- TO:
- ALL INCOME MAINTENANCE OFFICES
- FROM:
- ALYSON CAMPBELL, DIRECTOR
- SUBJECT:
- APPLICATION FOR MO HEALTHNET BENEFITS (IM-1MA), APPENDICES AND INSTRUCTIONS
- FORMS MANUAL REVISION #11
DISCUSSION:
In collaboration with staff and community partners, the Application for MO HealthNet benefits (IM-1MA) form, has been redesigned to make the form easier to understand and complete. This change allows the applicant and/or authorized representatives to provide the Family Support Division (FSD) with appropriate information at the initial application, resulting in fewer requests for additional information, quicker processing and more accurate determinations.
The IM-1MA, Appendices, and Instructions will also be available online to customers through the FSD website in a new fillable format. Fillable forms offer staff typed information for faster processing.
Staff should encourage customers to take advantage of this new option and assist them in completing their applications online. Once competed, help the customer print the application for easy submission.
Included in this memo:
Changes in the IM-1MA
A cover page provides information for the disabled and Spanish-speaking applicants, directing them to the FSD Information Center if they need help in completing the form.
The order of the questions is revised to more closely follow the order of the Family Assistance Management Information System (FAMIS) Controlled Flow. This change allows eligibility specialists (ES) to enter information from the form into FAMIS more quickly.
Section 1, Your Basic Information, asks for the full legal name of the applicant. This change should reduce the number of applicants applying using nicknames, and decrease the number of duplicate Department Client Numbers (DCNs).
Boxes to indicate conditions which may result in the application being processed by specific processing centers are added for staff to easily identify the type of application and promptly route the applications to the appropriate FSD Processing Centers. The boxes also help inform the applicants of the various adult medical programs available.
Section 2, Your household, asks for the date of marriage to reduce the need to request that information while processing applications.
Section 3, Money Available to You, gathers resource information. Questions clarify information needed for trusts and annuities, as well as pre-paid cards such as Direct Express needed for resource eligibility determinations.
Section 4, Your income and expenses, is reworded for clarity, and captures more details regarding income sources such as Veteran’s Assistance (VA) payments. Shelter expense information is captured for use in certain MO HealthNet determinations.
Section 7, Your Insurance, allows the applicant to provide more details regarding insurance types, cash surrender value, and costs.
Section 8, Blind Pension and Supplemental Aid to the Blind, has simplified language and allows the applicant to list an ophthalmologist/optometrist name and address.
NOTE: If medical information is listed on the application, the ES must complete the IM-61D OPTH, unless the ophthalmologist/optometrist information is provided on another Medical Review Team (MRT) form.
The Rights and Responsibilities section is reworded to be easier to understand. An electronic signature explanation and a box to give permission for automated calls are added.
The signature box is highlighted, reducing the likelihood of unsigned applications, and also includes options to indicate if the form has been completed by someone other than the applicant such as the guardian, an attorney, or an authorized representative.
IM-1MA Appendices
To provide applicants with forms needed for the determination as early as possible in the application process, forms appendices were developed including the Medical Review Team (MRT) Packet, a Division of Assets and/or Authorized Representative designations. For individuals requesting an application they will be completing without the assistance of FSD staff, determine which of these documents are needed and provide them with the IM-1MA. Do NOT provide all 3 of the appendices with every request for an IM-1MA. Doing so will result in the applicant completing unnecessary documents, possible confusion as to the program requirements, and increased postage expenses.
Instructions for the Completion of the IM-1MA
Instructions have been created to explain to the applicant what is needed in each section of the application and/or appendices, what sections should be completed based upon the application type, and how to obtain assistance when needed. The instructions include the Confidentiality Statement and should be provided to all applicants for MO HealthNet benefits using an IM-1MA.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Begin using the IM-1MA and Appendices with a revision date of 3/2015 or later immediately. Do not use versions with prior revision dates.
ATTACHMENTS
AC/mah