- TO:
- ALL FAMILY SUPPORT DIVISION OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- MO HEALTHNET REQUIREMENT TO APPLY FOR OTHER BENEFITS
DISCUSSION:
The purpose of this memorandum is to remind staff 42 CFR-435.608 requires MO HealthNet applicants and participants, or their representative, to apply for and take all necessary actions to acquire any potential income that may be available from annuities, pensions, retirement and disability benefits to which they may be entitled. This means the applicant/participant must:
- Complete and submit an application for benefits to the appropriate source;
- Provide the benefit source with all the information necessary to determine eligibility;
- Fully cooperate with the benefit source; and
- Request the maximum amount of benefits to which he or she is entitled at the time.
Examples of potential income sources include but are not limited to benefits available from:
- Veterans’ Administration,
- Social Security Administration retirement and disability,
- Railroad Retirement,
- Worker’s Compensation,
- Union funds, and
- Private or public employee benefits.
Individuals must pursue potential income to which they may be entitled at each application and annual review for MO HealthNet benefits, and other times that potential eligibility for other benefits is identified, unless they have:
- An application for benefits pending.
- A denial for benefits being appealed.
- Applied for benefits at one time, were denied, and remain ineligible for the same reason.
- Good cause for not applying.
MO HealthNet applicants/participants must file for benefits payable at the earliest month regardless of the impact on other benefits available from that same income source.
Example: This regulation does not allow an individual who would be eligible for Social Security benefits at the early retirement level to wait to apply for Social Security benefits at full retirement age to obtain a higher benefit. It also does not allow for an individual to apply for Medicare only at age 65 while waiting to apply for retirement benefits at a later to date to obtain a higher benefit.
Staff must notify MO HealthNet applicants/participants who are potentially eligible for other benefits of the:
- Requirement to apply for benefits, and
- Time limit to provide verification of the application.
MO HealthNet applicants/participants may claim good cause for failure to apply for other benefits. When requested verification of application for other benefits is not received, mail an Appointment Letter/Request for Contact (FA-331) to the applicant to determine if good cause exists.
EXAMPLE: The ES has received information the MO HealthNet applicant has major functional limitations, either physical or mental, preventing the individual from applying for benefits by phone, online, or in person, in the foreseeable future, and no one is available to act on the individual’s behalf. The ES with supervisory approval would determine that good cause exists.
NOTE: A separate medical determination is not required. The determination of good cause is based upon information available and the ES’s and supervisor’s judgment.
Good cause is not limited to the reasons in the example. The ES with supervisory approval can determine that the individual has “good cause” for reasons other than those above.
If good cause does exist, approve the application when eligible on all other factors. If the supervisor agrees there is not good cause, reject the application or initiate adverse action procedures to close an active case. Document the basis of the good cause determination in the case record.
If the MO HealthNet applicant is ineligible on another factor, do not delay completing the MO HealthNet eligibility determination for application for other benefits.
Refer to Income Maintenance Manual section 1000.005.00 APPLICATION FOR OTHER BENEFITS.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
AC/ko