MEMORANDUM

2013 Memorandums

IM-#86      09/27/13

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
P.O. BOX 2320
JEFFERSON CITY, MISSOURI
TO:
ALL COUNTY OFFICES
FROM:
ALYSON CAMPBELL, DIRECTOR
SUBJECT:
MO HEALTHNET SINGLE STREAMLINED APPLICATION

DISCUSSION:

The purpose of this memorandum is to introduce a new MO HealthNet application for use October 1, 2013. The new application replaces the MO HealthNet application for Kids, Pregnant Women, and Parents (IM-1UA).

This memorandum contains information on the following:

REASON FOR A SINGLE STREAMLINED APPLICATION

The Patient Protection and Affordable Care Act (ACA) requires states to have a single, streamlined application for applicants to have a seamless process when submitting an application for MO HealthNet benefits and/or applying for health insurance through the Federally Facilitated Marketplace (FFM).

The Centers for Medicaid and Medicare Services (CMS) created the single streamlined application template and offered it for use by states. The Family Support Division (FSD) chose to use the single streamlined application provided by CMS with modifications to fit the needs of Missouri.

NEW FAMILY MO HEALTHNET APPLICATION

The new MO HealthNet application is called the MO HealthNet Single Streamlined Application (IM-1SSL) and is used for all of the Family MO HealthNet programs. The last page of the IM-1SSL includes the MO HealthNet Rights and Responsibilities.

WHEN TO USE THE MO HEALTHNET SINGLE STREAMLINED APPLICATION

Use the IM-1SSL beginning October 1, 2013, when individuals are applying for the following Family MO HealthNet programs:

DELIVERY AND ORDERING INFORMATION

All FSD offices will receive an initial supply of the IM-1SSL from the warehouse. FSD offices should order additional copies from the warehouse as needed.

If an FSD office does not receive a supply of the IM-1SSL by October 1, 2013, make copies of the IM-1SSL until applications are received from the warehouse. A copy of the IM-1SSL is located in the online forms manual and is available as an attachment to this memorandum.

Provide IM-1SSL forms to Presumptive Eligibility (PE) providers and community partners when available. PE providers and community partners can also access it at dss.mo.gov.

ACCEPTING IM-1SSL APPLICATIONS OCTOBER 1, 2013 THROUGH DECEMBER 31, 2013

Beginning October 1, 2013, use the IM-1SSL and process the applications in the Family Assistance Management Information System (FAMIS) through December 31, 2013. 

The IM-1SSL is designed to capture information necessary to complete a Family MO HealthNet application as of January 1, 2014. Certain information needed to complete the FAMIS flow for the Children's Health Insurance Program (CHIP) level of care is not captured on the IM-1SSL. Therefore, ES must contact applicants for CHIP by phone or mail to request the following additional information:

If unable to contact by telephone, send a Request for Information (FA-325) to the applicant asking for the information required to complete the eligibility determination. If the applicant fails to provide the requested information, reject the application in FAMIS.

ADDITIONAL QUESTION ON IM-1SSL

An additional question will be added to the next printing of the IM-1SSL that is not on the current IM-1SSL being delivered from the warehouse. The additional question is on page 6 of 7 of the attached application:

3. Are you, or any woman in your household or who you are claiming as a tax dependent between the ages of 18 and 55 in need of family planning services? (Services include birth control, STD screenings, etc.)

□ YES.              □ NO.

If yes, please list individuals: __________________________________

Eligibility specialist (ES) need to ask for each female applicant age 18-55 if they want this coverage. Attempt to contact applicants by phone, and if an applicant does not answer, send a request for contact asking the applicant to call the ES to establish if Uninsured Women's Health Services eligibility must be explored. If the applicant does not respond, register an Uninsured Women's Health Services application and make a determination.

ACCEPTING HEALTHCARE.GOV APPLICATIONS

The ACA's requirement is to allow individuals to apply for MO HealthNet benefits or health insurance through the FFM with a single application. Healthcare.gov offers a similar application to the IM-1SSL. The FSD must accept a Single Streamlined application printed from healthcare.gov.

When receiving a healthcare.gov application:

Requesting the applicant to sign and return the MO HealthNet Rights and Responsibilities page from the IM-1SSL ensures FSD has provided rights and responsibilities to the applicant. The signature of the applicant confirms they have read and understand their rights and responsibilities. File the MO HealthNet Rights and Responsibilities page with the printed healthcare.gov application form.

Do not delay processing the eligibility determination while waiting on the MO HealthNet Rights and Responsibilities page to be returned. If the MO HealthNet Rights and Responsibilities page is not received within ten days, make a clear and concise comment in FAMIS on the Eligibility Unit Member Role (EUMEMROL\FM3Z) screen. The comment must include the date the MO HealthNet Rights and Responsibilities page and the Request for Information (IM-31A) was sent to the participant.

ACCEPTING IM-1UA APPLICATIONS

The IM-1SSL replaces the IM-1UA application form. Staff must discontinue using the IM-1UA. However, FSD offices must continue to accept the IM-1UA if an individual or PE provider submits an application using the IM-1UA until December 31, 2013.

IN-PERSON APPLICATIONS

The IM-1SSL requests information that is not captured in FAMIS or on the IM-1UA. For applications made in person, request the additional information in the IM-1SSL and complete the interview in FAMIS. The sections needing a response on the IM-1SSL are:

Sections

Person 1 Question #

Person 2 Question #

STEP 1

 

 

email address

16

 

STEP 2

 

 

Do you plan to file a federal tax return

6

7

How many babies are expected (if pregnant)

7a

8a

Are you a full-time student

14

17

Were you in foster care at the age of 18 or older

15

15

Employer phone number

19

21

Deductions

29

31

Yearly income

30

32

STEP 3

 

 

American Indian/Alaskan Native family members

1 – if yes complete Appendix b

 

STEP 5

Complete all questions and sign

 

APPENDIX A

Complete if applicable

 

MO HealthNet Rights and Responsibilities

Review and Sign

 

Requesting applicants to sign and return the MO HealthNet Rights and Responsibilities page from the IM-1SSL ensures FSD has provided the rights and responsibilities to the applicants. The signature of the applicant confirms they have read and understand their rights and responsibilities. File the MO HealthNet Rights and Responsibilities page with the application.

IM-1UA DROP OFF APPLICATIONS

For applications brought to a local FSD office when the applicant does not stay for the interview:

NOTE:  From October 1, 2013 through December 31, 2013, do not reject or close a Family MO HealthNet case for failure to provide responses to the additional IM-1SSL sections in the table.

IM-1UA MAIL IN APPLICATION

For applications mailed:

NOTE:  From October 1, 2013 through December 31, 2013, do not reject or close a Family MO HealthNet case for failure to provide responses to the additional IM-1SSL sections in the table.

REJECTED APPLICATIONS FROM OCTOBER 1, 2013 THROUGH DECEMBER 31, 2013

Early in January 2014, MEDES is scheduled to electronically receive the Family MO HealthNet applications rejected in FAMIS and complete a new eligibility determination under the ACA processing rules. Designated processing centers will enter the information from the rejected applications in MEDES. To do this, they must have the information from the signed IM-1SSL.

When an application for MO HealthNet for Families (MHF), MO HealthNet for Kids (MHK), Children's Health Insurance Premium (CHIP), MO HealthNet for Pregnant Women (MPW), and MO HealthNet for Uninsured Women's Health Services (UWHS) taken October 1 or after rejects for any of the FAMIS Rejection/closing codes in the attached table, each office must develop local processes to ensure that following occurs:

Once the Union Processing Center receives the RED file folder, the processing center creates a case record for the IM-1SSL forms.

FORMS MANUAL UPDATE

To Access the IM-1SSL in the Forms Manual from the FSD Intranet page:

MANUAL SECTIONS

Manual sections are forthcoming.

NECESSARY ACTION:

ATTACHMENTS:

AC/jl

2013 Memorandums