MEMORANDUM

DISCUSSION:

Effective April 1, 2016, 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), Show-Me Healthy Babies Program (SMHB), and Uninsured Women's Health Services (UWHS). New poverty income guidelines for Temporary MO HealthNet During Pregnancy (TEMP), Show-Me Health Babies Presumptive Eligibility (SMHB-PE) and Presumptive Eligibility for Kids (PE for Kids) will be provided presumptive eligibility providers by Income Maintenance Program and Policy.

MEDES determinations created on or after April 1, 2016, will use the new FPL income guidelines effective for April 2016. For determinations effective March 2016 and earlier, MEDES will apply the previous FPL income guidelines.

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 from FAMIS due to income, the case must be reviewed for eligibility under the Modified Adjusted Gross Income (MAGI) Methodology.

Active cases with positive outcomes will be adjusted in MEDES based on the new FPL income guidelines and notices sent. 

Active cases identified as needing adverse action will be evaluated by the eligibility specialist, who will need to manually complete the IM-80 process.

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 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 Internet pages Family Healthcare Program Descriptions, MHK/MHF/TA Income Chart, MO HealthNet for Kids, and Do Your Children Need Health Coverage are updated to include the change in FPL income limits.

NECESSARY ACTION:

• Begin using the new federal poverty level income guidelines effective for April 2016 and later.
• Review this memorandum with appropriate staff.

JG/mks