- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- UPDATED FORMS IN FORMS MANUAL
- FORMS MANUAL REVISION #28
DISCUSSION:
The purpose of this memorandum is to introduce updated forms in the Income Maintenance Forms Manual.
The forms attached replace forms in the Forms Manual and update terminology. The terminology changed on most forms is replacing Case Worker with Eligibility Specialist, Client Signature to Applicant/Participant Signature, Gross Income to Modified Adjusted Gross Income (MAGI), and Medicaid or MC+ to MO HealthNet.
The IM-1U changes include:
- The Maximum Monthly Income amounts are updated with the January 1, 2014 income guidelines for MAGI households of two (2), three (3), four (4), or five (5).
- The MO HealthNet Rights and Responsibilities are updated to current language.
- The Net Income and Child Care questions were removed, as they do not pertain to MAGI eligibility.
- Child support income was removed from the question asking if anyone receives any of the following unearned income.
- A new question was added asking if the Family Support Division may determine eligibility for the family through the Federal Data Hub. It provides a response of up to five (5) years or allows the participant to decline to allow this information be available for future eligibility determinations.
- A question was added asking about deductions to help determine MAGI.
The MO HealthNet for Kids Insurance Company Quotes (IM-5) form is now in the forms manual. The form is used to verify insurance quotes for MO HealthNet coverage. If affordable insurance must be verified to determine MO HealthNet coverage, print two IM-5 forms and have the participant complete the forms by contacting two different private insurance companies to obtain the required documentation.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Updated versions of the forms are available in the Forms Manual on the intranet.
ATTACHMENTS
- IM-1U MO HealthNet Annual Review
- IM-5 Insurance Company Quotes
- IM-6 Authorization for Release of Information
- IM-7 Financial Information Release
- IM-10 School Verification Report
- IM-12 Employment Information Request
- IM-31A Request for Information
- IM-33 Notice of Case Action
- IM-39 Request for Employment Security – Out of State
- IM-39A Out of State Inquiry Letter
- IM-80 Adverse Action Notice
- IM-80A Waiver of 10-day Advance Notice
- IM-80PRE Pre-Closing Notice
- IM-108 Student Income Verification
AC/jl