MEMORANDUM

DISCUSSION:

Pursuant to 42 CFR 435.912(c)3, 435.912(e), applications for MO HealthNet not based upon Modified Adjusted Gross Income (MAGI) requirements must be processed within established time standards. The Family Support Division (FSD) must determine eligibility prior to the expiration of these standards except when a determination cannot be made at that time because the applicant or other necessary person fails to take a required action or when there is an administrative action beyond the Agency’s control.

This memo addresses:

• The appropriate process to request information for a MO HealthNet for the Aged, Blind and Disabled (MHABD) application.
• New rejection standards for MHABD MO HealthNet applications
• Cancel rejection eligibility and process

When there is insufficient information to make an eligibility determination, the Eligibility Specialist (ES) must request the needed information from the participant and the Authorized Representative via an FA-325 or IM-31A, Request for Information. The request must clearly state what the participant needs to provide, including what the participant must provide if a third party fails to respond to the request.

REJECTING AN APPLICATION FOR FAILURE TO COOPERATE OR FAILURE TO PROVIDE VERIFICATION

Effective immediately, for all MHABD MO HealthNet applications, staff must send two Requests for Information prior to rejecting an application for failure to cooperate (COO)/failure to provide verification (VER). This includes any currently pending applications. Further FA325s are not required unless:

• The applicant provided part, but not all, of the information requested on the original FA325 or
• The applicant has provided the information requested but it is insufficient to be used in determining eligibility or
• The applicant has shown a good faith effort in obtaining the information but has requested more time.

In any of these scenarios, a follow up FA325 must be generated. If FAMIS fails to automatically generate the subsequent FA325s, staff must follow the FAMIS User Guide instructions for Editing and Adding Text to the FA325 or complete the IM31A Request for Information. All requests should be clear enough for the participant to determine exactly what is needed or why previously submitted information was insufficient. If the IM31A is used, the Agency copy must be scanned and indexed into the Share Point/ECM Virtual File Room within twenty-four (24) hours of creation.

NOTE: This does not change the requirement to generate an FA325 and a follow up contact if the person fails to provide information when requesting verification of application for Social Security (OASDI) or Supplemental Security Income (SSI).

If the requested information is not provided prior to the expiration of the last request, the application should be rejected after the request expires. Before rejecting the application, the ES must ensure that the information has not been received by checking all appropriate document sources such as ITrackRS and the Virtual File Room (VFR), review EUMEMROL comments for any indication that the participant or Authorized Representative requested more time to provide the information, and must make comments at EUMEMROL supporting the review and decision to reject. The General Information section of the Income Maintenance Manual has been updated to reflect this change.

REQUESTED INFORMATION PROVIDED AFTER REJECTION BUT ON OR BEFORE THE APPLICATION DUE DATE

If the application is rejected for COO or VER and all of the requested information comes in prior to what would have been the final due date of the application (see Timeframe chart below), immediately cancel reject the application and process using the original due date. Do not cancel reject if all of the information is not received prior to the original due date. At this time, FAMIS will only allow cancel rejection for sixty (60) days. If the original application date is outside of this, the ES should reregister the application using the original application date.

Example: Bob Smith applied for MHABD on September 25, 20XX. He is 72 years old. On September 25, 20XX, an FA-325 was generated requesting verification of his self-employment income and expenses. The FA-325 expired on October 5, 20XX. The information was not received. On October 6, 20XX, the ES checked FAMIS to see if a second request went out. It did and expires October 16, 20XX. On October 17, 20XX, the ES reviewed ITrackRS, the VFR and EUMEMROL. No information was received and there were no comments that the participant had requested more time. The ES rejected the application. On October 25, 20XX, the information was received. The ES cancel rejects the application and processes using September 25, 20XX as the application date.

Timeframes for processing MHABD MO HealthNet applications

If all necessary information is not provided by the original due date of the application, no further action is necessary.

Field offices responsible for processing MHABD MO HealthNet applications, in conjunction with the MHABD Program Administrator, should develop procedures to ensure that any cancel rejected applications are processed in accordance with policy.

The appropriate Income Maintenance Manual sections have been updated to reflect this clarification.

NECESSARY ACTION:

• Review this memorandum with all staff that process MHABD MO HealthNet applications.
• Implement the rejection and cancel rejection processes for MHABD applications immediately.
• Field offices must develop a plan to monitor and process the applications within the correct timeframes until FAMIS modifications are complete.

PL/mah