- TO:
- ALL COUNTY OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- RESPONSIBILITIES OF FAMIS OFFICES FOR MODIFIED ADJUSTED GROSS INCOME (MAGI) CASES
DISCUSSION:
The purpose of this memorandum is to explain roles and responsibilities of the Family Support Division (FSD) staff when the new rules for processing cases under the Modified Adjusted Gross Income (MAGI) rules become effective January 1, 2014.
The programs that are impacted by the new rules include:
- MO HealthNet for Families (MHF)
- MO HealthNet for Kids (MHK)
- MO HealthNet for Newborns (NBN)
- Children’s Health Insurance Program (CHIP)
- MO HealthNet for Pregnant Women (MPW)
- Uninsured Women’s Health Services (UWHS)
- Gateway to Better Health (GTBH)
- Extended Women’s Health Services (EWHS)
GENERAL DISCUSSION:
Applications for the programs listed above that were received on or before December 31, 2013, must be entered and processed in the Family Assistance Management Information System (FAMIS), even if not yet registered in FAMIS. Staff should register the application in FAMIS with the appropriate received date.
Applications for the programs listed above that are received after January 1, 2014, must be entered and processed in the Missouri Eligibility Determination and Enrollment System (MEDES).
All FSD staff will continue to have access to FAMIS after January 1, 2014. Access to the caseworker portal in MEDES will be restricted to staff in the MAGI processing centers in the Jefferson City, Union, and Joplin offices.
For purposes of this memorandum:
- FSD offices that will continue to process work in the FAMIS system will be referred to as FAMIS offices;
- FSD offices that will enter and process applications for the programs listed in the DISCUSSION section above will be referred to as MAGI processing centers; and
- Cases in the programs listed in the DISCUSSION section above will be referred to as MAGI cases.
FAMIS OFFICES – ROLES AND RESPONSIBILITIES
This section of the memorandum will explain roles and responsibilities of staff in a FAMIS office.
Changes on Active Cases in FAMIS Offices
FAMIS offices will continue to be responsible for active family MO HealthNet cases (not active in MEDES) and can act on changes such as changes of address or income for these cases in FAMIS until:
- An application for a new MAGI category of assistance;
- A report of a new eligibility unit (EU) member that results in an add-a-person application for a MAGI category;
- A report an active EU member has a newborn; or
- A report an active EU member is pregnant.
In one or more of the above circumstances, FAMIS offices must notify the MAGI processing center to enter the case in MEDES by scanning appropriate forms and documentation to the FSD WorkSite SharePoint at http://moteam.state.mo.us/dss03/FSD/WorkSite.
NOTE: Scanning instructions are forthcoming. Do not scan documents to the FSD WorkSite SharePoint until instructions are received.
- Change Reported on Active Case by Mail, FAX, Drop Off, or Web to FAMIS Office:
- Log the document in ITrackR.
- If the reported change results in a MAGI application, an add-a-person request for a MAGI category, newborn application or reported pregnancy, notify the MAGI office by scanning the documents to the FSD WorkSite SharePoint.
- If a reported change is received for a case that is active in MEDES, notify the MAGI office by scanning the documents to the FSD WorkSite SharePoint.
- All other actions will be processed in FAMIS following FAMIS office procedures until the MAGI case is moved to MEDES at the annual review.
- Change Reported on Active Case by Telephone to FAMIS Office:
- Gather the pertinent case information.
- If the reported change results in an application for a MAGI category, an add-a-person request for a MAGI case, newborn or reported pregnancy, notify the MAGI office by recording pertinent case information and details of the reported change, and scanning the document to the FSD WorkSite SharePoint.
- If a reported change is received for a case that is active in MEDES, notify the MAGI office by recording pertinent case information and details of the reported change, and scanning the document to the FSD WorkSite SharePoint.
- All other actions will be processed in FAMIS following FAMIS office procedures until the MAGI case is moved to MEDES at the annual review.
The MAGI processing center will enter the case in MEDES and close the FAMIS case using the reason “MDS” when:
- The individual’s benefit continues at the same, or better, level of care under MAGI eligibility.
NOTE: If the benefits would be better for the individual(s) under existing rules, the case will not be closed and the individual(s) will continue to receive benefits in FAMIS until the next annual review date.
EXAMPLE 1: A family of three has an active case in FAMIS. The family reports a new household member on February 1, 2014. The FAMIS office notifies the MAGI processing center by sending a completed IM-1UA SUPP to the FSD WorkSite SharePoint. The IM-1UA SUPP should be signed by the participant only when the report is made in-person.
The MAGI processing center determines the new household member's eligibility in MEDES. The other three household members are still active in FAMIS. In FAMIS, the children in the household were receiving MHK. In MEDES, the household is eligible for MHF. The MAGI processing center authorizes the benefit in MEDES and closes the case in FAMIS using the "MDS" code.
EXAMPLE 2: A family has an active case in FAMIS. A change is reported to add a new household member. The FAMIS office notifies the MAGI processing center by sending a completed IM-1UA SUPP to the FSD WorkSite SharePoint. The IM-1UA SUPP should be signed by the participant only when the report is made in-person.
The MAGI processing center determines the household is eligible for CHIP. In FAMIS, the children are receiving MHF. For this household, the benefit is better in FAMIS. The children currently active on MHF will continue to receive benefits in FAMIS until the next FAMIS review date. The new household member will receive CHIP benefits through the MEDES system.
If the FAMIS office receives a report of an additional change on the case, check MXIX field "SYS" for code "MS" to determine if the child is active in MEDES. If the child is in MEDES, scan the reported change to the FSD WorkSite SharePoint.
EXAMPLE 3: A woman on UWHS with children on MHK in FAMIS reports she is pregnant. The FAMIS office notifies the MAGI processing center by sending a completed IM-1UA SUPP to the FSD WorkSite SharePoint. The IM-1UA SUPP should be signed by the participant only when the report is made in-person.
The MAGI processing center applies MAGI methodology to the case. The MPW will be approved in MEDES. The children's benefit using MAGI methodology is the same. The case will be entered in MEDES since the benefit is the same or better. The benefit in MEDES will be authorized and the case in FAMIS will be closed with reason code "MDS".
EXAMPLE 4: A woman with 2 children is active on MHF. She reports she is pregnant. The FAMIS office notifies the MAGI processing center by sending a completed IM-1UA SUPP to the FSD WorkSite SharePoint. The IM-1UA SUPP should be signed by the participant only when the report is made in-person.
The MAGI processing center applies MAGI methodology to the case. The woman qualifies for MPW and the children continue to qualify for MHF. Since this is the same or better benefit under MAGI methodology, the benefit in MEDES will be authorized and the case in FAMIS will be closed with reason code "MDS".
EXAMPLE 5: Mom is active in FAMIS on MPW. The child was born on December 28, 2013. The hospital notifies the FAMIS office of the birth. The FAMIS office must complete the newborn eligibility in FAMIS, using current procedures because the birth occurred prior to January 1, 2014.
Mom applied through the citizen portal at https://mydss.mo.gov on January 3, 2014. MEDES will complete an eligibility determination based on this application. The mother and child will be approved for MO HealthNet for Families. Since this is the same or better benefit under MAGI methodology, the benefit in MEDES will be authorized and the case in FAMIS will be closed with reason code "MDS".
Annual Reviews on Active Cases in FAMIS
Staff in FAMIS offices will not be responsible for processing annual reviews for MAGI cases. At the time the annual review becomes due, the notification for the review will be directed to staff in a MAGI processing center. Any documents related to the MAGI annual review that are received in a FAMIS office will be scanned to the FSD WorkSite SharePoint.
NOTE: There will be no annual review for cases in the MAGI categories due in the months of January, February, or March 2014.
NOTE: If the case requiring annual review is a combination case of more than one assistance type, staff in the FAMIS office will be required to complete the annual review for the non-MAGI assistance program(s).
In-Person Applications
Staff in FAMIS offices will continue to accept and receive applications for MAGI cases. If the applicant comes into a FAMIS office to apply for one of the MAGI programs, and is not applying for or receiving any other type of assistance, staff in the FAMIS office will:
- Offer voter registration;
- Register the application in ITrackR;
- If the FAMIS office has customer-only computers for customer use, offer the applicant the opportunity to complete the application online through the citizen portal at https://mydss.mo.gov and assist them in signing on and completing the application as needed. Do not leave the applicant unattended.
- If the office does not have customer-only computers, or if the applicant requests or requires assistance with completing the application, the staff member assisting the applicant will:
- Access https://mydss.mo.gov
- Turn the monitor and the keyboard to the applicant and allow the applicant to create an account, assisting them as needed.
- After the account has been created and the password entered, have the applicant return the keyboard to the staff member.
- Read the application questions to the applicant and enter their answers on the citizen portal.
- Have the applicant complete and sign a Child Support Referral/Information for Services (CS-201) if appropriate.
- Obtain copies of any verification that the applicant has available such as identity, SSN cards, wage stubs, etc.
- Print a summary for the applicant.
- Scan the CS-201, and verifications if provided, to the FSD WorkSite SharePoint at http://moteam.state.mo.us/dss03/FSD/WorkSite.
NOTE: If questions arise during the application process through the citizen portal, staff members can call 855-373-9994 for assistance.
If the applicant comes into a FAMIS office to apply for MAGI assistance and one or more other types of assistance, staff in the FAMIS office will:
- Offer voter registration;
- Enter the applications in ITrackR;
- Enter the non-MAGI applications in FAMIS (do not enter the MAGI application in FAMIS);
- Print the Request for Application (FA-100) form for the FAMIS applications, manually mark the MAGI category, and obtain the customer signature on the form;
- Complete the interactive interview in FAMIS;
- Complete the MEDES Family Healthcare Application Supplement (IM-1UA SUPP).
- Print the MEDES Family HealthCare Application Supplement and obtain the applicant signature.
- Obtain the applicant signature on the Rights and Responsibilities.
- Have the applicant complete and sign a Child Support Referral/Information for Services (CS-201) if appropriate.
- Obtain copies of any verification that the applicant has available such as identity, SSN cards, wage stubs, etc.
- Scan the FA-100, IM-1UA SUPP and the Rights and Responsibilities, the CS-201, and verifications if provided, to the FSD WorkSite SharePoint.
Applications by Mail, FAX, and Drop-Off
If a FAMIS office receives an application for MAGI assistance only, staff will:
- Enter the application in ITrackR; and
- Scan the Single Streamlined Application (IM-1SSL), any MO HealthNet Single Streamlined Addition (IM-1ADP), and the Rights and Responsibilities to the FSD WorkSite SharePoint.
If a FAMIS office receives an application for MAGI and one or more other assistance programs, staff will:
- Enter the application in ITrackR;
- Scan the Single Streamlined Application (IM-1SSL), any MO HealthNet Single Streamlined Addition (IM-1ADP), and the Rights and Responsibilities to the FSD WorkSite SharePoint; and
- Enter the non-MAGI assistance program application(s) in FAMIS to process eligibility.
Application Requests by Telephone
If a FAMIS office receives a call from someone who wants to obtain an application for MAGI assistance only, staff will:
- Inform the individual of the methods available for applying for MAGI, including:
- Online at https://mydss.mo.gov;
- By phone at 1-855-373-9994; or
- By completing a paper application
If customers request a paper application, staff will mail the IM-1SSL form including the Rights and Responsibilities, the IM-1ADP with adequate pages for the number of household members, and voter registration information.
DETERMINING IF A CASE OR INDIVIDUAL IS ACTIVE IN MEDES
FAMIS offices will review the EU Action Log (EULOG/FM40) screen to determine the status of a MAGI case. If the EULOG shows closed with the reason "MDS" MO HealthNet Benefits Redetermined, the MAGI case is in MEDES.
FAMIS offices cannot register or approve applications, complete interim changes, or issue benefits in FAMIS for MAGI cases that are closed with reason MDS.
FAMIS offices will review the MO HealthNet Division Title XIX Cross Reference Eligibility Screen (MXIX) field "SYS" for code "MS" to determine if an individual is active in MEDES.
NECESSARY ACTION:
- Review this memorandum with all staff.
- Scan documents needed by the MAGI Processing Centers to the FSD WorkSite SharePoint at http://moteam.state.mo.us/dss03/FSD/WorkSite when scanning instructions are received.
- Send all questions regarding policy through supervisory channels to the appropriate policy liaison for the region on a Request for Interpretation of Policy (IM-14) form. The policy liaison will send it to Program and Policy for interpretation if required.
- Check MXIX "SYS" field for code "MS", active MEDES case, to determine if and individual is active in MEDES. Check EULOG for closing reason MDS to determine if a case is active in MEDES.
AC/cw/jl