropriate number of IM-1ADP forms.
EXAMPLE: An individual requests a MO HealthNet application. Before providing the application, an eligibility specialist asks if there are more than two people including them, their spouse/partner, and children or other family members who live with them, and/or anyone on their same federal income tax return if they file a return. The applicant states four people — themselves, their spouse, their child, and their niece. The eligibility specialist gives the applicant the IM-1SSLwhich asks about person 1 and 2 and two IM-1ADP forms for the additional individuals.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Provide the IM-1ADP with the IM-1SSL to applicants who have more than two persons in the MAGI household.
- Access .pdf versions of the forms in the Forms Manual on the intranet.
ATTACHMENT:
- MO HEALTHNET SINGLE STREAMLINED APPLICATION (IM-1SSL)
- MO HEALTHNET SINGLE STREAMLINED ADDITION (IM-1ADP)
AC/pc