MEMORANDUM

DISCUSSION:

Effective April 1, 2015, the Federal Poverty Level (FPL) income guidelines are increased for MO HealthNet for Kids (MHK), Children’s Health Insurance Program (CHIP), MO HealthNet for Pregnant Women (MPW), and Uninsured Women's Health Services (UWHS). New poverty income guidelines for Temporary MO HealthNet During Pregnancy (TEMP) and Presumptive Eligibility for Kids (PE for Kids) were provided to qualified providers and presumptive eligibility providers by Income Maintenance Program and Policy.

NOTE: The income limits for Family MO HealthNet programs in FAMIS remain at the pre Affordable Care Act (ACA) percentages. If contacted by a recipient who has received adverse action due to income, the case must be reviewed for eligibility under the Modified Adjusted Gross Income (MAGI) Methodology.

Active cases with positive outcomes were adjusted in MEDES based on the new FPL income guidelines and notices have been sent. Active cases needing adverse action will receive notice, prior to the reduction in coverage.

For MEDES determinations after April 1, 2015, MEDES uses the new FPL income guidelines effective for April 2015. For determinations effective March 2015 and earlier, MEDES applies the previous FPL income guidelines.

PREMIUM REFUNDS

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to become eligible as a non-premium case. The refund process will take approximately eight (8) weeks to complete.

REQUEST FOR HEARING/CONTINUED BENEFITS

Any household receiving an IM-80 Adverse Action Notice may request a hearing on the adjustment action within 10 days from the date of the notice.

If a household receiving an IM-80 Adverse Action Notice requests a hearing on the adjustment within 10 days of the notice, the household may request benefits continue at the level before the FPL adjustment until the hearing decision is made. Staff should inform the household that if continued benefits are issued and the agency is determined to be correct, a claim will be established for any overpayment.

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

The Family Healthcare Program Descriptions and MHK/MHF/TA Income Chart are updated on the Internet to include the change in FPL income limits. The MO HealthNet for Kids, MO HealthNet for Pregnant Women, MO HealthNet for the Aged, Blind, and Disabled, Uninsured Women's Health Services Program, and Do Your Children Need Health Coverage internet pages have been updated to include the change in FPL income limits.

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines effective for April 2015 and later.
• Review this memorandum with appropriate staff.

AC/mks