MEMORANDUM

DISCUSSION:

This memorandum introduces the requirement for eligibility specialists (ES) to manually send case action notices to Supplemental Aid to the Blind (SAB) and Blind Pension (BP) applicants and recipients when Family Assistance Management Information System (FAMIS) notices do not provide specific or accurate information to the customer about the reason for a case action.

Automated notices sent by the FAMIS for some SAB and/or BP determinations do not include all necessary information regarding the reason for the determinations.  In these situations, the ES is required to manually send both the Adverse Action Notice (IM-80) and the Notice of Case Action for Adult Medicaid and Cash Assistance (IM-33).

The following require manual notices:

• An applicant for SAB/BP is approved as MHABD non-spend down or spend down, prior to a determination the individual is not eligible for SAB/BP
• An individual receiving SAB/BP is determined no longer visually eligible by the state ophthalmologist
• An individual receiving SAB/BP fails to cooperate
• An individual receiving SAB/BP fails to provide information

  EXAMPLE 1: Mr. A submitted an application for MO HealthNet which stated he is blind and would like to pursue cash assistance for the blind.  He is over age 65 or disabled, eligible on all other factors and is approved for MO HealthNet for the Aged, Blind or Disabled (MHABD) as a non spend down or spend down. His SAB/BP application continues to pend while awaiting the ophthalmologist’s determination.  The state ophthalmologist determines that Mr. A is not visually eligible for SAB or BP. The ES updates the determination on the Ophthalmologist Details (FMJQ/OPTHINFO) screen and completes an eligibility determination (EDRES).  This creates a no change (NOCH) action, but does not create a notice to Mr. A concerning his rejection for SAB and BP. The ES

• Manually creates and sends the IM-33 notifying him the SAB and BP applications were rejected with the correct reason and legal reference on the notice.
• Comments in FAMIS on the FMJQ/OPTHINFO screen and the Eligibility Unit Member Role (FM3Z/EUMEMROL) screens. The comments clearly explain the rejection action date and content of the manual IM-33 sent to Mr. A.
• Scans the IM-33 into SharePoint or the Electronic Content Management System (ECM), whichever is currently in use.

  EXAMPLE 2: Ms. B was approved 5 years ago for SAB or BP. Ms. B cooperated and kept the appointment set for her visual examination. The report was received and the state ophthalmologist determined that Ms. B’s vision has improved significantly and she is no longer visually eligible. The ES:

• Updates the determination on FMJQ/OPTHINFO and completes an EDRES.  FAMIS creates a MO HealthNet Adverse Action Notice (FA420) which advises Ms. B that her SAB or BP is ending, but only states it is due to a change in her circumstances.
• Manually creates and sends the IM-80 to advise the SAB will be closed with the correct reason and legal reference.
• Manually tracks and sends the IM-33 when the IM-80 expires.
• Comments in FAMIS on FMJQ and FM3Z/EUMEMROL to clearly explain the case rejection date and content of the IM-80 and IM-33 sent to Mrs. B.
• Scans the manual forms into SharePoint or the ECM, whichever is currently in use.

  EXAMPLE 3: Ms. C is receiving SAB or BP. She fails to cooperate; she doesn’t provide information, doesn’t contact the FSD to schedule the visual exam or fails to attend the scheduled appointment. The ES:

• Begins closing the case, by entering the date the Request for Information (IM-31A) expires, or the date of the missed visual exam as the rejection date on FMJQ/OPTHINFO and completes an EDRES. This creates notices to Ms. B, but the notices will not give the correct reason for the closing, failure to cooperate.
• Manually creates and sends the IM-80 to advise the SAB will be closed with the correct reason and legal reference.
• Manually tracks and sends the IM-33 when the IM-80 expires.
• Comments in FAMIS on FMJQ/OPTHINFO and FM3Z/EUMEMROL to clearly explain the rejection date and content of the manual form(s) sent.
• Scans the manual forms into SharePoint or ECM, whichever is currently in use in that office.

The reasons for the rejection or closing are:

• The State Ophthalmologist has determined you do not meet the visual eligibility conditions for the Supplemental Aid to the Blind (SAB) and/or Blind Pension programs. RSMo 209.040
• You did not cooperate when you failed to timely take a required action that is necessary for us to determine your eligibility. This includes, but is not limited to, providing information or verification on income, or resources, failing to keep a scheduled appointment, etc. 42 CFR 435.911, RSMo 208.010, RSMo 208.147, RSMo 208.210

  NOTE: When closing or rejecting due to failure to cooperate or provide information, be specific about what the participant failed to do or failed to provide. The example above is given as a starting point; the ES should add an additional sentence which clearly states what the participant did not do or provide.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
• Immediately begin sending manual IM-80 and/or IM-33 to SAB and BP participants who are losing eligibility in one of the situations listed above.
• Scan the manual notices into SharePoint or ECM.
• Enter comments in FAMIS that the manual notices were sent and when.

AC/vb