IM-57  05/29/98  Mail-in Medicaid Applications

Maintaining quality programs through efficient service delivery is one of the primary focuses of the Division of Family Services.  To improve service delivery, we are simplifying the application process for all Medicaid and adult cash assistance programs.  The changes in the application process reduce the burden on staff and consumers while retaining program integrity.  Effective immediately, policy is changed to:
  1. Accept applications through the mail;

  3. Reduce verification requirements; and

  5. Allow interviews to be conducted by phone or waived in some cases.
This policy includes Medical Assistance for Families (MAF), but not Temporary Assistance or Refugee Assistance.

Note:  Due to Work First policy, it is necessary for Temporary Assistance applicants to apply in person.

For mail-outs, the date of application is the date the signed application is received in the DFS office.  When a mail-out application is requested, mail the appropriate forms the same day.  Briefly discuss the applicant's situation and explain the various programs available to determine which type of assistance they are requesting.  It is permissible to explain what information will be needed to process the application.

NOTE:  The changes outlined in this memorandum DO NOT apply to Food Stamp mail-out application procedures and policy.  Continue to interview all Food Stamp applicants.  Follow current verification policy when determining Food Stamp eligibility.

Two cover letters, the IM-3MA and IM-3MC, have been developed to introduce the Medicaid mail-out application.  The cover letters contain:

  • instructions for completing the application;

  • an explanation of the agency's time frames for processing  the application;

  • a list of some of the verification that must be obtained  prior to processing the application; and

  • information currently on the IM-3, IM-50, and IM-2E (Part One).  Do not include these forms in the application packet.

The mail-out packets will vary depending on the type of assistance requested.

Medicaid for Pregnant Women/Medicaid for Children

The Medicaid for Children (MC) and Medicaid for Pregnant Women (MPW) packets should include the IM-3MC, IM-1UA, and a self-addressed return envelope.  The date of application is the date the signed IM-1UA is received in the office, unless it is received from a designated out-station site.  The date of application remains the date received by the out-station facility (including those not staffed with a DFS caseworker).

Designated out-station sites include:

  • Federally Qualified Health Centers,

  • Disproportionate Share Hospitals, and

  • other agencies designated through agreements with the Department.
Medical Assistance for Families

The Medical Assistance for Families (MAF) packet should include the IM-3MC, IM-1, modified IM-2, and a self-addressed envelope.  Enter the name, address, and type of assistance on the IM-1 prior to mailing.  The date of application is the date the signed IM-1 is received in the office.

If, at a later date, the client requests to apply for Temporary Assistance they will be required to come in for a face-to-face interview.  At that time they should sign a new IM-1 and complete an IM-2.  The date of application will be the date of request.  Follow current policy as outlined in IMNL sections 0105.005.00 and 0105.010.00.

Adult Programs

Mail-out packets for the adult Medicaid and cash assistance programs (MA, SAB, BP, QMB, SLMB, GR, SNC) will include the IM-3MA, IM-1, IM-2D, and a self-addressed envelope.  Enter the name, address, and type of assistance requested on the IM-1 prior to mailing.  The date of application is the date the signed IM-1 is received in the office.

NOTE:  This policy DOES NOT replace the existing policy concerning home visit requests.  Home visits may be scheduled if the applicant cannot visit the local office and needs help completing the application.  When making a home visit, the date of request will remain the date of application.  Follow current policy as outlined in IMNL 0105.005.00.


Local office procedures must be implemented to track mail-out requests.  It is only necessary to keep a log of applications being mailed out.  It is not necessary to record when the application is returned to the office.  County offices must keep a record of the number of Medicaid applications received in the mail.  Area offices will be asked to provide a county by county report detailing mail-out procedures and activities.

When an application is received in the mail:

  • Date stamp the application to show date received.

  • Review the application immediately to determine if it is  signed and completed.
    1. If unsigned, it must be returned to the applicant for their signature.  It is not considered an application  and should not be registered until a signature is obtained.

    3. If signed, but incomplete, register the application and contact the applicant.  If the missing information is obtained during a telephone interview, record it on the eligibility statement.  If the applicant cannot be contacted by telephone, make a copy of the application and send to the applicant for completion.
  • Determine if an interview is necessary, or if additional  information is needed from the client.  Send an IM-31A  immediately, requesting verification or completion of any  additional forms (IM-7, IM-12 etc.).

  • Allow the applicant ten days to provide verification or return necessary forms.  If a phone interview is needed, the IM-31A  should also give the client a deadline to contact the caseworker for an interview.

  • Process the mail-in application in the same manner as any other application.

The need for and method of conducting interviews will vary depending on each applicant's situation.  Face-to-face interviews should not be routinely required.  Many applications can be processed without requiring any interview.  If all information is provided, and the client's management is not questionable, the interview may be waived.  If additional information or clarification is needed prior to processing the application, a phone interview may be needed.  If the applicant does not have a telephone or cannot be contacted during normal business hours, an IM-31A must be sent allowing them ten days to contact the caseworker.  If the caseworker determines that a face-to-face interview is needed, an IM-31 must be sent to schedule an appointment.  The case record should be documented to indicate if the interview was waived, or, if a phone or face-to-face interview was completed.

Some applications for the adult Medicaid programs will require additional information and forms.  These may include an IM-60, IM-61, IM-61B, IM-78, spenddown expenses, etc.  It may benefit the caseworker and customer to schedule face-to-face interviews for these applications.  This decision will be left to the discretion of the caseworker.

Medical Support Referrals

There are two acceptable methods of obtaining information for Medicaid-only cases requiring a Medical Support referral to the Division of Child Support Enforcement (DCSE):

  1. View DPAR to determine if the applicant has an open case, for each child, with DCSE.  If so, send an IM-16 to DCSE notifying them when the Medicaid case has been approved.

  3. If there is no open DCSE case, obtain a CSE-201 for each absent parent.
The CSE-201 may be mailed to the applicant or completed by the caseworker during a telephone interview.  If the CSE-201 is completed by telephone interview, a notation should be made in the signature section that information was obtained by telephone and the date of the interview.  If the applicant fails to provide the information to complete the CSE-201, sanction the applicant for non-cooperation.  Send an IM-16 to DCSE to notify them of the sanction, if the children are eligible.

If the applicant has claimed good cause for non-cooperation, the IM-2E (Part Two) must be sent to them with an IM-31A.  The IM-31A should request that the IM-2E (Part Two) be signed and returned along with documentation to substantiate their claim.  Follow current policy in IMNL 0205.070.00 for determination of good cause.


There may be little or no verbal contact with those customers who are applying through the mail.  Thus, the IM-4 pamphlets may be the only means of providing necessary information to the customers.  Include the appropriate IM-4 pamphlets with every approval letter.  These should include, but are not limited to, the IM-4 (hearings), IM-4 (Medicaid and You), Healthy Children and Youth Program, etc.  Refer to IMNL 0105.020.15 for a complete listing of pamphlets to provide to the customer.  If the customer might be eligible for other programs, such as Child Care or Food Stamps, pamphlets for these programs may also be included.

Verification Requirements

Verification requirements for Medicaid and adult cash assistance are changed to allow workers to accept the applicant's statement, unless questionable, for most eligibility factors.  Following is a list of acceptable verification for each eligibility factor.  For those factors not listed below, follow current policy.

  • Residency/Household Composition - Accept the applicant's  statement, unless questionable.

  • Age/Relationship - Verification of age and relationship for all household members born in Missouri should be obtained by viewing IBTH.  It is appropriate to accept the applicant's statement, unless questionable, for anyone born outside Missouri.

  • Social Security Number - Obtain a copy of the Social Security card for all members of the assistance group at the time of initial application whatever possible.  If a card is not available but the number is known, accept the applicant's statement and enter the Social Security number into the SUPD system.  If the number is correct, it will be verified by the system.  It is only necessary to obtain further verification if the system match returns an indicator other than "V".

  • Citizenship/Alien Status - Whenever possible obtain a copy of the IM-94 or other INS document for all aliens in the household.  If documentation is not available but the alien registration number is known, accept the applicant's statement and proceed with the SAVE procedures.

  • Earned Income - Obtaining verification of income is necessary for all Medicaid applications.  Acceptable verification will vary depending on the type of assistance requested.  For MAF, MC and MPW it may be appropriate to accept a single pay stub and the applicant's statement of earnings.  IMES information or  TALX may also be used as verification if the applicant's  employer and earnings in the past quarter are consistent with what is claimed on the Eligibility Statement.  If income is questionable or earnings could cause ineligibility, it will necessary to obtain additional pay stubs or contact the employer for more accurate information.  For Medical Assistance and adult cash programs it is important to use the most accurate information available to determine the correct spenddown amount or grant amount.  It may be necessary to obtain two or more months of income verification for these  applications to ensure payment accuracy.

  • Interest Income - If interest income claimed will not adversely affect the eligibility determination, accept the applicant's statement.

  • Child Care Expenses - It is not necessary to verify child care expenses unless the amount claimed is excessive or there is reason to question the applicant's statement.

  • Collateral Contacts - A collateral contact is not required prior to approval of any Medicaid application.  If information provided by the applicant is questionable, it may be helpful to contact a collateral to clarify the household's situation.  Do not routinely contact a collateral prior to approving Medicaid applications.
Staff are encouraged to take advantage of the mail-in process whenever possible.  County offices should explore working with local hospitals, nursing homes, community centers and other appropriate locations to have packets available at their sites.

An initial supply of the IM-3MA and IM-3MC are being distributed.  We are in the process of combining the IM-1UA and IM-3MC into a single form.  Changes to these forms will also be needed for implementation of the 1115 waiver.  The IM-2D is being revised to eliminate the need for the IM-1 on adult applications.  Additional supplies of the IM-3MA and IM-3MC will not be available prior to revision.  Copies should be made if you deplete your supply.

  • Discuss this memorandum with appropriate staff.

  • Develop and implement local office procedures to track Medicaid mail-out requests.

  • Keep track of the number of Medicaid applications received through the mail.

  • Immediately begin following the procedures outlined in this memorandum to accept Medicaid applications through the mail.
Distribution #2

[ Memorandum Table of Contents ]