MEMORANDUM

DISCUSSION:

Federal regulation 42 CFR Section 435.907 requires a written application signed under penalty of perjury to ensure individuals meet financial and categorical requirements for Medicaid. The application must include facts to support the Family Support Division's (FSD) decision when determining an individual's eligibility for a MO HealthNet program.

It is imperative that staff obtain a signed Request for Application, FA100, or an IM-1BC, Breast or Cervical Cancer Treatment (BCCT) Medical Assistance Application; IM-1MA, Medicaid Application/Eligibility Statement; IM-1MAGW, MO HealthNet/Gateway to Better Health Application/Eligibility Statement; IM-1UA, MO HealthNet for Families, Children, and Pregnant Women; and/or IM-2, Application for Benefits when an individual applies for MHN benefits. When accepting MO HealthNet applications:

• Ensure that the individual completing the form has signed and dated the form in the appropriate sections.
• Review the application form for completeness.
• Maintain a copy of the signed application form in the physical case record.

  NOTE: The Interview Summary (FA102) should also be signed and maintained in the case record if it is completed during an in-person interview.

Documentation of eligibility factors must be maintained in the case file to support the determination of eligibility and the level of care for MO HealthNet benefits. Maintaining documentation of eligibility in the case file and making appropriate entries, including comments supporting entries and the eligibility determination in FAMIS, will reduce instances of improper payment of MO HealthNet benefits.

Eligibility specialists must act on reported/known changes including matches such as the Public Assistance Reporting Information System (PARIS), Beneficiary and Earnings Data Exchange (BENDEX), or SSI/State Data Exchange (SDX), and FAMIS Alerts, Reminders, and Interfaces within ten days of the report or date the change became known. Promptly acting on changes in circumstances will reduce instances of improper payment of MO HealthNet benefits.

When overpayments are discovered, staff should establish claims promptly. Refer to Income Maintenance Manual Section Chapter X, Section V.

NECESSARY ACTION:

• Review this memorandum with all appropriate staff.
• Staff must maintain the case file (electronic and physical record) to support the eligibility determination.
• Act on changes within timeframes.
• Establish claims when appropriate.

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