MEMORANDUM

DISCUSSION:

Effective April 1, 2017, 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);
• Uninsured Women's Health Services (UWHS); and
• All Presumptive Eligibility programs
  • Temporary MO HealthNet During Pregnancy (TEMP);
  • Show-Me Health Babies Presumptive Eligibility (SMHB-PE);
  • Presumptive Eligibility for Children (PC); and
  • Presumptive Eligibility for Children (PC); and

NOTE: New poverty income guidelines for Presumptive Eligibility programs will be provided to Qualified Entities by Income Maintenance Program and Policy.

For new applicants or changes in circumstances after April 1, 2017, MEDES will use the new affordability standard effective for April 2017. All CHIP premium cases existing prior to April 1, 2017 will be adjusted in June 2017.

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 MHK/MHF/TA Income Chart 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 2017 and later
• Review this memorandum with appropriate staff.

PL/df