1805.000.00 ELIGIBILITY AND VERIFICATION

All Family MO HealthNet applicants/participants must meet and provide information regarding the following eligibility requirements under 13 CSR 40-7.015:

• Resident of Missouri
• Age
• Date of Birth
• Gender
• The Family Relationships of Each Individual Who Resides with the Participant(s)
• Legal Relationships of Each Individual Who Resides with the Participant(s)
• Expected Tax Filing Status and Tax Dependents
• Social Security Number
• Citizenship and Immigrant Status
• Income guidelines based on Modified Adjusted Gross Income (MAGI) Methodology

  NOTE: Refer to Appendix A for the individual Family MO HealthNet program income guidelines which include the five percent (5%) of FPL disregard.

• Cooperation in Pursuit of Medical Support
• Active Insurance Coverage through an Employer or Private Insurer

NOTE: RSMo 208.215 states that MO HealthNet is the payer of last resort.

13 CSR 40-7.040 states the Family Support Division (FSD) must verify all eligibility factors through available means, including information obtained through:

• Electronic data sources;
• An applicant’s/participant’s statement; or
• Other information the FSD has obtained.

Except where the law requires other procedures, the FSD may accept a participant’s statement of information needed to determine the eligibility of an individual for MO HealthNet without requiring further proof from the individual, unless the FSD has information not reasonably compatible with the statement. For additional information, refer to section 1805.030.15 Reasonable Compatibility.

If verification cannot be obtained by the FSD through electronic data sources or if the information is not reasonably compatible with collected information, the FSD must ask for any additional information by sending a Request for Information (IM-31A) to the participant.

The participant must provide the required verification within ten (10) days from the date that the FSD requests the information in writing. A participant may request additional time to provide the information. The additional time shall be granted if the participant is making a reasonable effort to obtain the information.

NOTE: Only one IM-31A is required to be sent.

If a participant fails to provide the requested verification within ten (10) days from the date of the written request or fails to obtain additional time to provide the information, the division must:

• Reject the application; or
• Issue an adverse action notice to the participant notifying them that their coverage will terminate ten (10) days from the date of the adverse action notice.

Comments on the case must support all information requested and additional time granted.

The FSD will only accept an applicant’s/participant’s statement from the following:

• The applicant/participant;
• Adults in the applicant’s household; or
• An appointed authorized representative; or someone legally acting on behalf of the applicant/participant when the applicant/participant is a minor or incapacitated.

  NOTE: Verification of Social Security Number (SSN), Identity, Citizenship, Immigrant status, and Income are required by law.

Comments on the case must support what was used to verify eligibility factors.

1805.000.02 - Federal Hub Calls

Federal Hub Calls (H-calls) are the electronic services provided by the Secretary of Health and Human Services, which States may use to verify or obtain certain information, 42 CFR 435.949.

H-calls are used by the Marketplace and States to obtain information provided by Federal Agencies, Social Security Administration (SSA), the Department of Treasury, the Department of Homeland Security and other data sources.

H-calls lessen the burden of requiring households to provide verification. Because of H-call and other electronic sources, the individual does not have to provide the same verification(s) to multiple agencies.

NOTE: Family Support Division (FSD) must check the electronic data sources to obtain information regarding the individual or household’s circumstances whenever possible.

As conditions of eligibility, all individuals seeking MO HealthNet (MHN) must provide and verify their Social Security Number, Citizenship and Immigration Status. H-calls should be used instead of requesting the individual to provide the documentation. H-calls can provide the following information:

• Income Information
• Social Security Number Verification
• Citizenship Verification
• Immigration Status Verification
• Medicare Information

Individuals must not be required to provide additional information or documentation unless electronic data sources cannot provide the information required to determine eligibility. When information received from H-calls or other electronic data source cannot be used to determine eligibility, clarification should be requested. Clarification should be requested when:

• Self-attested income is not reasonably compatible with electronic data sources.

  NOTE: MAGI Policy manual section 1805.030.15 Reasonable Compatibility explains how to treat income that is not compatible.

• Self-attested non-financial information is inconsistent with electronic data sources.

  EXAMPLE: Xavier attested that he is a lawful permanent resident and has been in the United States legally for over five years. The H-call for citizenship returned conflicting information; it showed that Xavier has only been in the United States for three years. Xavier must have been in the United States legally for five years to receive MHN benefits. An IM-31A Request for Information is sent to Xavier requesting he provide clarifying documentation regarding his immigration status.

In the event that H-call services are down and not working, or an error or no response is received, and other electronic data sources cannot provide the information, request the individual provide the required information.

1805.000.05 - Reasonable Opportunity

Reasonable opportunity applies to the 90 day period participants are given to provide:

• Citizenship verification or proof of qualified immigrant status
• Social Security Number

  NOTE: Section 6036 of the Deficit Reduction Act of 2005 (DRA) states that when documentation of citizenship includes proof of identity, the application may be approved pending documentation of citizenship even when proof of identity has not been provided. Do not provide a reasonable opportunity period for verification of identity only.

Section 1902(a) of the Social Security Act requires individuals to apply for and provide a Social Security Number (SSN) as a condition of eligibility for MO HealthNet. See 1805.015.00 SOCIAL SECURITY NUMBER for exceptions.

Allow reasonable opportunity for persons requesting benefits who do not have citizenship documents/proof of qualified immigrant status or a SSN at the time of application.

Reasonable opportunity for SSN is only allowed when proof of application for a SSN is provided. Reasonable opportunity for SSN is not given if:

• Proof/documentation of applying for a SSN is not provided; or

  NOTE: If the application for SSN is for employment authorization only, they may receive the RO period.

• The person already has a SSN, but refuses to provide it to FSD.

When an applicant does not already have a SSN at the time of the Family MO HealthNet application:

1. Send the participant a Request for Information to provide proof of application for SSN. Self-attestation of application for a SSN is not acceptable; documentation must be provided.

NOTE: Under 42 CFR 435.910, FSD staff must assist applicants in obtaining a SSN. Refer to 1805.015.00 SOCIAL SECURITY NUMBER for more information.

2. When proof of application for a SSN is received, and all other eligibility criteria are met, approve the Family MO HealthNet application. Do not deny or delay the approval pending the issuance of a SSN once the application for SSN has been verified.
3. Allow a 90 day reasonable opportunity period for the participant to provide his or her SSN.

NOTE: The 90 day reasonable opportunity period begins the day the MO Health Net application is approved.

4. Close coverage for individuals who fail to provide a SSN by the end of the 90 day reasonable opportunity period, (see manual section 1805.015.05 Failure to Complete a SSN Application or Furnish a SSN).

Example: Ms. Jones states on her Family MO HealthNet application that she does not have a SSN. A Request for Information notice is sent to Ms. Jones to request proof of application for a SSN. Ms. Jones submits verification that she has filed for a SSN. She is eligible on all other factors and is approved for coverage. She is given a 90 day reasonable opportunity period to provide the SSN.

Section 6036 of the DRA requires individuals claiming U.S. citizenship or qualified immigrant status to provide satisfactory documentary evidence of citizenship or nationality when applying for MO HealthNet. Refer to MAGI Manual section 1805.020.05.05 Documents to Verify Citizenship for information on acceptable citizenship documentation. Refer to MAGI Manual section 1805.020.10 Qualified Immigrant for information on persons with qualified immigrant status.

Applicants for Family MO HealthNet must declare under penalty of perjury that they are citizens or qualified immigrants on a document that explains the penalties under state law for obtaining public assistance benefits fraudulently. The signed application serves as this declaration. RSMo. 208.009 states that an applicant who cannot provide proof of citizenship or qualified immigrant status at the time of application may be given a reasonable opportunity to provide the information if:
• The signed application contains the individual’s Social Security Number or any applicable federal identification number; or
• FSD receives a signed statement of attestation to either United States citizenship or classification by the United States as an alien lawfully admitted for permanent residence which contains the individual’s Social Security Number or any applicable federal identification number.

NOTE: Social Security Numbers issued to non-citizens are allowable since the individual may have qualified immigrant status. If a participant provides a SSN, but does NOT claim citizenship or qualified immigrant status, do NOT pend the application for citizenship/qualified immigrant status and do NOT provide a 90 day reasonable opportunity period.

An applicant who has provided a sworn statement of citizenship or qualified immigrant status, and provided a Social Security number (or provided proof of application for a SSN), or applicable federal identification number is eligible to receive MO HealthNet for Families program coverage as follows:
• For ninety (90) days or until such time that it is determined that the applicant is not lawfully present in the United States, whichever is earlier; or
• Indefinitely if the applicant provides a copy of a completed application for a birth certificate that is pending in Missouri or some other state. An extension of the reasonable opportunity period for a birth certificate ends when FSD receives a copy of the applicant's birth certificate or a determination that a birth certificate does not exist because the applicant is not a United States citizen.

NOTE: When waiting on a birth certificate, staff must still review the case in ninety (90) days and then provide 30 day extensions of the reasonable opportunity period as needed.

When an applicant does not provide a SSN, other federal identification number, or citizenship documents/proof of qualified immigrant status at the time of the Family MO HealthNet application:

1. Send the participant a Request for Information to provide the SSN (or proof of application for a SSN), applicable federal identification number, and citizenship verification documents/proof of qualified immigrant status.

NOTE: Self-attestation of SSN or applicable federal identification number is acceptable to provide the reasonable opportunity period. If an applicant declares citizenship status, but does not have a SSN or citizenship documentation, FSD must assist the participant in applying for a SSN (see 1805.015.00 SOCIAL SECURITY NUMBER). If the participant is submitting a birth certificate, they must provide verification that they have applied for it in order to receive reasonable opportunity.

2. When the SSN/proof of application for a SSN or applicable federal identification number is received, or the participant has submitted proof they have ordered a birth certificate, and all other eligibility criteria are met, approve the Family MO HealthNet application. Do not deny or delay the approval pending the citizenship/proof of qualified immigrant status documents.
3. Allow a 90 day reasonable opportunity period for the participant to provide his or her citizenship documents/proof of qualified immigrant status or birth certificate.

Example: Ms. Jones applies for Family MO HealthNet coverage as a qualified immigrant, but does not include a SSN or applicable federal identification number on her application. A Request for Information notice is sent to Ms. Jones to request SSN, applicable federal identification number, and qualified immigrant documents. Ms. Jones submits her alien identification number, but not her supporting documents. She is eligible on all other factors and is approved for coverage. She is given a 90 day reasonable opportunity period to provide the qualified immigrant documents.

NOTE: The 90 day reasonable opportunity period begins the day the MO Health Net application is approved. If proof of application for SSN is received, staff may approve the application and provide a 90 day reasonable opportunity period for both citizenship and SSN concurrently.

4. Close coverage for individuals who fail to provide citizenship or qualified immigrant documents by the end of the reasonable opportunity period.

NOTE: The reasonable opportunity period may be extended beyond the 90 day period if a participant is making a good faith effort to provide verification of citizenship or qualified immigration status.

If documentation has not been provided within 90 days:

• Send an Adverse Action Notice (IM-80) to discontinue MO HealthNet coverage for all members for whom citizenship documentation has not been provided, and
• Once the Adverse Action Notice (IM-80) expires, discontinue coverage for all participants for whom documentation of citizenship or qualified immigrant has not been provided.

If the participant responds before the expiration of the Adverse Action Notice, but does not have citizenship documentation or proof of qualified immigrant status:

• Determine whether the participant is making a good faith effort to provide documentation.
• If the participant is making a good faith effort to provide documentation, staff may provide a 30 day extension of the reasonable opportunity period with supervisor approval. If the participant is continuing to make a good faith effort, but more time is required, staff will need to submit a Request for Interpretation of Policy (IM-14) with supporting documents through proper supervisory channels. Staff should follow-up on good faith efforts until FSD receives the requested information or a determination that the documentation does not exist because the applicant is not a United States citizen or qualified immigrant.
• If the participant is not making a good faith effort to provide documentation, discontinue MO HealthNet coverage for all members for whom citizenship documentation or proof of qualified immigrant status has not been provided once the Adverse Action Notice (IM-80) expires.

EXAMPLE: Ms. Jenkins did not provide documentation of qualified immigrant status when she applied for Family MO HealthNet. She supplied her applicable federal identification number, was found eligible on all other factors, was approved for coverage, and was given 90 days to provide verification of qualified immigrant status on 8/10/2016. The 90 reasonable opportunity period ends in November 2016.

Ms. Jenkins fails to provide documentation of qualified immigrant status by November. The Eligibility Specialist sends Ms. Jenkins an Adverse Action Notice (IM-80) to discontinue MO HealthNet coverage. Before the expiration of the Adverse Action Notice, Ms. Jenkins provides a letter from the United States Citizenship and Immigration Services (USCIS) explaining the paperwork delay. The Eligibility Specialist, with supervisor approval, voids the adverse action, and sends a new Request for Information providing Ms. Jenkins with a 30 day extension of the reasonable opportunity period.

Approval notices for Family MO HealthNet benefits approved with a reasonable period must state that the participant’s continued eligibility is contingent on the provision of SSN or verification of citizenship/qualified immigrant status.>

1805.000.05.05 Reapplication After 90-Day Reasonable Opportunity

IM-#13, February 1, 2017

An individual may reapply for MAGI coverage after being closed for not providing citizenship documents and/or Social Security Number (SSN) within the 90 day reasonable opportunity period. However, the individual cannot receive an additional 90 day reasonable opportunity period after coverage has closed for failure to provide citizenship/SSN information.

NOTE:  It is important to note that while a participant must provide documentation of citizenship or immigrant status, he or she only needs to provide FSD with the Social Security Number, NOT a copy of the Social Security card.

If coverage ended after the 90 day reasonable opportunity period because the individual failed to provide citizenship and/or SSN information, do not authorize another 90 day reasonable opportunity period.  The applicant is given a Request for Information allowing the applicant ten days to provide the information.  If the information is not provided the application is rejected.

Example: On 07/23/2016, Ms. Smith's application was approved with 90 day reasonable opportunity.  She must provide citizenship documentation for herself and her three children.  Ms. Smith fails to provide the passports or any other citizenship documentation within 90 days and does not contact FSD claiming a good faith effort in submitting the information. An Adverse Action notice is sent, and when it expires, the MAGI case closes and an Action Notice is sent to Ms. Smith. On 12/23/16, Ms. Smith reapplies for herself and her three children. Again, Ms. Smith does not provide verification of citizenship for herself or her children. Ms. Smith is given the Request for Information allowing her 10 days to provide citizenship documentation.  Ms. Smith fails to provide verification of citizenship at the end of the 10 day period and therefore, her application rejects.

1805.005.00 RESIDENT OF MISSOURI

IM-#97, November 9, 2015, IM-#125, December 31, 2013

42 CFR subsection 435.403 requires individuals to reside in the state where they are applying for benefits. The residence requirement is verified through self-attestation.

1805.010.00 AGE AND DATE OF BIRTH

IM-#97, November 9, 2015, IM-#125, December 31, 2013

A participant’s statement of an individual’s age, date of birth, and household size is acceptable verification.

1805.015.00 SOCIAL SECURITY NUMBER

IM-#47, May 12, 2017,IM-#13, February 1, 2017, IM-#97, November 9, 2015

Section 1902(a) of the Social Security Act requires individuals to apply for and provide a Social Security Number (SSN) as a condition of eligibility for MO HealthNet.

Note: This requirement applies only to those persons requesting or receiving MO HealthNet benefits. It does not apply to parents or children included in the household who are not requesting benefits.

Obtain a SSN for all individuals including children under one requesting benefits at the time of the initial application whenever possible. Accept self-attestation for verification of SSN.

EXCEPTION: An exception may be given to applicants who do not have, or do not agree to apply for, a SSN due to a well-established religious belief. A well-established religious belief means that the applicant is a member of and abides by the belief of the religious organization. Self-attestation is accepted unless it is questionable.

If an individual has a SSN but does not know it, provide a Request for Information (IM-31A) and allow ten days to provide the SSN.

Note:When an individual attests to having a SSN but fails to provide it to FSD, the individual should be rejected after the IM-31A Request for Information expires. Do not allow Reasonable Opportunity (RO) in this situation.

If the individual does not have a SSN, s/he must agree to apply for a number at the Social Security Administration (SSA) Office. FSD will assist the individual in making an application for SSN.

• Provide the applicant with the Social Security Administration Application for a Social Security Card (SS-5) form. The SS-5 form can be found on the Social Security (SS) website at www.socialsecurity.gov. The form can be completed online and printed or printed and completed by hand.

Note: FSD should assist in completing the SS-5 and mailing it to the SSA Office whenever necessary. The applying individual MUST sign the SS-5 prior to being submitted to the SSA Office.

Note: Whenever the completed SS-5 form is mailed to the SSA Office by FSD on behalf of the individual applying for a SSN, provide the individual with a copy of the completed SS-5 prior to mailing it to the SSA Office.

Note: Inform the individual the SSA Office requires, and may request from them, original documents (i.e. birth certificate, marriage certificate, etc.) when making application for a SSN.

• The completed and signed form must be either mailed or brought into the nearest SSA Office.

Note:To find local Social Security Office for the individual applying for a SSN go to the Social Security website and utilize the Social Security Office Locator tool. Use this tool when determining which office to direct the individual or to mail the SS-5 for the individual.

Enter a comment providing details on how the FSD assisted with the application for SSN, when the SSN application was made, etc.

Allow reasonable opportunity for persons requesting benefits who do not have a SSN. Refer to manual section 1805.000.05 Reasonable Opportunity.

Note: The application for SSN from the Social Security Administration office must be received prior to allowing the 90 day Reasonable Opportunity period. Providing the individual with the SS-5 does not meet the requirement for proof of application for SSN, nor does a SS-5 completed by the individual. The individual must provide proof that they have made application through the Social Security Administration Office.

Missouri Rule 13 CSR 40-2.260 provides that Newborns born to women with active Title XIX coverage at the time of the baby’s birth continue to be eligible for Newborn coverage up to age one whether or not they have a SSN on file with FSD.

Note: Review MAGI Manual 1860.010.00 Eligibility for a list of MHN Programs that are Title XIX.

Within 60 days of Newborns (babies born to women actively receiving Title XIX coverage on the baby’s date of birth) turning one year old, a review of their coverage will be completed. Any missing case information, along with SSN, should be obtained at that time.

Note: The 90 day Reasonable Opportunity (RO) period does not apply to Newborns during their first year of life when born to women born with Title XIX coverage at the baby’s birth. These babies are automatically eligible from the date of birth until their first birthday regardless if the FSD has been provided with the baby’s SSN.

When FSD has not been provided with the Newborn’s SSN by the baby’s first birthday, send an IM-31A requesting the SSN. If the SSN is not provided, the baby cannot continue to receive any MO HealthNet programs after the first birthday.

If application for a SSN has been made for the Newborn, but the participant has not yet received the SSN by the baby’s first birthday, give the participant the 90 day RO period to supply the number.

Applications for children under age 1 (MHK under 1) whose mother was not active Title XIX coverage on the baby’s date of birth are not automatically eligible for Newborn coverage during the first year of life. Request the baby’s SSN by sending the IM-31A when processing the application for MHK under 1.

Note: The 90 day RO period may be allowed if the application for the baby’s SSN has been made but not received by the family. Request proof of the application for the baby’s SSN by sending the IM-31A. Once proof is provided, allow the 90 day RO period.

Refer to MAGI Manual section, 1805.000.05 Reasonable Opportunity.

 

1805.015.05 Failure to Complete a SSN Application or Furnish a SSN

IM-#97, November 9, 2015

Individuals failing to complete an application for a SSN or failing to provide an existing SSN are not eligible for MO HealthNet. Include their needs and income in the budget when determining eligibility for the remaining members.

When processing applications which include individuals who have not applied for a SSN or who have not provided an existing number:

1. At application, provide a Request for Information (IM-31A) form allowing 10 days to apply for a SSN or provide the SSN.

   EXCEPTIONS: Newborn children who are automatically MO HealthNet eligible may receive for one year without providing verification of a social security number.

2. When some members have complied with the IM-31A, while others have not applied for or provided a SSN by the 30th day following application:
   1. Approve eligible members of the household that have complied with the SSN requirement.
   2. Notify the household of approval of compliant individuals and denial of the individual/s who failed to comply with the SSN requirements.
3. If the non-compliant individual is the only eligible child or if all members of the household do not comply, deny the application by the 30th day and notify the household.

   NOTE: If there is non-compliant individual is the only child in the home, the caretakers do not qualify for MO HealthNet for Families (MHF).

Individuals denied due to failure to apply for, or disclose an existing SSN must verify they have complied to be eligible. Individuals who were denied can become eligible no earlier than the first day of the prior quarter preceding the date they comply.

Determine cooperation on this factor at each review.

1805.020.00 CITIZENSHIP AND IMMIGRANT STATUS

IM-#13, February 1, 2017, IM-#97, November 9, 2015

Section 6036 of the Deficit Reduction Act of 2005 amended section 1903 of the Social Security Act to require states to obtain satisfactory documentation of citizenship and identity prior to approving MO HealthNet benefits, effective July 1, 2006.

Individuals exempt from providing documentation of citizenship and identity are listed in Section 1805.020.05.

Section 1805.020.15 lists acceptable documents to use as verification.

Section 211 of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) signed February 4, 2009, amended section 1903(x) of the Social Security Act. The law allows an individual declaring to be a citizen or national of the United States who is required to present documentary evidence of citizenship or nationality a reasonable opportunity to present the documentation. The reasonable opportunity period is defined as 90 days from the date of approval. Refer to section 1805.000.05 Reasonable Opportunity for more information.

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 changed eligibility for individuals who are not citizens of the United States. MO HealthNet eligibility for immigrants is based on:

• The immigrant’s status as qualified or non-qualified; and
• The immigrant’s date of entry into the United States.

1805.020.05 Citizenship

IM-#97, November 9, 2015

Effective July 1, 2006, states must obtain documents establishing citizenship and identity for new applicants and participants for all categories of MO HealthNet. Individuals are exempt from the requirement when he or she receives at least one of the following:

• Supplemental Security Income (SSI);
• Medicare;
• Social Security Disability Insurance (SSDI); or
• Old Age Survivors Disability Insurance (OASDI) benefits based upon their own disability.

  NOTE: For immigrants from Micronesia, Palau, and the Marshall Islands, refer to Section 1805.020.10.30

1805.020.05.05 Documents to Verify Citizenship

IM-#32 April 23, 2018, IM-#147 November 27, 2017, IM-#70 June 15, 2017, IM-#94 December 28, 2016

42 CFR §435.407 and §436.407 describe the documents needed to verify citizenship and identity.

NOTE:  As of January 20, 2017, a photocopy, facsimile, scanned or other copy of a document must be accepted to the same extent as an original document under this section, unless information on the copy submitted is inconsistent with other information available to the agency or the agency otherwise has reason to question the validity of, or the information in, the document.

Acceptable forms of documentation that verify both citizenship and identity are:

• U.S. passport,
• Certificate of Naturalization (N-550 or N-570), and
• Certificate of Citizenship (N-560 or N-561).
• A valid State-issued driver's license as follows:
• Missouri Driver's License Inquiry (MODL) system where the Detail Identification Inquiry screen (upper right side) indicates that the person is a verified U.S. citizen.

NOTE: MODL cannot be used to verify relationships as it does not capture coding details for why a name has been changed.

• For driver’s licenses/state ID’s from states other than Missouri, the license is proof of citizenship and identity when the State issuing the license requires:
• proof of U.S. citizenship before issuance of such license, or
• obtains and verifies the Social Security Number (SSN) from the applicant.

Staff will need to check with the issuing state to verify the state’s process.

• A data match with the Social Security Administration.  Using the State Verification and Exchange System (SVES), SSA will compare an individual's name, SSN, and citizenship declaration with data in its Master File of SSN Holders.

  NOTE: A verified SSN is NOT a verification of citizenship. Citizenship may be verified through a Bendex, SDX or IIVE alien indicator. Refer to the CITIZENSHIP DOCUMENT ENTRY FOR APPLICATIONS guide in MEDES Resources for more information.

• Documentary evidence issued by a Federally recognized Indian Tribe identified in the Federal Register by the Bureau of Indian Affairs within the U.S. Department of the Interior, and including Tribes located in a State that has an international border, which –
  • Identifies the Federally recognized Indian Tribe that issued the document;
  • Identifies the individual by name; and
  • Confirms the individual's membership, enrollment, or affiliation with the Tribe.

  NOTE:  The documents listed above may include, but are not limited to:

  • A Tribal enrollment card;
  • American Indian Card ( I-872)
  • A Certificate of Degree of Indian Blood;
  • A Tribal census document;
  • Documents on Tribal letterhead, issued under the signature of the appropriate Tribal official, that meet the requirements of paragraph (a)(5)(i) of this section.
• Section 1903(x) of the Social Security Act states that individuals who are eligible for MO HealthNet or CHIP as "deemed newborns" are considered to have provided satisfactory documentation of citizenship and identity (by virtue of being born in the United States) and will not be required to further document citizenship or nationality at any subsequent MO HealthNet or CHIP eligibility determination or redetermination.

  NOTE:  In Missouri, LOC of "G" (newborn coverage) on the MXIX screen verifies this factor.

If one of the above forms is not available, you must obtain one of the following documents to verify citizenship and a second source to verify identity.  The following documents may be used to identify citizenship for MAGI programs:

• A U.S. public birth certificate showing birth in one of the 50 States, the District of Columbia, Guam, American Samoa, Swain's Island, Puerto Rico (if born on or after January 13, 1941), the Virgin Islands of the U.S. or the CNMI (if born after November 4, 1986, (CNMI local time))

  NOTE:  Evidence of birth in Puerto Rico and the applicant's statement that he or she was residing in the U.S., a U.S. possession, or Puerto Rico on January 13, 1941 is acceptable.

• IBTH if born in Missouri,

  NOTE:  Do NOT print IBTH screens or file in the case record

• Certification of Birth (DS-1350),
• Consular Report of Birth (FS-240),
• Certificate of Birth Abroad (FS-545),
• U.S. Citizen ID Card (I-197 or I-179),
• Northern Marianas Identification (NMI) card (I-873),
• Final adoption decree,
• Evidence of U.S. Civil Service employment before June 1, 1976,
• U.S. Military Record showing a U.S. place of birth,
• A data match with the SAVE Program or any other process established by DHS to verify that an individual is a natural born, naturalized or derived citizen.

  NOTE: MEDES verifies a participant’s citizenship and immigration status by:

  1. Sending a request to the Hub (Federal Data Services Hub) to verify citizenship or immigration status.
  2. If additional verification is needed, the Hub will automatically submit additional data to SAVE requesting DHS verify the status of the case. No action is taken by the ES to verify status.
  3. If citizenship cannot be established, the ES will need to take appropriate action to gather citizenship and immigration documentation for the participant by following the steps outlined in the Verify Lawful Presence guide in MEDES Resources.

• Hospital record on hospital letterhead,
  • Note: For children under 5, must be at or near time of birth
• Statement signed by physician or midwife present at time of birth,
• Medical (clinic, doctor, or hospital) records that created at least five years before application.
• Life or health insurance record showing a U.S. place of birth created at least five years prior to application,
• Official religious record recorded in the U.S. showing that the birth occurred in the U.S.
• School records, including pre-school, Head Start and daycare, showing the child's name and U.S. place of birth.
• Federal or State census record showing U.S. citizenship or a U.S. place of birth.
• U.S. State Vital Statistics official notification of birth registration,
• Institutional admission papers created at least five years prior to application date that includes a U.S. place of birth,
• If the applicant does not have one of the citizenship documents listed above, he or she may submit an affidavit signed by another individual under penalty of perjury who can reasonably attest to the applicant's citizenship, and that contains the applicant's name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized.

FSD must accept the following as proof of identity for MAGI cases, provided such document has a photograph or other identifying information sufficient to establish identity, including, but not limited to, name, age, sex, race, height, weight, eye color, or address:

• Driver's license issued by the State or U.S. Territory,
• School identification card,
• U.S. military card or draft card with photograph,
• Identification card issued by the Federal, State, or Local government,
• Military dependent's identification card
• U.S. Coast Guard Merchant Mariner card
• For children under age 19, a clinic, doctor, hospital, or school record, including preschool or day care records.
• For children newborn up to but not including age 16, identity can be verified by the signature of a parent/related caretaker/legal guardian on the application or reinvestigation forms. This signature is considered an affidavit to the child's identity.

  NOTE: Do not request verification of identity again when the child turns 16 years old as long as there is continuous eligibility for that child and there is the prior affidavit signature of the parent/related caretaker/legal guardian.

• A finding of identity from the following FSD programs as defined in section 1902(e)(13)(F) of the Social Security Act:
  • Food Stamps
  • Temporary Assistance for Needy Families
  • Any MO HealthNet program
• A finding of identity from specific public agencies and Indian Tribes and Tribal organizations such as:
  • The Head Start Act
  • The Richard B. Russell National School Lunch Act
  • The Child Nutrition Act of 1966
  • The Child Care and Development Block Grant Act of 1990
  • The Stewart B. McKinney Homeless Assistance Act
  • The United States Housing Act of 1937
  • The Native American Housing Assistance and Self-Determination Act of 1996
  • The Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization
• Two other documents containing consistent information that corroborates an applicant's identity. Such documents include, but are not limited to, employer identification cards; high school, high school equivalency and college diplomas; marriage certificates; divorce decrees; and property deeds or titles.
• FSD may accept as proof of identity for MAGI programs a finding of identity from a Federal agency or another State agency, including but not limited to a law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual.
• If the applicant does not have any document specified above, the agency must accept an affidavit signed, under penalty of perjury, by a person other than the applicant who can reasonably attest to the applicant's identity. Such statements must contain the applicant's name and other identifying information establishing identity including but not limited to, name, age, sex, race, height, weight, eye color, or address. The affidavit does not have to be notarized.

FSD may rely, without further documentation of citizenship or identity, on a verification of citizenship made by a Federal agency or another State agency, if such verification was done on or after July 1, 2006.

FSD must provide assistance to individuals who need assistance in securing satisfactory documentary evidence of citizenship in a timely manner.  If the individual is unable to obtain documentation listed above for either citizenship or identity, contact the MHN Program and Policy Unit for further assistance.

1805.020.10 Qualified Immigrant

IM-#97, November 9, 2015

A qualified immigrant is one who is:

• A lawful permanent resident under the Immigration and Nationality Act (INA);
• A refugee (207 of INA);
• An asylee (208 of INA);
• An immigrant who has had deportation or removal withheld under 243(h) of (INA) or 241(b)(3);
• An immigrant granted parole for at least one year by the INS under 212(d)(5) of INA;
• An immigrant granted conditional entry under 203(a)(7) of immigration law in effect before April 1, 1980;
• An immigrant granted status as a Cuban or Haitian entrant (as defined in section 501(e) of the Refugee Education Assistance Act of 1980);
• A battered immigrant, as defined by P.L. 104-208;
• An American Indian born in Canada, if s/he is at least one-half American Indian blood;
• An Amerasian Immigrant; or
• Trafficking Victim, as defined by the Trafficking Victims Act of 2000.

1805.020.10.05 Qualified Immigrants Entering Prior To 8/22/96

IM-#97, November 9, 2015

All qualified immigrants who were in the U.S. PRIOR to August 22, 1996, and who otherwise meet MO HealthNet eligibility criteria, are eligible.

1805.020.10.10 Qualified Immigrants Entering After 8/22/96

IM-#97, November 9, 2015

Qualified immigrants entering the U.S. ON OR AFTER August 22, 1996, may be eligible for MO HealthNet immediately, or may be subject to a five-year period of ineligibility.

1805.020.10.10.05 Qualified Immigrants with No Waiting Period

IM-#97, November 9, 2015

Qualified immigrants entering the U.S. on or after August 22, 1996 who are members of one of the groups listed below have no waiting period:

• American Indians born in Canada;
• Amerasian Immigrant;
• Asylees under 208 of INA;
• Cubans and Haitian entrants defined in Section 501(e) of the Refugee Education Assistance Act of 1980;
• Immigrants for whom deportation or removal has been withheld under either 243(h) or 214(b)(3) of the INA;
• Iraqi and Afghan Special Immigrants;
• Refugees under 207 of INA; or
• Trafficking Victim, as defined by the Trafficking Victims Act of 2000;
  • Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR) has been delegated the authority to conduct certifications for victims for trafficking. To receive a certification, a victim of trafficking must be willing to assist with the investigation and prosecution of trafficking cases AND either (1) have made a bona fide application for a T visa OR (2) be an individual whose continued presence the Attorney General is ensuring to effectuate a trafficking prosecution.
  • When a victim of trafficking applies for benefits, record the “entry date” which is considered the certification date. Record the expiration dates of the certification/eligibility letter for children.
  • Redeterminations of eligibility as a victim of trafficking must be completed when the certification/eligibility letter expires.
  • Victims of trafficking may not possess standard identity documents, such as driver's licenses or social security cards. Do not automatically deny the applications but call the Trafficking Verification line at (202) 401-5510 for assistance.

1805.020.10.10.10 Qualified Immigrants with a Five-Year Period of Ineligibility

IM-#97, November 9, 2015

Qualified immigrants entering the U.S. on or after August 22, 1996 who are not eligible for MO HealthNet for five years following their date of entry are listed below. Once the five-year period of ineligibility has expired, these qualified immigrants who otherwise meet MO HealthNet eligibility criteria can receive MO HealthNet:

• Lawful Permanent Resident;
• An immigrant granted parole for at least one year by the INS under 212(d)(5) of INA;
• An immigrant granted conditional entry under 203(a)(7) of INA in effect before April 1,1980;
• A battered immigrant, as defined by P.L. 104-208 is an immigrant:
  • Who has been battered or subjected to extreme cruelty in the U.S. by a spouse or parent; or a member of the spouse of parent's family residing in the same household as the immigrant if the spouse or parent consented to, or acquiesced in, such battery or cruelty;
  • Whose child has been subjected to same by a spouse or a parent or the immigrant (without the active participation of the alien), or by a member of the spouse or parents family residing in the same household if the spouse or parent consented to, or acquiesced in, such battery or cruelty; or
  • Child who resides in the same household as a parent who has been battered or subjected to extreme cruelty in the U.S. by that parent s spouse or by a member of the spouse s family residing in the same household as the parent and the spouse consented or acquiesced to such battery or cruelty, but only if there is substantial connection between such battery or cruelty and the need for benefits to be provided.

EXCEPTION: The five-year ineligibility period DOES NOT APPLY to the immigrants listed above if they are:

• On active duty in the U.S. Armed Forces;
• A veteran of the U.S. Armed Forces;
• The spouse or dependent child of a veteran or active duty U. S. Armed Forces personnel (A dependent child is an unmarried child under age 18 or a child claimed as a dependent on the active duty person's or veteran's income tax form.); or
• The unmarried surviving spouse of a veteran.

NOTE: Qualified immigrants subject to the five-year period of ineligibility may be eligible for emergency medical care for ineligible immigrants, see Income Maintenance Manual section 1700.000.00 Emergency MO HealthNet Care for Ineligible Aliens (EMCIA)

1805.020.10.15 Non-Qualified Immigrants

IM-#97, November 9, 2015

Non-qualified immigrants are ineligible for MO HealthNet benefits.

NOTE: Non-qualified immigrants may be eligible for emergency medical care for ineligible immigrants, see Income Maintenance Manual section 1700.000.00 Emergency MO HealthNet Care for Ineligible Aliens (EMCIA).

1805.020.10.20 Immigrants from Micronesia, Palau, and Marshall Islands

Immigrants from Micronesia, Palau and the Marshall Islands have signed a Compact of Free Association with the United States, which allows them to enter and leave the U.S. at will. These individuals are not eligible to receive MO HealthNet benefits unless they apply for immigrant status with the United States Citizenship and Immigration Service (USCIS - formerly Immigration and Naturalization Service) and are given a qualified immigrant status. Immigrants with a qualified status may be eligible for MO HealthNet benefits if all eligibility criteria are met.

1805.020.15 Documentation and Verification of Alien or Immigrant Status

IM-#32 April 23, 2018, IM-#47, July 18, 2016, IM-#97, November 9, 2015

All non-citizen applicants for MO HealthNet who declare they are qualified immigrants must provide Department of Homeland Security (DHS) documents to establish immigration status.

If the applicant provides the requested documentation, verify the documentation with the DHS using the SAVE System.

   NOTE: MEDES verifies a participant’s citizenship and immigration status by:

1. Sending a request to the Hub (Federal Data Services Hub) to verify citizenship or immigration status.
2. If additional verification is needed, the Hub will automatically submit additional data to SAVE requesting DHS verify the status of the case. No action is taken by the ES to verify status.
3. If citizenship cannot be established, the ES will need to take appropriate action to gather citizenship and immigration documentation for the participant by following the steps outlined in the Verify Lawful Presence guide in MEDES Resources

EXCEPTION: The DHS SAVE system does not contain information about victims of severe forms of trafficking. Until further notice, do not contact SAVE concerning these individuals. See Income Maintenance Manual section 1510.020.00 for more information on victims of trafficking.

If the applicant presents an expired DHS document or is unable to present any documentation of his or her immigration status, refer the person to the local DHS District Office to obtain evidence of status unless he or she can provide an immigrant registration number.

If the applicant provides documentation with an immigrant registration number, use the VLP Scan and Upload process to send documentation to the DHS to verify immigration status. DHS will determine the authenticity of the document and determine whether immigration status is met. If the applicant presents verification he or she has applied to DHS for a replacement document, contact the DHS to verify status by using the SAVE System.

When verification of qualified immigrant status is not available through paper documentation when Step 3 is triggered, and the individual meets all other eligibility requirements, approve the MO HealthNet application based on the applicant’s statement. A period of 90 days from the date of approval is allowed as a reasonable opportunity to provide documentary evidence for individuals stating they are lawfully present in the United States and:

• Have been lawfully present for at least five years, or
• Meet an exception to the five year period of ineligibility.

See Income Maintenance Manual sections 1805.020.10.10.05 and 1805.020.10.10.10 for policy on the five year ineligibility period and exceptions to the five year period of ineligibility.

If requested verification is not provided within 90 days, close the applicant’s benefits by manually sending a Notice of Adverse Action (IM-80) using the code CTV- failed to provide citizenship/alien documentation. At the end of the IM-80 period, manually send a Case Action Notice (IM-33C) using the CTV code and send an e-mail to the Cole.MHNPolicy@dss.mo.gov for a Program Development Specialist (PDS) to enter an override to end the individuals MO HealthNet benefit.

Each office must manually track the 90 day reasonable opportunity period using the same method offices use today for tracking citizenship reasonable opportunity periods.

Acceptable documentation of qualified immigrant status:

Immigration Status	Verification Document (Department of Homeland Security (DHS) U.S. Citizenship and Immigration Services (USCIS) forms unless otherwise noted. Access the Systematic Alien Verification for Entitlements (SAVE) database to verify USCIS documents.)
Lawful Permanent Resident (LPR)	USCIS Form I-551 (Permanent Resident Card or Alien Registration Receipt Card (Form I-551 also known as a green card) Temporary I-551 stamp in a foreign passport or on Form I-94 for recent arrivals or immigrants who have applied for a replacement I-551
Refugees	U.S Customs and Border Protection (CBP) electronic I-94 that can be obtained by the participant at www.cbp.gov/I94; and   U.S Department of State's Transportation Boarding Letter with CBP date stamp noting the person has been admitted as a refugee under section 207. NOTE:  Newly arriving refugees (as of 8/7/15) are required to provide the Department of Homeland Security electronic I-94 form and the Transportation Boarding letter with a date stamp showing entry as a refugee. A paper USCIS Form I-94 for refugees arriving to the U.S. prior to the use of the electronic format, indicating the person has been admitted as a refugee under section 207. USCIS Form I-766 (Employment Authorization Document) annotated "Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole" USCIS Form I-571 (Refugee Travel Document) NOTE: Refugees usually adjust to Lawful Permanent Resident LPR status after 12 months in the U.S., but are still considered refugees for eligibility purposes. Review the coding on the I-551 for codes RE-6, RE-7, RE-8, or RE-9.
Asylee	USCIS Form I-94 annotated with stamp showing grant of asylum under 208 of the INA Grant letter from the Asylum Office of the INS Form I-766 annotated "Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole", with an eligible status code of A05
Afghan Special Immigrants	Refer to Documentation for Special Immigrants chart
Iraqi Special Immigrants	Refer to Documentation for Special Immigrants chart
Immigrant with Deportation or Removal Withheld	Order of an Immigration Judge showing deportation withheld under 243(h) or 241(b)(3) of the INA and date of the grant; Form I-766 annotated "Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole"
Immigrant Granted Parole for at Least One Year	Form I-94 annotated with stamp showing grant of parole under 212(d)(5) of the INA and a date showing granting of parole for at least one year
Immigrant Granted Conditional Entry	Form I-94 with stamp showing admission under 203(a)(7) of the INA, refugee-conditional entry; Form I-766 annotated "Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole"
Cubans and Haitians	Form I-94 annotated parole into the U.S. on or after April 21, 1980 or parole at any time as a "Cuban/Haitian Entrant (status pending)" NOTE: The stamp may also include variations of the following (usually handwritten) notations, and may also be stamped in an individual's passport: Public interest or Lottery To file I-589 Pending final asylum hearing Exclusion proceeding Pending removal hearing CM or CMPP – Cuban parolee processed under medical professional program CP – Cuban Parolee processed under special migration program USCIS Form I-551 with the code CU6, CH6, HA6, or HB6; Cuban or Haitian passport with a 212(d)(5) stamp dated after October 10, 1980; DHS Form I-221; DHS Form I-862; DHS Form I-220A; DHS I-122; DHS Form I-221S; Copy of DHS Form I-589 date stamped by the Executive Office for Immigration Review (EOIR); Copy of DHS Form I-485 date stamped by EOIR; or EOIR-26;Other applications for relief that have been date stamped by EOIR; or Other documentation pertaining to an applicant's removal, exclusion or deportation proceedings; USCIS Form I-766 with an eligible status code C08, C10 or C11; DHS receipt for filing Form I-589 (Application for Asylum and Withhold of Removal). U.S. Visa (with the subheading "Not a Visa" and annotation of "Special Parole for noncurrent Haitian IV Beneficiaries" and USCIS Form I-94 stamped "Parole" with the written code of HF/HPI. NOTE: Persons admitted on B2 visas are not qualified immigrants, or lawfully residing in the U.S. under section 214 of CHIPRA and are not eligible for benefits as a Cuban/Haitian Entrant.
Battered Immigrant	Contact Income Maintenance (IM) Program and Policy for Further Instructions. EXCEPTION: The battered immigrant will not be a qualified immigrant during any period in which the individual responsible for such battery or cruelty resides in the same household as the individual subjected to such battery or cruelty.
American Indian born in Canada (Cross-border Native American)	Birth or baptismal certificate issued on a reservation; Tribal records; Letter from the Canadian Department of Indian Affairs; or School records NOTE: This does not include a spouse or child of such Indian, or a non-citizen whose membership in an Indian tribe or family is created by adoption unless such person is of at least fifty percent (50%) or more Indian by descent
Amerasian Immigrant	USCIS Form I-551 coded AM6, AM7, or AM8 Unexpired temporary I-551 stamp in foreign passport or on Form I-94 with the code AM1, AM2, or AM3
Trafficking Victim	Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR) original certification letter or eligibility letter for children. Verify the letter by calling Trafficking Verification (202) 401-5510 and notify ORR of the benefits for which the individual has applied. Trafficking victims are not required to provide any additional documentation of their identity or immigration status.
U.S. Military Veteran	Original or notarized copy of Department of Defense DD Form 214 Separation Document showing at least 2 years of active duty service and honorable discharge. A character of discharge "Under Honorable Conditions" is not an "Honorable" discharge for these purposes. NOTE: If the applicant cannot provide the DD-214, send a signed authorization requesting a copy of the DD-214 to the Military Personnel Record Center, 9700 Page, St. Louis, MO 63132.
U.S. Military Active Duty Personnel (Army, Air Force, Marine Corp, or Coast Guard)	Current military ID card (DD Form 2 (Active)) that lists an expiration date of more than one year from the date of issue. If the card will expire within one year, use a copy of his/her military order to document active duty status. A member of a reserve component shall establish active duty status by showing a current DD Form 2 (Reserve){red} and military active duty orders showing such persons is on active duty, but NOT on active duty for training. No other method of verifying this status is currently available. NOTE: If the individual is unable to furnish either of the above, active duty may be verified through the nearest RAPD (Real Time Automated Personnel Identification System) located at many military installations or by requesting verification in writing (which can be transmitted by facsimile) from the DEERS Support Office: DEERS Support Office ATTN: Research and Analysis 400 Gigling Road Seaside, California 93944-6771 FAX Number: (408)655-8317
Spouse, Unmarried Surviving Spouse ,or Child of a Veteran or Active Duty Armed Forces Military	Unexpired Uniformed Services Identification and Privilege Card DD1173 showing the individual is married to a veteran or active duty member, the individual is a non-married surviving spouse a child is dependent on the veteran or active duty member of the Armed Forces for his/her support and is under the age of eighteen (18) or if a full-time student, under age twenty-two (22). NOTE: If the Military ID Card is unavailable or further documentation is needed, refer the individual to the Veterans Administration (VA) regional office.

1805.025.00 PREGNANCY

IM-#97, November 9, 2015

A participant’s statement of pregnancy is acceptable verification of pregnancy and estimated due date, unless the agency has information that is not reasonably compatible with the participant’s statement.

1805.030.00 MODIFIED ADJUSTED GROSS INCOME (MAGI) METHODOLOGY

IM-#97, November 9, 2015

The Patient Protection and Affordable Care Act (PPACA or ACA), effective January 1, 2014, introduced the Modified Adjusted Gross Income (MAGI) methodology. MAGI is a methodology for determining MO HealthNet eligibility based on federal income tax filing rules for income and family size.

These income eligibility rules will apply to all participants eligible for the following MO HealthNet programs:

• MO HealthNet for Families (MHF),
• MO HealthNet for Kids (MHK),
• MO HealthNet for Newborns (NBN),
• Children’s Health Insurance Program (CHIP),
• MO HealthNet for Pregnant Women (MPW),
• Extended Women’s Health Services (EWHS), and
• Uninsured Women’s Health Services (UWHS).

  NOTE: The Patient Protection and Affordable Care Act (PPACA or ACA) does not change MO HealthNet eligibility rules for participants who are 65 years of age or older or those in eligibility categories based on disability.

1805.030.05 Income Evidence

IM-#96 July 13, 2017, IM-#17 February 21, 2017, IM-#97, November 9, 2015

Income is verified by self-attestation. Self-attested income that is countable within the MAGI budget must be confirmed, see 1805.030.20.05 Income Included Under MAGI.

Confirmation of Self-Attested Income

Electronic data source income information should be used first to confirm the income whenever possible.

For self-attested income to be considered confirmed, the income should meet criteria in one of the following bullets.  Apply the following order when confirming income.

1. Self-attested income and the electronic data source income are reasonably compatible, see 1805.030.15 Reasonable Compatibility; OR
2. If the self-attested income is not reasonably compatible, the individual should provide a clarifying statement that reasonably explains the difference between self-attested income and the electronic data source income information; OR
3. When the income is not reasonably compatible and a reasonable explanation is not given, income documentation should be requested.

Electronic Data Sources

If information is available from the electronic data sources the agency must obtain the electronic data information before attempting to confirm the income any other way (i.e. clarifying statement, or income documentation).

Available electronic data sources must be used in the following order prior to requesting clarification or income documentation from the individual.

1. The Federal Data Hub (Federal level information from the IRS.),

   NOTE:  The individual must give the FSD permission to access the Federal Data Hub.  This is usually done on the filer consent when the individual signs the paper application or when the individual submits an online application.  The permission is given to the FSD to access Federal Data Hub information for a period of time, 0 to 5 years, as determined by the individual.

   NOTE:  IRS information received from the Federal Data Hub cannot be printed, saved or stored.  The information can only be viewed.

2. The Work Number  (State level information from Equifax.),

NOTE: When determining current and ongoing eligibility, the Work Number is used as an electronic data source. If the self-attested amount is not Reasonably Compatible (RC) with the electronic data sources (including The Work Number), clarification of income should be requested.

When determining eligibility in Prior Quarter (PQ) months, information provided by The Work Number can be used as income verification.

3. IMES or IIVE  (Provides state level information from DOLIR.),
4. Quarterly Wage Matches/New Hire Matches (State level information from DOLIR.), and

   NOTE: New Hire Matches and Quarterly Wage Matches can only be used as income verification if the participant has reported the source of income, and the information is reasonably compatible.

5. Income verified for any other FSD program within the last twelve (12) months.

Store the electronic data source income information (excluding IRS information) in the Virtual File Room.

Requesting Income documentation:

When the electronic data source and reasonable statement request fails, it is appropriate to requested income documentation. Only request documentation of self-attested income when:

• The electronic data source information is insufficient and cannot be used to confirm self-attested income; OR
• The electronic data source returns an error and cannot be used to confirm self-attested income; OR
• The electronic data source information is inconsistent with the self-attested income or the income is not reasonably compatible.
  
  AND
• The individual fails to provide a statement that reasonably explains the difference between the self-attested income and the electronic data source income information; OR
• The individual's explanation of the difference between the self-attested income and the electronic data source income information is not considered a reasonable explanation.

Request the previous 30 days of pay history. If the previous 30 days does not accurately reflect a projection of ongoing income request further pay history to accurately project income.  See MAGI Policy Manual, 1805.030.25.05 Projection of Income.

NOTE:  Pay history from the past 30 days may not accurately reflect a projection of ongoing income when the individual is a seasonal worker, income includes overtime, the individual was on leave without pay, the individual started or stopped a job, etc.

Employer or Income Source Discrepancies

If the individual has not reported an employer or income source, and the electronic data source has information of an employer or income source, contact the participant for clarification.

When self-attestation of an employer or income source is different than what is received from the electronic data source or different from information in our records, determine if the sources and income are compatible. 

NOTE:  If our records indicate a different employer/income source than what is self-attested, do not request verification that the income source in our records has ended unless it is questionable or not compatible.  End the income source in our records based on self-attestation.

The sources are considered compatible when; income from both meets the guidelines for Reasonable Compatibility, and the employer or income sources are similar.  If the sources and income are compatible accept self-attestation, if they are not compatible request clarification.

EXAMPLE:  James reports he works at Wal-Mart and earns $8.25 per hour and works 32 hours per week.  James' self-attested income would be equal to $1,143.65 per month (32 x 2 = 64 x $8.25 = $528.00 x 2.166 = $1,143.65/month).  With James' income and household size he falls within MHK category of 148% of the FPL.  The electronic data source income shows James is employed at Target and earns $900 per month, which is within the MHK category as well.  The income sources and income amounts are similar therefore no further information is needed.

Zero Income

Income of individuals or households attesting zero income must be confirmed.  Treat self-attestation of no income the same as self-attestation of income.

When zero income is attested and:

• The electronic data source income shows zero income.
  • The income is reasonably compatible, not further clarification is needed.
• The electronic data source shows income.
  • Request a clarification that reasonably explains the difference between attested income and the electronic data source income.

When income is attested and:

• The electronic data source shows zero or no income.
  • Request a clarification that reasonably explains the difference between the attested income and the electronic data source income.

1805.030.10 MAGI Household Composition

IM-#75, June 20, 2017, IM-#97, November 9, 2015

Modified Adjusted Gross Income (MAGI) methodology uses federal tax filing status to determine the household composition. Individuals on the same case or application may have different household compositions than other individuals in their household.

It must be first be determined if the individual expects to file taxes or expects to be claimed as a dependent before applying tax filer rules or non-filer rules. Self-attestation is accepted for tax filing status/tax filing relationships.

NOTE: When the tax filing status is unknown or questionable, send an IM-31A to request clarification of the expected tax filing status and tax relationships. If the individual fails to provide the requested clarification, reject/close the case/application for Failure to Cooperate.

Tax filer rules apply if the individual intends to file a federal income tax return or be claimed as a dependent on a federal income tax return for the year coverage is requested;. When the individual attests to being a filer or a dependent on a federal tax return, apply tax filer rules even when the individual is not required to file, and regardless of whether the tax return is actually filed.

Non-filer rules apply when the individual does not plan to file a federal income tax return and does not expect to be claimed as a tax dependent on a federal income tax return for the year coverage is requested.

Tax dependents are normally part of the tax-filer’s household with some exceptions: refer to manual section, 1805.030.10.20 Exceptions to MAGI Household Composition.

1805.030.10.05 Legal Basis

IM-#97, November 9, 2015

Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA or ACA) of March 2010 requires household composition to be determined using Modified Adjusted Gross Income (MAGI) methodologies per 42 CFR 435.603 (f).

1805.030.10.10 MAGI Household Composition for Tax Filers

IM-#44, May 11, 2017IM-#97, November 9, 2015

For tax filing households, the tax filer and individuals to be claimed as dependents on a taxpayer’s federal income tax return are included when determining household size, (with some exceptions).

The household for a tax filer consists of the following individuals:

• The tax filer;
• The tax filer’s spouse if living together; and
• All of the tax filer’s dependents (a tax dependent can be a person of any age), which may include:
  • Children and siblings including step-children, and
  • Children over age 19 (when claimed as dependents).

The household of the tax dependent is the same as the tax filer’s household; unless the tax dependent meets one of the exceptions in 1805.030.10.20 Exceptions to MAGI Household Composition. When a tax dependent meets an exception, non-tax filer rules apply.

Exception: For Family MO HealthNet programs, a “Child” or “Children” means a person or persons who are under nineteen (19) years of age” under 13 CSR 40-7.010(B). Therefore, the parents of a person under age 19 must be included in the household composition and the parents’ income is counted even if the child claims he is a non-dependent tax filer. These individuals fall under non-filer rules because they are children who are not claimed as tax dependents.

• Example: Mary is age 18 and she applies for MO HealthNet for Pregnant Women (MPW). She is working part-time and lives with her parents and younger brother. She states that she is a tax filer and that her parents do not claim her as a tax dependent. Mary is under age 19, but does not claim to be a tax dependent, so her household falls under non-filer rules. Her household must include her parents, her younger brother, and her unborn child.
• Example: Linda is age 18 and she applies for MO HealthNet for Pregnant Women (MPW). She is married to Bob and they have a son, Larry, who is 6 months old. Linda lives with her parents, her spouse, and her son. Bob is working part-time. Linda states that she and Bob are joint tax filers who claim Larry as a tax dependent. Linda is under age 19, but does not claim to be a tax dependent, so her household falls under non-filer rules. Her household must include her spouse, her son, her unborn child, and her parents.

1805.030.10.15 MAGI Household Composition for Non-Tax Filers

IM-#97, November 9, 2015

Household composition based on non-tax filer rules includes family members who live with the individual. Non-tax filer households include the following:

• The individual requesting coverage;
• The spouse of the individual requesting coverage;
• Children and step-children of the individual requesting coverage; and
• For individuals who are children:
  • The individual’s parents, and
  • Any siblings and stepsiblings, who are dependent children (children under the age of 19).

1805.030.10.20 Exceptions to MAGI Household Composition

IM-#97, November 9, 2015

Apply non-tax filer rules if the individual meets any of the following exceptions:

• The individual expects to be claimed as a tax dependent of someone other than a spouse or a biological, adopted or stepparent.
• The individual is a child under age 19 living with both parents, but will be claimed as a tax dependent by only one parent.
• The individual is a child under age 19 who expects to be claimed by a non-custodial parent.

EXAMPLE ONE: Mom and Dad, not married, both over age 19, live together, and have a child (age 3). Mom and Dad each file taxes separately. Dad claims their child as his tax dependent. The MAGI households for each applicant would be as follows:

• Dad is a tax filer. He is not married to Mom. Dad is claiming the child as his dependent.
  • Dad is a MAGI household of 2 (Dad and Child).
  • Dad receives MHF if he and the child meet all eligibility factors.
• Child is not expected to file a tax return. Child will be claimed as a tax dependent by Dad.
  • Child meets the exception: “The individual is a child under age 19 living with both parents, but will be claimed as a tax dependent by only one parent.” Non-tax filer rules apply to the child.
  • Child is a MAGI household of three (Child, Dad and Mom).
  • Child receives MHF if he/she meets all eligibility factors.
• Mom is filing taxes, she is not claiming dependents nor does she expect to be claimed as a dependent herself. Mom is not married to Dad.
  • Mom is a MAGI household of one (Mom only) using tax filer rules.
  • Mom meets the definition of caretaker relative as she has care of the child.
  • Mom receives MHF if she and her child meet all eligibility factors.

EXAMPLE TWO: Mom and Dad, not married, both over age 19, live together, and have a child (age 3). Mom is a non-tax filer and Dad is a tax filer. Dad claims their child as his tax dependent. The MAGI households for each applicant would be as follows:

• The MAGI households for Dad and Child are the same as in Example One. Dad is filing taxes. He is not married to Mom. Dad is claiming the child as his dependent.
  • Dad is a MAGI household of 2 (Dad and Child).
  • Dad receives MHF if he and the child meet all eligibility factors.
• Mom is not a tax filer and does not expect to be claimed as a tax dependent. Mom is not married to Dad.
  • Using non-tax filer rules, Mom is a MAGI household of 2 (Mom and Child).
  • Mom meets the definition of caretaker relative as she has care of the child
  • Mom receives MHF if she and her child meet all eligibility factors.

EXAMPLE THREE: Grandmother and two granddaughters (both under age 19 and sisters) live together. Grandmother is a non-tax filer. The households for each applicant would be as follows:

• The granddaughters are not tax filers and do not expect to be claimed as tax dependents by anyone.
  • Using non-tax filer rules, the granddaughters are a MAGI household of 2 (grandmother is not counted).
  • The granddaughters would have potential eligibility for MHK if they meet all other eligibility factors.
• Grandmother is not a tax filer and does not expect to be claimed as a tax dependent.
  • Using non-tax filing rules, Grandmother is a MAGI household of 1.
  • Grandmother is a non-parent caretaker who receives MHF if she and at least one of the granddaughters meet all eligibility factors.

1805.030.10.20.05 JOINT CUSTODY

IM# 120 September 11, 2017, IM# 45 May 12, 2017IM# 82 December 6, 2016

True joint 50/50 custody occurs when the child(ren) spend an equal number of overnight visits with each parent. Per Missouri Rule 13 CSR 40-7.010 the non-custodial parent is defined as the parent who does not have physical custody of the child.

The parent with whom the child spends more than 50% of their overnight visits with is considered to be the parent exercising the majority of the child’s care and control and therefore is the custodial parent regardless of tax filing status.

NOTE: 42 CFR 435.4 provides that parents must reside in the home of the eligible child(ren) in order for the parent to be eligible for MAGI MO HealthNet for Families (MHF).

NOTE: Parents who claim the child(ren) as a tax dependent but do not practice true 50/50 joint custody (they have the child(ren) less than 50% of the time) are not eligible for MHF due to ineligible living arrangements.

EXAMPLE:  John and Linda have a divorce decree stating they have joint physical custody of their child, Lauren. John claims Lauren as a tax dependent on his taxes. Linda applied for benefits on Lauren. Linda states she has Lauren more than 50% of the time. Linda provided a revised parenting plan, signed by John and Linda, which states Lauren stays with Linda 4 nights per week. Lauren is physically with Linda more than she is with John, therefore Linda may apply for benefits for Lauren.

The custodial parent must carry health care coverage for the child. The custodial parent is the parent that applies for MO HealthNet (MHN) benefits.

EXAMPLE:  Mom and dad exercise true 50/50 joint custody, dad claims the child as a tax dependent each year and must carry coverage for the child. Mom is a tax filer but does not claim any dependents and does not have any other household members. Mom applies for MHF coverage on herself and reports the child in her home 50% of the time. Mom does not qualify for MHF because she is the non-custodial parent. The mom's household size is one: herself. The child's household size is two: the child and dad.

If the custodial parent is in question, follow the steps below to determine which parent is considered the custodial parent for the purpose of making a MHN application.

1. Determine which parent intends to claim the child(ren) as a tax dependent.
   • When the custodial parent cannot be determined by the tax filing status continue to step 2 of this section.
2. Review court orders, legally binding separation orders, divorce decrees, parenting plans, and/or custody agreements to determine which parent is the custodial parent.
   • If the custodial parent cannot be determined by steps 1 or 2 of this section, continue to step 3.
3. Determine which parent the child(ren) expects to spend more overnight visits with during the period for which eligibility is being determined.

   NOTE: It may be necessary to count the overnight stays with each parent to determine where the child is more often.

   • When the custodial parent cannot be determined by steps 1, 2 or 3, continue to step 4 of this section.
4. When steps 1-3 of this section do not determine who the custodial parent is, the first parent to apply for MHN benefits is considered the custodial parent for the purpose of the MHN application.

   NOTE: It may be necessary to count the overnight stays with each parent to determine where the child is more often.

   • If step 4 does not solve who the custodial parent is, move to step 5.
5. Determine which parent has the higher MAGI (Modified Adjusted Gross Income), The parent with the higher MAGI is considered the custodial parent for MHN purposes and is the parent that can apply/receive MHN benefits on behalf of the child(ren).If both parents are tax filers, and true 50/50 joint custody is practiced, count the child in the household of the parent with the higher adjusted gross income.

   NOTE: If the parents alternate each year claiming the children as part of their tax filing household, the non-custodial parent is considered the parent who does not plan to claim the child as a tax dependent for the period MHN benefits are being requested. The parents must alternate years they each apply for MHN for the child.

Refer to the Household Composition Flow Chart to help determine household composition.




1805.030.10.25 Caretakers Relatives

IM-65, June 14, 2017  IM-#, November 4, 2016

Caretaker relatives are an exception to the MAGI Household Composition.  Caretaker relatives can make application for a dependent child and themselves if the caretaker relative is assuming primary responsibility of the child.  The caretaker relative must meet income guidelines for MHN.

Claiming the child as a tax dependent can demonstrate an assumption of primary responsibility, however it is not the sole determining factor.  A caretaker relative must live in the same household as the dependent child, assume primary responsibility, and be related to the dependent child.

NOTE: The caretaker relative assuming primary responsibility of the child does not have to be claiming the child as a tax dependent.

A caretaker relative relationship can be defined as the child's parent, or as:

• Any blood relative including those of half-blood and including first cousins, first cousins of parents, nephews, or nieces.
• Relationships to persons of preceding generations as denoted by prefixes of grand, great, or great-great.
• Relationship to a person through marriage such as stepfather, stepmother, stepbrother, and stepsister.
• A relationship to a person through legally adopting a child or adopting the parent of a child, and other relatives by adoption that meets the criteria established for blood relatives.

  NOTE: Caretaker relatives by marriage are still to be included even if the marriage has been terminated, either by death or divorce. The caretaker relative must be assuming primary responsibility for the dependent child as defined above.

  EXAMPLE:  Jon lives with, and is the uncle to, Gavin, age 10.  Jon is the caretaker relative to Gavin.  Jon is not a tax filer and Gavin is not expected to be claimed as a tax dependent by anyone else.  Jon applies for MHN for himself and Gavin.  Jon's MAGI household size is 1 for himself and Gavin's MAGI household is 1 for himself.  Non-tax filer rules apply for the dependent child.

The tax filer of the dependent child may reside in the same home as the caretaker relative and the dependent child, when the tax dependent child is an in-common child of the tax filer and the caretaker relative. 

EXAMPLE:  Melissa applied for MHN for herself and her two children. She lives with the father of her children but she is not married to the father. The father claims the children as tax dependents. Melissa does not work and does not file taxes. Melissa’s household would follow non-tax filer rules. She would be eligible for MHF as a household size of 3 (herself and two children), if all other eligible criteria are met. The children’s household size is four: the two children, the mother and the father.

Client's statement is acceptable when a person is claiming to be a caretaker relative of a child.  If the situation is questionable or if the tax filer disputes the caretaker relative's statement, request further documentation.

1805.030.15 Reasonable Compatibility

IM-#39 March 15, 2019, IM-#96 July 13, 2017, IM-46 May, 12, 2017, IM-7 January, 27, 2017, IM-#97, November 9, 2015

Reasonable Compatibility (RC) is defined as the allowable difference between the self-attested income and the income reported by the Electronic Data Sources (EOI).

RC is used to confirm the self-attestation of income. When the self-attested income is not RC with the EOI further clarification is required from the individual to substantiate the self-attested income.

NOTE: RC’s primary purpose is to determine if further clarification should be requested from the individual. When the income is not RC, the EOI returns no response or an error, or when the self-attested/EOI information is questionable; further clarification should be requested.

Income is considered RC when:

1. 1. • Both the self-attested income and the EOI fall within the same MO HealthNet program eligibility threshold.

OR

1. 1. • The self-attested income is below the MO HealthNet program eligibility threshold and EOI falls in a different MHN program category above the threshold, but the EOI is within 10% or less of the self-attested income.

NOTE:  The eligibility determination is based on the self-attested income.  Neither RC nor the EOI are used to make an eligibility determination.

Income is NOT considered RC when:

• The self-attested income is above the MO HealthNet program eligibility threshold and EOI falls in a different MHN program category below the threshold.

NOTE: Whether the difference is within 10% or not, income is not considered RC and additional verification will need to be requested.

Whenever there is a Change in Circumstance (CIC) that affects the budget, RC should be applied to determine if further clarification is needed from the individual. RC should be applied in the following situations, as appropriate:

1. 1. • Application
      • Annual Renewal
      • Ex-parte Review
      • Add/Remove a Person
      • Marriage/Divorce
      • Income Change

When self-attestation of the employer, or the income source, is different than what is received from the EOI, determine if the sources are compatible. The sources are considered compatible when:

1. 1. • income from both sources fall within the same MHN category or
      • the self-attested income is below the threshold and the EOI amount is above the threshold but is within 10% of the self-attested amount, and

If the employers/income sources are compatible accept self-attestation for the income source.

NOTE:  If our records indicate a different employer/income source than what is self-attested, and the employers/income sources are compatible, do not request verification that the income source in our records has ended.  It is appropriate to accept self-attestation in this situation.

Paystubs are considered the individual's self-attestation and the verification of income. Paystubs trump the information returned by an EOI when there are discrepancies. Use the pay stubs as verified income evidence.

EXAMPLE:  Sue provided her weekly pay stubs for the past 4 weeks with her application. Her pay stubs are used as Sue's attestation and verification of her income. With Sue's pay stubs/self-attestation, Sue's income is below the eligibility threshold for MHK (148% of FPL). The EOI shows income above the eligibility threshold for MHK and more than 10% difference from the pay stubs.

Outcome: Based on her self-attestation, Sue is MHK eligible. RC does not need to be explored as the pay stubs are considered verified and reflect information more recent than the EOI.

When pay stubs are provided, RC does not need to be completed.

Explore RC with all available EOI before requesting additional information/clarification from the individual.

Applying Reasonable Compatibility

To determine if the income is RC gather the following information:

1. 1. • household size,
      • MO HealthNet program's income threshold for the household size,
      • self-attested income, and
      • electronic data source income.

The MO HealthNet program thresholds are grouped together as listed below.

1. 1. • MHF – MHF income limit for household size
      • MPW – 196% of the FPL
      • Children under the age of 1 – 196% of the FPL
      • MHK for children age 1 to age 18 – 148% of the FPL
      • CHIP 71/72 – 150% of the FPL
      • CHIP 73 – 185% of the FPL
      • CHIP 74 – 225% of the FPL
      • CHIP 75 – 300% of the FPL
      • SMHB – 150% to 300% of the FPL
      • UWHS – 201% of the FPL

NOTE:  RC should be applied to each CHIP category (CHIP 71/72, CHIP 73, CHIP 74, and CHIP 75) separately.

Applying the 10% Reasonable Compatibility Test

The income is considered RC when the self-attested income falls below the MO Health Net program income threshold and EOI falls above, and the EOI is within 10% of the self-attested amount. This is called the 10% Reasonable Compatibility Test.

To apply the 10% RC Test, complete the following steps for each individual in the household with income:

1. 1. • Compare the individual's self-attested income to the individual's EOI. If the self-attested income is below the threshold,
      • Determine if the EOI is within 10% of the self-attested income.
        

        NOTE:  MO HealthNet eligibility is determined for each individual by the individual's household size and applicable income. Since households are determined by the tax filing unit, each person in the household could potentially have a different household size.

If the self-attested income is below the threshold and the electronic data source income are within 10% of each other, the individual's income is reasonably compatible.  Use the self-attested income for the budget and eligibility determination.

OR

If the self-attested income is below the threshold and the EOI is above but not within 10% of each other, or the self-attested income is above the threshold while the EOI is below, or the self-attested income and the EOI fall in different MO HealthNet program thresholds, the individual's income is not reasonably compatible.  Request a reasonable explanation to clarify the difference between the self-attested income and the electronic data source income. 

OR

If a reasonable explanation is not given or the explanation given is not reasonable, request further verification.

EXAMPLE:  George self-attested his income at within the MHK threshold (148% of the FPL), the electronic data source income for George was within CHIP 71 threshold (150% of the FPL), but his self-attested income and the electronic data income was within 10% of each other.  George's income is reasonably compatible.  He would be eligible at the MHK category level based on his self-attestation.

NOTE: When applying the 10% Reasonable Compatibility Test and one of the household member's income passes the 10% Reasonable Compatibility Test and another household member's income fails, only request a reasonable explanation/clarification for the income that failed the test.

Attested Income	Electronic Data Source	Outcome
Is below the income eligibility threshold.	Is below the eligibility threshold.	Self-attested income is used.  Individual is eligible.  10% Reasonable Compatibility Test is not required.
Is below the income eligibility threshold.	Is above the eligibility threshold.	The 10% Reasonable Compatibility Test is required.
Is below the income eligibility threshold.	Is not available.	Request additional verification/clarification.
Is above the income eligibility threshold.	Is above the income eligibility threshold.	Individual is ineligible.  10% Reasonable Compatibility Test is not required.  Refer to the FFM.
Is above the income eligibility threshold.	Is below the income eligibility threshold.	Request additional verification/clarification.
Is above the income eligibility threshold.	Is not available.	Request additional verification/clarification.

Refer to the Reasonable Compatibility Calculator within the MAGI Policy Manual, Appendix B.

1805.030.15.10 Reasonable Compatibility with More Than One Income in the Household

IM-#09 January 25, 2019

Always begin by looking at the income as a whole. If total attested household income is NOT reasonably compatible with EOI, you must look at each income separately.

EXAMPLE: Marilee and Jacob are married with two children both over age one (1). They attested their combined income is $2900.00 per month. EOI shows their combined income as $3250.00 per month

When the income is entered in the Reasonable Compatibility Calculator (Appendix B) it shows that their statement of combined income is below the MHK income guideline of $3201 for a household of 4.

Reasonable Compatibility Calculation Sheet (revised 04-01-2018)
Date:
Budget Month:
Head of Household Name:	Marilee
DCN:
Household Size:	4
Program:	MHK 1-18
Income Standard for Household Size of Selected Program	3201
Monthly Self-Attested Household Modified Adjusted Gross Income (MAGI)	2900.00
Monthly Electronically Obtained Income (EOI)	3250.00
Are self-attested income and EOI both above the income standard for the selected program?	NO
If YES, household is ineligible for selected program. Stop here, determine if eligibility exists for any other program. If so, update program and income standard to desired program. If not, reject case or start adverse action.
If NO, continue to the next question below.
Are self-attested income and EOI both below the income standard for the selected program?	NO
If YES, income is reasonably compatible. Accept applicant/participant attestation of income and do not request further clarification of income.
If NO and one income is above the income standard and one is below the income standard, compare income sources using the chart below.
Income Standard for household size of selected program:	3201
Self-Attested Household MAGI:	2900.00
Electronically-Obtained Income (EOI) converted to a monthly amount:	3250.00
Percentage Difference (Self-Attested amount minus EOI amount) divided by self-attested amount:	12.07%
Is the difference more than 10%?	YES
If YES, the income is not reasonably compatible. Request clarification of income.
If NO, the income is reasonably compatible. Accept client attestation of income.

The difference in the two (2) incomes is 12.07%.

Their combined income is not reasonably compatible.

Because there are two (2) incomes it must be determined if one or both incomes are not reasonably compatible.

Separate the two incomes and enter each one in the Reasonable Compatibility Calculator. You will ONLY look at the percentage at the bottom of the calculator. Is each individual’s income at or below 10%? If so, the income for that person is reasonably compatible.

After entering each individual income, send a Request for Information (IM-31A) asking for verification of income that is not reasonably compatible. Once you receive that verification, determine if it is reasonably compatible with their original statement.

EXAMPLE (cont’d): The application shows that Marilee’s income is $500 per month. EOI shows her income as $515 per month. The difference in her attestation and the EOI is 3%. Marilee’s statement of income is reasonably compatible. No further verification is necessary.

The application shows that Jacob’s income is $2400 per month. EOI shows his income as $2735 per month. The difference in his attestation and the EOI is 13.96%. Jacob’s statement of income is NOT reasonably compatible. Request verification for Jacob’s income.

Marilee:

Self-Attested Household MAGI:	500.00
Electronically Obtained Income (EOI) converted to a monthly amount:	515.00
Percentage Difference (Self-Attested amount minus EOI amount) divided by self-attested amount:	3.00%
Is the difference more than 10%?	NO
If YES, the income is not reasonably compatible. Request clarification of income.
If NO, the income is reasonably compatible. Accept client attestation of income.

Jacob:

Self-Attested Household MAGI:	2400.00
Electronically Obtained Income (EOI) converted to a monthly amount:	2735.00
Percentage Difference (Self-Attested amount minus EOI amount) divided by self-attested amount:	13.96%
Is the difference more than 10%?	YES
If YES, the income is not reasonably compatible. Request clarification of income.
If NO, the income is reasonably compatible. Accept client attestation of income.

1805.030.20 Income, Deductions, and the Five Percent (5%) Disregard

IM-#97, November 9, 2015

The following sections describe what income is included and excluded, what deductions are allowable, and applying the five percent (5%) disregard for MAGI households.

1805.030.20.05 Income Included Under MAGI

IM-#124, September 12, 2017, IM-#73, November 4, 2016, IM-#45, July 18, 2016, IM#32, June 07. 2016, IM-#97, November 9, 2015

All income must be entered into MEDES.

Types of included income under MAGI methodology include but are not limited to:

1. Taxable wages, salaries and tips (Pretax contributions to dependent care accounts, health insurance premiums, flexible spending accounts, retirement accounts and commuter expenses are NOT included as income);
2. Foreign earned income;
3. Interest, including tax-exempt interest;
4. Self-employment income minus allowable expenses, including depreciation;
5. Net capital gains (profit after subtracting capital losses);
6. Most investment income such as trusts, annuities, interest and dividends;

   NOTE: Prior to processing the eligibility determination, the following must be sent with a Request for Interpretation of Policy (IM-14) through the proper supervisory channels:

   • All trusts, including the "Schedule A" and an itemization of the assets used to fund the trust; and,
   • All annuity contracts, including the annuity contract application.

   These will be reviewed by MHN Program and Policy and/or Division of Legal Services staff and the response will include a decision on whether or not the income is countable for MAGI programs.

7. Unemployment compensation;
8. Rental or royalty income;
9. Other taxable income such as canceled debts, court awards, jury duty pay not given to an employer, cash support, and gambling prizes or awards;
10. Alimony (current and arrears);
11. Most retirement benefits, including Railroad Retirement;
12. Grants and Scholarships for living expenses;
13. Disability Benefits;
14. Income from boarders or lodgers; and
15. Social Security benefits, regardless of whether they are considered taxable or non-taxable income for federal tax purposes and some pensions;

    NOTE: Supplemental Security Income (SSI) is not the same as Social Security Administration benefits (SSA). SSI is not included as income.

    NOTE: Count a child’s income only when that child must file taxes on the income. The Internal Revenue Service (IRS) excludes SSA income for children until it reaches a formulaic threshold in combination with the child’s other income sources. In 2015 the threshold is $25,000 (the threshold may change annually).

    The current formula for calculating taxable SSA income of a child is:

    • Start with the amount from box 5 of a child’s Form(s) SSA-1099 and RRB-1099 (if more than one form is received, combine the amounts from box 5). This amount can also be calculated by multiplying the monthly SSA amount by the number of months SSA was received in that tax year.
    • Include the full amount of any lump-sum SSA benefit payments received in current tax year.
    • Total 1 and 2 above, then divide in half.
    • Add any taxable pensions, wages, interest, dividends, and other taxable income.
    • Compare this total to $25,000.
      1. If total is under $25,000, the child’s SSA income is considered non-taxable and is EXCLUDED in the MAGI household income.
      2. If total is over $25,000, the child’s SSA income is considered taxable and is INCLUDED in the MAGI household income.

    EXAMPLE: Child receives SSA of $1405 per month. The child started receiving SSA two years ago, and did not receive a lump sum during the tax year. The family was not able to provide the SSA-1099. The child has no other income.

    Determine annual SSA income	$1,405 x12 = $16,860
    Include the full amount of any lump-sum SSA benefit payments received in current tax year.	+ zero (No lump sum received in tax year.)
    Divide in half.	($16,860 + 0)/2=$8,430
    Add any taxable pensions, wages, interest, dividends, and other taxable income.	+ zero (No additional pensions, wages, interest, etc. received in tax year.)
    Compare to $25,000	$8,430 is under $25,000 so the child’s SSA income is EXCLUDED in MEDES.

16. Compensation in lieu of wages/bartering

    NOTE: Compensation in lieu of wages/bartering is defined as:

    • An exchange of property or services.
    • Include as income the fair market value of property or services received in bartering at the time received.
    • The value of the services must be agreed on ahead of time.
    • The value will be accepted as fair market value unless the value can be shown to be otherwise.

    Generally, this income is reported on a Schedule C or Schedule C-EZ (Form 1040).

    EXAMPLE: Applicant works at the front desk of a hotel in exchange for a room to stay in at the hotel.  The applicant and the manager of the hotel agreed that the weekly rate for the hotel room was $380.00 and that the applicant was to work 40 hours per week in exchange for the room.  The $380.00 is considered compensation in lieu of wages/bartering and is included as the weekly income source for the applicant. 

    NOTE: If there is evidence that income should not be taxable, as there are some exceptions depending on the source of the income, submit an IM-14 (Request for Interpretation of Policy) with supporting documents through proper supervisory channels.

1805.030.20.10 Income Excluded Under MAGI

All sources of income must be entered into MEDES including excluded income. Participant statement is acceptable for verification of excluded income, however, if an electronic data source is available, use reasonable compatibility guidelines.

Types of excluded income under MAGI methodology include:

1. Child Support;

   NOTE: When a custodial parent receives money from a non-custodial parent that is not court ordered but is intended to be used to support the child(ren), enter the amount received in MEDES as child support. Enter the child support income under the child’s name or divide it equally between the children it is intended to support, who reside in the home.

2. Earned income from a child whose income is under the tax filer threshold of $6,350 per year as found in 2017 IRS Publication 501, and the child is not required to file a tax return;
3. Unearned income from a child whose income is under the tax filer threshold of $1,050 per year as found in, 2017 IRS Publication 501, and the child is not required to file a tax return. This does not include a child’s SSA income;
4. SSA income of a child if determined amount is below the threshold (see formula above);
5. Certain Alaskan and American Indian incomes (Income derived from distributions, payments, ownership interests, and real property usage rights);
   • Any funds distributed per capita to or held in trust for members of any Indian tribe under Public Law 92-254, Section 7 of Public Law 93-134, Public Law 94-540, Section 4 of Public Law 97-458, or Section 2 of Public Law 98-64.
   • Pursuant to Section 15 of Public Law 100-241, any of the following distributions from a Native Corporation established pursuant to the Alaska Native Claims Settlement Act (Public Law 92-203).
     • Cash (including cash dividends on stock received from a Native Corporation) not exceeding $2000 per individual per year.
     • Stock (including stock issued or distributed by a Native Corporation as a dividend or distribution on stock).
     • A partnership interest in land, land, or an interest in land received from a Native Corporation as a dividend or distribution on stock.
     • An interest in a settlement trust.
   • Payments received by any member of the Passamaquoddy Indian Tribe, the Penobscot Nation, or the Houlton Band of Malisset Indians pursuant to the Maine Indian Claims Act of 1980 (Public Law 96-420).
   • Payments received by any member of the Aroostook Band of Micmacs pursuant to the Aroostook Band of Micmacs Settlement Act (Public Law 102-171).
6. Lump sum payments (An amount received as a lump sum is counted as income in the month received);

   EXCEPTION: Gifts and inheritances are not included, except when there is income generated from the gifts or inheritances such as rent received from property. That income is taxable and counted under MAGI methodology;

7. Supplemental Security Income (SSI);
8. All Veterans Benefits;
9. Temporary Assistance, Blind Pension, Supplemental Aid to the Blind, Vocational Rehabilitation, and other government cash assistance;
10. Welfare payments from another state;
11. Foster Care Payments;
12. Worker’s Compensation Payments;
13. Federal tax credits and federal income tax refunds;
14. Proceeds from life insurance, accident insurance, or health insurance;
15. Volunteer Income;
    • Any payments for supportive services or reimbursement of out-of-pocket expenses made to individual volunteers serving as foster grandparents, senior health aides, or senior companions; in the Service Corps of Retired Executives (SCORE) and Active Corps of Executives (ACE); and in any other programs under Titles II and III of the Domestic Volunteer Services Act of 1973 (Public Law 93-113).
    • Payments to volunteers under Title I, Section 404 (g) of Public Law 93-113 (includes Vista, University Year for Action (UYA), etc.).
16. Scholarships and grants for educational purposes, and not living expenses (Income associated with room and board expenses is included);
    • Loans or grants to an undergraduate student for educational purposes made or insured under any program administered by the Commissioner of Education. This includes:
      • Basic Educational Opportunity Grants Program (BEOG)
      • Supplemental Educational Opportunity Grants (SEOG)
      • PELL grants.

      NOTE: Include as income any of the above grants available to students for current living expenses (grants - educational expenses = money available for current living expenses).

    • Scholarship monies for educational purposes.

      NOTE: Include as income any scholarships available to students for current living expenses (scholarships - educational expenses = money available for current living expenses).

    • Other grants received. Grants not available for current living expenses are excluded as income in preparing the budget.
17. HUD Community Development Block Grants for property rehabilitation;
18. All income from College Work Study. This applies only to the federal program specifically titled College Work Study. It does not apply to any other work study program;
19. Income for nutrition programs for the elderly, any benefits paid under Title VII of the Older Americans Act of 1965, as amended;
20. Highway relocation assistance paid under the Federal Aid Highway Act of 1968;
21. Supplemental food assistance received under the Child Nutrition Act of 1966 as amended and the special food service program for children under the National School Lunch Act;
22. A bona fide (valid) loan from any source, including student loans;
    • National Direct Student Loans (NDSL)
    • Guaranteed Student Loans

    A loan must be:

    1. Supported by a written agreement to repay within a specified time, or
    2. Received from an individual or establishment engaged in the business of making loans.
    3. If neither of the above conditions apply, consider money received to be a valid loan if the participant acknowledges either verbally or by a written statement to the lender:
       • An obligation to repay (with or without interest);
       • A pledge of real or personal property or anticipated income with the intent to repay when funds become available or future anticipated income is received; or
       • A written timetable and plan for repayment.
23. Experimental Housing Allowance Program payments made under Annual Contributions Contracts entered into prior to January 1, 1975, under Section 23 of the U.S. Housing Act of 1937, as amended;
24. Earned Income Credit (EIC) advance payments and refunds;
25. Income received when the President declares a disaster, any federal major disaster and emergency assistance provided to individuals and families under the Disaster Relief Act as amended and comparable disaster assistance provided by states, local governments, and disaster assistance organizations under Public Law 100-707;
26. Agent Orange Settlement Fund payments or payments received from any other fund established pursuant to the settlement in the Agent Orange product liability litigation;
27. Restitution payments not exceeding $20,000 received by individuals of Japanese ancestry who were interned during World War II. These payments are authorized under Section 105 of Public Law 100-383, the Civil Liberties Act of 1988;
28. Restitution payments not exceeding $12,000 received by Aleuts who were interned during World War II. These payments are authorized under section 206 of Public Law 100-383, Aleutian and Pribilof Islands Restitution Act;
29. Radiation Exposure Compensation Act payments authorized by Public Law 101-426, enacted October 15, 1990;
30. The allowance provided to children of Vietnam veterans (including adult children) who were born with the congenital defect spina bifida;
31. Vocational rehabilitation payments made for maintenance, transportation, tuition, fees, etc., in connection with a participation in training or school attendance subsidized by the Division of Vocational Rehabilitation;
32. Small non-recurring cash gifts such as those for Christmas, birthdays, and graduations not exceeding the percentage of need standard for the assistance group in a month;
33. Case management advance payment or reimbursement to the individual for child care, transportation, work-related expenses, and work-related supportive services;
34. Welfare to Work funds received for a time limited training program (Work Experience);
35. Workforce Investment Act (WIA) funds received for a time limited training program (Work Experience);
36. Chaffee Foster Care Independence Program crisis intervention funds in the form of payment to third party vendors;
37. Income received from the Crime Victims Fund;
38. Trade Adjustment Assistance (TAA) and Trade Readjustment Allowance (TRA) benefits are available to workers who lose their jobs or whose work hours and wages are reduced as a result of increased imports. TRA is a weekly benefit payable to eligible workers following exhaustion of unemployment benefits. It is paid only to individuals enrolled in a training program. An individual may also receive an allowance for transportation and living expenses if attending training or conducting a job search beyond the normal commuting distance from home. If the individual finds a job beyond the normal commuting distance from home and wants to relocate to the job site, TAA may provide a relocation allowance. Count as income TRA and TAA payments for living expenses (room, board, clothing, etc.). Exempt from income TRA and TAA allowances for transportation, education;
39. Reimbursements for living expenses;
40. Severance pay; and
41. For Achieving a Better Life Experience (ABLE) accounts, the following income is not counted under MAGI:
    • Contributions to an ABLE account from a third party
      • EXAMPLE: Amy is age 25. Amy’s mother deposits $100 into Amy’s ABLE account. The amount her mother deposits is not taxed or counted as part of her income because it is considered a non-taxable gift to Amy.
    • Distributions from a Special Needs Trust deposited into an ABLE account
    • Distributions or withdrawals from an ABLE account used for qualified disability expenses (QDEs)
    • Account earnings such as interest, dividends, or other distributed returns to an ABLE account.

NOTE: Income contributed to an ABLE account by the owner or beneficiary him- or herself is NOT disregarded from the participant’s income.

EXAMPLE: John, age 23, receives $500 a month from a part-time job. He deposits $50 of his earnings into his own ABLE account. In this instance, his entire wage amount counts for his MAGI determination because how John spends the earnings he receives does not change its designation as taxable, countable income.

1805.030.20.15 Allowable Deductions

Deductions are expenses that lower taxable income. Because MAGI MO HealthNet (MHN) is based on taxable income, deductions must be incorporated in the calculation of the MAGI-based income.

Self-attestation is accepted for deductions allowed in the calculation of MAGI income. The self-attested income and deductions must be found Reasonably Compatible (RC) with electronic data sources. If the self-attested amount is not RC, additional information should be requested. If the additional information is not provided, do not deny or reject the application or case. Eligibility is determined without including the deductions.

EXAMPLE: Samuel applied for benefits on his 3 year old daughter, Mikayla. Samuel claims Mikayla as a tax dependent and is the custodial parent. Samuel attests to self-employment income of $1,500 per month. Samuel also attests to expenses related to his business: health insurance for himself of $250 per month and self-employment tax of $1,300 per year. Samuel is sent an IM-31A to provide verification of his deductions. Samuel failed to provide the required verification by the end of the IM-31A period. All other eligibility factors were met. The application is approved, however, the deductions are not allowed in the MAGI income as verification was not provided. Eligibility determination is made on Samuel’s gross income.

Pre-Tax Deductions

Pre-tax deductions are taken out of an individual’s income before any Federal, State and local taxes are deducted.

• Some health insurance premiums paid by the employee;
• This may include premiums paid for dental and vision.
• Some employee contributions to 401(k) and 403(b) retirement plans; and
• Contributions to deferred compensation plans.
• Health Savings Accounts (HSA)

Pre-tax deductions cannot be claimed on an individual’s tax return as this expense has already been excluded from the individual’s taxable income. Therefore, tax documents will not include verification of pre-tax deductions.

EXAMPLE: Jan is employed and is paid semi-monthly (twice per month) a salaried amount of $1,716.00. Jan’s pre-tax deductions were not RC with the electronic sources. She provided her pay stubs to verify her pre-tax deductions which include: health, vision, and dental insurance for herself, her spouse and children, and contributions to her deferred compensation plan. Jan does not claim any other deductions. To calculate Jan’s MAGI income, convert her income and deductions into monthly amounts and then subtract her deductions from her gross pay. Review Jan’s pay stub below to identify her gross pay and pre-tax deductions.

• Convert Jan’s income to reflect her monthly gross salary.
• $1,716.00 x 2 = $3,432.00
• Convert Jan’s pre-tax deductions to monthly amounts.
• Dental Insurance  $43.94 x 2 = $87.88
• Health Insurance $44.50 x 2 = $89.00
• Vision Insurance $7.89 x 2 = 15.78
• Medical Cafeteria Plan $75.00 x 2 = $150.00
• Deferred Comp Contribution $37.50 x 2 = $75.00
• Total Monthly Deductions = $417.66

Outcome: Jan’s household MAGI income, after pre-tax deductions, is $3,014.34 ($3,432.00 - $417.66 = $3,014.34)

NOTE: Contributions to cafeteria plans for medical expenses are allowed as a MAGI pre-tax deduction. Cafeteria contributions are deducted from the taxable income and set aside for medical expenses incurred during that particular tax year. Only allow cafeteria plan deductions for medical expenses. Cafeteria plan contributions for child care expense are not allowed as a MAGI pre-tax deduction.

Other Allowable Income Deductions (Adjustments to Gross Income)

In addition to pre-tax deductions, MAGI allows other income deductions which are “adjustments” to the individual’s gross income. These adjustments allow certain types of expenses to be deducted from the income after taxes are paid. Meaning, income taxes have already been paid prior to incurring these expenses. These deductions are claimed as a deduction on the Federal Income Tax Return at the end of the tax year.

EXAMPLE: Jon applies for MAGI Family MO HealthNet (MHN) for his 8 year old daughter, Hazel, who he expects to claim as a dependent. Jon is an elementary school teacher. His monthly gross income is $2,250. He spent $240 on supplies for his classroom (Educator Expense Deduction) in the taxable year.

Hazel’s MAGI-based household size is herself and her father, Jon.

To calculate Jon’s income, and Hazel’s MAGI household income, divide the Educator Expense by 12 months ($240 / 12 = $20), and subtract that amount from the MAGI household income ($2,250 - $20 = $2,230). The monthly MAGI household income is $2,230.

These deductions can be found on IRS form 1040, lines 23-35. However, the individual does not have to file a tax return to get the deduction.

When other allowable deductions are not reported or they are unknown, make an eligibility determination without applying the deduction. Do not deny or close an application or case for verification of deductions.

Allow the following expenses as deductions from an individual’s Adjusted Gross Income:

• Educator Expenses
• Line 23 of the IRS form 1040.
• To receive the educator expense the individual must be an eligible educator.  An eligible educator is a full time teacher of kindergarten through twelfth grade. Half-time, part-time, or homeschool teachers do not qualify for an educator expense deduction.
• An eligible educator can deduct up to $250 per tax year of qualified expenses. If married and both spouses are eligible educators, they can deduct up to $500 per tax year of qualified expenses. However, neither spouse can deduct more than their own expense, up to $250.
• Qualified educator expenses include materials used in a classroom such as: books, supplies, and equipment (computers, software and services).  Home schooling supplies and non-athletic supplies for physical education or health classes are not qualified expenses.
• Certain Business Expenses of Reservists, Performing Artists, and Free-Basis Government Officials
• Line 24 of the IRS form 1040.
• o Certain business expenses of National Guard and reserve members who traveled more than 100 miles from home (one-way) and stayed overnight to perform services as a National Guard or reserve member;
• Performing arts-related expenses as a qualified performing artist; and
• Business expenses of fee-basis state or local government officials.
• Health Savings Account (HSA) Deduction
• Line 25 of the IRS form 1040.

NOTE: This is different than the HSA pre-tax deduction. This amount is based on Form 8889, not the individual’s pay stub.

• A deduction for contributions made from a person’s income to a qualified HSA during the year.

NOTE: An individual may not claim this deduction if the contribution was made by someone other than their self, such as: employer contributions, rollovers, or qualified HSA funding distribution from an IRA.

• Moving Expense (related to a job change)
  • Line 26 of the IRS form 1040.
  • Costs of moving related to a job or business or to start a new job. The individual’s new workplace must be at least 50 miles farther from the person’s old home than the old home was from the old workplace. For people without a former workplace, the new workplace must be at least 50 miles from the new home.
• Deductible Part of Self-Employment Tax
• Line 27 of the IRS form 1040.

NOTE: This is based on the Schedule SE (Self-Employment Tax); Section A of the Schedule SE, line 6, or Section B of the Schedule SE, line 13.

• The deductible amount of self-employment tax owed by an individual for their self-employment business.
• Self-Employed SEP, SIMPLE, and Qualified Plans
• Line 28 of the IRS form 1040.
• A deduction for contributions to a qualified retirement plan for the self-employed and clergy members.
• Self-Employed Health Insurance Deduction
• Line 29 of the IRS form 1040.

NOTE: This is based on forms; Schedule C, C-EZ, or F

• Amount paid for health insurance when an individual is self-employed.
• This deduction may include the expense paid for the self-employed individual, and the individual’s; spouse, children (under the age of 27 at the end of the tax year) and tax dependents.
• The insurance plan must be established under the self-employment business.

NOTE: If the self-employed individual is enrolled under a spouse’s health insurance plan (or any other health insurance plan other than under the business), do not use the amount paid for health insurance.

• Penalties on Early Withdrawal of Savings
• Line 30 of the IRS form 1040.
• A deduction for penalties paid for early withdrawal of savings from certain financial accounts.
• Penalties on Early Withdrawal of Savings
• Line 30 of the IRS form 1040.
• A deduction for penalties paid for early withdrawal of savings from certain financial accounts.
• Alimony Paid
• Line 31a and 31b of the IRS form 1040.
• A deduction for payments to or for a spouse or former spouse under a divorce or separation agreement.
• Contributions to Individual Retirement Accounts (IRA’s)
• Line 32 of the IRS form 1040.
• Contributions made to a traditional IRA during the taxable year may be deducted. The person must have earnings in the year to qualify for the deduction.

NOTE: This does not include contributions to Roth IRAs.

• Student Loan Interest Deduction
• Line 33 of the IRS form 1040.
• A person may take this deduction if all of the following apply:
• The person paid interest in the taxable year on a qualified student loan;
• NOTE: The individual does not have to be a student in the current tax year.
• The person’s filing status is any status except married filing separately;
• The person’s modified adjusted gross income is less than the allowable amount as listed in the instructions for Form 1040, line 33. This amount is subject to change each year. Review the Form 1040 Instructions to find the allowable amount for the applicable year. The instructions can be found at www.irs.gov, Forms, Instructions & Publications.
• The person is not claimed as a dependent on someone else’s tax return.
• A qualified student loan is defined as any loan taken out to pay qualified higher education expenses for any of the following people:
• The individual or their spouse.
• The individual’s tax dependent.
• Any person the individual could have claimed as a tax dependent but did not because of one of the following:
• The person filed a joint tax return with someone other than the tax filer paying the qualified student loan interest.
• The person had gross income that was equal to or more than the exemption amount for that particular tax year.
• The individual or their spouse could be claimed as a tax dependent by another person.

  NOTE: A student loan is not considered qualified when: 1) any of the proceeds of the loan were used for purposes other than the qualified higher education expenses, 2) the loan proceeds were borrowed from a relative, or 3) the loan proceeds were borrowed from a qualified employer plan.

• Tuition and fees
• Line 34
• The individual paid qualified tuition and fees for their self, or for the individual’s spouse or dependent.
• Qualified higher education expenses include tuition, fees, room and board, books and supplies. The expenses must be for education in a degree or certificate at an eligible education institution.
• An eligible education institution is defined in IRS Publication 970 as one whose primary function is the presentation of formal instruction and that normally maintains a regular faculty and curriculum, and normally has a regularly enrolled body of students where educational activities occur.

  NOTE: For an individual to qualify as attending an eligible education institution, they must receive Form 1098-T from the education institution.

Deductions may exceed the MAGI based household income. When this occurs, the MAGI household income would be less than zero. To determine financial eligibility, use $0 as the MAGI household income.

NOTE: Income and deductions should be entered as reported by the individual. Allow the system to calculate the $0 budget; do not manually enter a $0 budget.




1805.030.20.20 Five Percent Disregard - Legal Basis

IM-#97, November 9, 2015

A component of MAGI methodology, the five percent (5%) disregard, is introduced in 42 CFR 435.603(d)(1). The five percent (5%) disregard replaces earned income disregards previously used to determine eligibility for the Family MO HealthNet programs.

1805.030.20.20.05 Calculation of the Five Percent Disregard

IM#27, March 30, 2018, IM#127, October 10, 2017, IM#108, August 08, 2017, IM#36, April 24, 2017, IM#25, May 5, 2016, IM-#97, November 9, 2015

The income disregard equals five percent (5%) of the Federal Poverty Level (FPL) for the household size. The five percent (5%) disregard is added to the income standard for the program based on household size, when an individual would be determined eligible if the FPL income standard was five percent (5%) higher. This disregard applies to the following programs:

• Children’s Health Insurance Program (CHIP)
• MO HealthNet for Kids (MHK)
• MO HealthNet for Pregnant Women (MPW)
• Uninsured Women’s Health Services (UWHS)

MO HealthNet for Families (MHF) eligibility is not based upon a percentage of federal poverty level. The income standard for MHF is a dollar amount based upon the July 16, 1996 Aid to Families with Dependent Children (AFDC) standard converted to a MAGI based standard. To determine the five percent income disregard for MHF, 5% of 100% of the FPL is added to the MHF income standard.

The resulting figure is always rounded up to the benefit of the participant.

EXAMPLE 1: Mr. Jones is applying for CHIP on behalf of his two children. He files taxes and claims both children as dependents. The household composition for each child is the same as the tax filer’s, and consists of Mr. Jones, Child 1, and Child 2. Mr. Jones is employed and earns $30.00 per hour working 40 hours per week or $5199.60 per month ($30.00 x 40= $1,200.00 x 4.333).

Mr. Jones’ income	$5,199.60 per month
CHIP 75 income maximum (300% FPL)	$5,195 per month

In this example it appears the children are not eligible for any coverage as the household income is above $5,195.00 (300%) per month. However, Mr. Jones’s income is barely above the limit for CHIP coverage, so the 5% disregard may make a difference in the level of care.

In order to calculate the 5% disregard you will need to know that 100% of the annual federal poverty level for a household of three is $20,780.00.

To determine the CHIP 75 income level including the 5% disregard:

• 5% of FPL is added to the 300% CHIP standard (5% + 300% = 305%);
• Multiply $20,780.00 X 305% which equals $63,379. This is the annual figure for 305% FPL;
• Divide $63,379 by 12 which equals = $5,281.58. This is the monthly figure for 305% of FPL;
• If needed, round up the monthly figure. In this instance, the monthly figure of $5281.58 would be rounded up to $5282. This is the CHIP 75 income standard including the 5% disregard for this household size.

Since Mr. Jones’ income of $5,199.60 per month is below $5,2282.00 (305% of FPL) his children are eligible for CHIP 75 level of care. He will have a premium to pay.

EXAMPLE 2:Mr. Brown is applying for MO HealthNet for Kids (MHK) for his three children all over the age of six. Mr. Brown files taxes and claims the three children as dependents. The household composition for each child is the same as the tax filer, and consists of Mr. Brown, Child 1, Child 2, and Child 3. Mr. Brown is employed and earns $3,200 per month.

Mr. Brown’s income	$3,200 per month
CHIP 71 or 72 income maximum (150% FPL/non-premium)	$3,138 per month
CHIP 73 income maximum (185% FPL/premium)	$3,870 per month

(CHIP 71 is for children ages 1-5; CHIP 72 is for children ages 6-18)

In this example it appears the children are not eligible for a non-premium level of care as the income maximum for non-premium CHIP coverage is $3,138.00 per month. However, Mr. Brown’s income is barely above the limit for non-premium CHIP 71 or 72 coverage, so the 5% disregard may make a difference in the level of care.

In order to calculate the 5% disregard you will need to know that 100% of the annual federal poverty level for a household of four is $25,100.00.

To determine the CHIP 71 or 72 income level including the 5% disregard:

• 5% of FPL is added to the 150% CHIP standard (5% + 150% = 155%);
• Multiply $25,100 X 155% which equals $38,905.00. This is the annual figure for 155% of FPL;
• Divide $38,905.00 by 12 which equals = $3,242.08177.50 per month. This is the monthly figure for 155% of FPL;
• Round up $3242.08 to $3243.00. This is the CHIP 71 or 72 income standard including the 5% disregard for this household size.

Since Mr. Brown’s income of $3,200 per month is below $3,243 (155% of FPL) his children are eligible for CHIP 72 level of care (all over the age of six) and he will not need to pay a premium.

EXAMPLE 3: Mrs. Smith is applying for MO HealthNet for Families (MHF) for herself and her six children. Mrs. Smith does not file taxes. Mrs. Smith’s household composition is herself and her six children. Her income is $519 per month.

Mrs. Smith’s income	$519 per month
MHF income maximum	$490 per month
MHK POV income maximum (above MHF/up to 148%)	$4,695 per month

In this example it appears Mrs. Smith and her children are not eligible for MHF coverage as the income maximum for MHF is $490 per month. However, Mrs. Smith’s income is barely above the limit for MHF coverage, so the 5% disregard may make a difference in the level of care.

In order to calculate the 5% disregard you will need to know that 100% of the annual federal poverty level for a household of seven is $38.060.00.

To determine the MHF income level including the 5% disregard:

• 5% of 100% FPL is added to the MHF maximum of $490;
• Multiply $38,060.00 X 5% which equals $1903.00. This is the annual figure for 5% of FPL;
• Divide $1903.00 by 12 which equals = $158.58 per month. This is the monthly figure for 5% of FPL;
• Round up $158.58 to $159.00.
• Add the $159 to the $490 maximum. $649 is the MHF income standard including the 5% disregard for this household size.

Since Mrs. Smith’s income of $519.00 per month is below $649.00 (MHF standard plus 5% of FPL) she and her children are eligible for MHF level of care.

1805.030.25 Determining MAGI

IM-#97, November 9, 2015

In determining eligibility based on MAGI methodology, use the following calculations:

	Total adjusted gross income (earned and unearned income)
PLUS	Foreign earned income, tax-exempt interest, or tax-exempt Social Security income
MINUS	Allowable deductions
EQUALS	Modified Adjusted Gross Income (MAGI)

1805.030.25 Determining MAGI

IM-#97, November 9, 2015

In determining eligibility based on MAGI methodology, use the following calculations:

	Total adjusted gross income (earned and unearned income)
PLUS	Foreign earned income, tax-exempt interest, or tax-exempt Social Security income
MINUS	Allowable deductions
EQUALS	Modified Adjusted Gross Income (MAGI)

NOTE: See sections on included income, excluded income, and allowable deductions for examples.

The Modified Adjusted Gross Income (MAGI) is then compared to income guidelines for the specific program. Refer to Appendix A in the Family Healthcare Manual (MAGI) for

the MAGI Income with 5% of FPL included chart.

Determine the amount of earned income the family will receive in present and future months. Discuss employment with them, including:

• Length of employment and employment status such as full-time permanent, part-time permanent, full-time temporary, etc. with present employer,
• Hours worked (regular or irregular hours, overtime, etc.),
• Wages received (steady rate, piecework, commission, etc.),
• Recent raises or promotions,
• Anticipated raises or promotions,
• Recent layoffs, or anticipated layoffs, etc.

Obtain an accurate account of the participant's employment. Use the past thirty (30) days to evaluate income stability in determining how to anticipate future income and whether to average income over a longer period.

Once the individual's employment situation is determined, budget projected monthly income. Use the following guidelines to determine a monthly income amount.

If income received is other than monthly, convert it to a monthly amount:

• If paid weekly, compute the monthly amount by multiplying by 4.333 weeks.
• If paid every two weeks, multiply by 2.166.
• If paid bimonthly, multiply by 2.

When able to predict that the employment situation will not vary, such as a salaried employee, budget the monthly amount. Infrequent and unpredictable overtime or conversely, infrequent and unpredictable workdays missed; do not alter the certainty of the employment situation.

When an employee's income varies from pay period to pay period, determine the likely pattern of future income to calculate a monthly average. Use past patterns of income if these patterns will continue.

When evaluating the length of time to use in determining patterns of income for projecting future income, always consider information from at least the past 30 days. If income fluctuates to the extent that a 30-day period does not provide an accurate indication of projected income, choose a different period that provides a more accurate indication of future income. Using a two-month time-period is recommended if no reason exists why a shorter or longer period would better predict future monthly income. Use a longer or shorter period if adequate for determining monthly income. Record the basis for the time-period used.

In some situations, recent past earnings records serve only as a partial guide for determining monthly income. For example, the employee or employer indicates that a change in hourly wage rates, hours of work, job responsibilities, etc., recently occurred or is imminent.

In other situations such as new employment, no recent past earnings records exist to use as a guide. In these situations, carefully evaluate the information available from the employee, in comparison with known past earnings records and work patterns, if any, to determine a monthly income amount. It may be necessary to set a priority to verify accuracy of monthly income.

When unearned income fluctuates, compute it on an annual or other representative period and convert it to a monthly amount.

1805.030.25.05 Projection of MAGI

IM-#103 July 28, 2017, IM-#17 February 21, 2017, IM-#97, November 9, 2015

Projection of income is an estimate of income that is expected to continue through the certification period. This estimate is based on expectation and knowledge of the participant's current, past, or future circumstances. In estimating the amount of included income, consider all factors that most accurately estimate and reflect the amount received.

Use current monthly income to evaluate eligibility for MO HealthNet . Current monthly income is an average of income received within the past 30 days.

• Follow the hierarchy of income evidence to use in the MAGI Policy Manual section, 1805.030.05 Income Evidence.
• For instructions on converting income to a monthly amount see the MAGI Policy section, 1805.030.25.10 Patterns of Income.

If income fluctuates to the extent that a 30-day period does not accurately reflect projected income, choose a method that accurately indicates or reflects future income. Enter a detailed comment to record the reason for the time-period used.

1. A participant works the same number of hours each pay period but began working various amounts of overtime prior to the application. If overtime is expected to continue, average the income that includes overtime to determine the monthly income amount to budget.

   EXAMPLE: Ms. Johnson works as a clerk in an insurance firm. Her regular hourly rate is $10.00. However, for the past four months she has been working overtime during each weekly pay period. Her gross weekly earnings with overtime is $460. Convert this to monthly income by multiplying $460 x 4.333 = $1993.18. Ms. Johnson's projected monthly income is $1993.18. Since she has been working overtime consistently for over 30 days it is appropriate to include the overtime in her budget.

2. If the overtime is to stop, complete the budget for the month the overtime pay will not be received without considering the overtime.

   EXAMPLE: Two months after approval, Ms. Johnson reports she is no longer working overtime. Complete the budget based on Ms. Johnson's normal wages of $10.00 per hour for 40 hours per week. Convert her income to monthly,$10.00 x 40 hours = $400 x 4.333 weeks = $1,733.20. Ms. Johnson's expected monthly income amount is now $1,733.20.

3. The participant's income varies with no set pattern. Average past earnings to determine the representative monthly amount to project income.

   EXAMPLE: Ms. Smith has worked at the local factory for the past three years doing piece work. She regularly works 40 hours per week. Her income varies from pay period to pay period depending on her production. No changes are expected in the piece work rate Ms. Smith is paid, nor in the hours worked. After discussing with Ms. Smith variations in her earnings over the past several months, the most recent 30 days are not an adequate representation of her earnings. After evaluating information provided by Ms. Smith, the past 12 weeks yield the most accurate estimate of her average earnings. Total earnings for this period are $1,200, averaging $100 per week. Convert this to monthly income of 4.333 x $100 = $433.33. Project $433.33 as the monthly earnings on the budget.

"Actual income" is the income that was actually received in a particular month. Actual income is not considered a projection of income or used for ongoing projection of income. In the following situations actual income is used:

• Prior quarter months.
  • EXAMPLE: Kerry applied in September and requested prior quarter coverage. Obtain the income actually received for the months of June, July, and August. Enter a budget for each of the prior quarter months with the income that was actually received within that month. Enter a budget for the current month with actual income received within the application month. Enter a 5th budget month for October and ongoing months with a projection of income.
• Month in which income begins.
  • EXAMPLE: Amy reports she began working at a department store in February. She expects to receive her first two pay checks within February.  The first pay check will include training hours and does not accurately reflect ongoing income. Amy attests that her second paycheck accurately reflects what she anticipates for her ongoing income. The budget for February will be an actual budget combining the two paychecks she receives during the month, her first and second checks. Use her second paycheck amount to budget for March and ongoing.
• Month in which income ends.
  • EXAMPLE: Sawyer reports he was fired from ABC, Inc. in April. Enter an actual budget for April with the income that was actually received in April. End the income source. A future budget reflecting ongoing income is not needed.
• Month in which a pay period is zero.
  • EXAMPLE: Kayla works at Break Time and is paid weekly. She missed two weeks of work in June due to an illness. Kayla does not have sick time therefore she was on leave without pay. The budget for June is actual and will include the income actually received by Kayla within June. The July and ongoing budget should be an accurate reflection of expected ongoing income.
• Lump Sum Payments.
  • EXAMPLE:Henry applied for MO HealthNet benefits for himself and his daughter Kennedy on June 20th.  Henry received a one-time inheritance payment on June 5th in the amount of $5,500.  Since lump sum payments are only counted in the month received, an actual budget should be used.  Henry’s inheritance is entered for June as actual income.  An ongoing budget is not needed since this was a one-time payment.

Claims that are established based on the projection of income are because one of the following applies:

• The participant failed to report income or circumstances he/she was aware of: or
• The eligibility specialist made an error considering information that was available.

Always record a comment regarding the projections of income. The comment should include what was used to determine the projected income, why it was used, how it was calculated, and any other pertinent information.

1805.030.25.10 Patterns of Income

IM-#37 April 25, 2017, IM-#17 February 21, 2017, IM-#97, November 9, 2015

A pattern of income is used to indicate or predict future income.  Income patterns are typically identified as consistent and reoccurring.

When determining income eligibility, it may be necessary to convert the income to a monthly amount.  Some income pattern types and conversions are:

• Weekly – Received once a week.
  • EXAMPLE:  Brittany is paid $320 weekly.  The amount never or rarely varies.  To convert Brittany's income to monthly multiply the weekly amount by 4.333, $320 x 4.333 = $1,386.56.  Her monthly income amount is $1,386.56.
• Bi-Weekly – Received every two weeks.
  • EXAMPLE:  Sammy is paid every other Friday, or bi-weekly.  He is paid $8.00 per hour and paid for 80 hours each pay period, or $640 every two weeks, $8.00 x 80 = $640.  To convert Sammy's income to monthly multiply the bi-weekly amount by 2.166, $640 x 2.166 = $1,386.24.  His monthly income amount is $1,386.24.
• Monthly – Received once a month.
• Semi-Monthly – Received twice per month.
  • EXAMPLE:  Ben attests to being paid $940 semi-monthly, on the 15th and 30th.  He is salaried and does not anticipate any changes.  To convert Ben's income to monthly multiply the semi-monthly amount by 2, $940 x 2 = $1,880.  His monthly income amount is $1,880.
• Bi-Monthly – Received once every two months.
  • EXAMPLE:  Jill is paid $2,400 bi-monthly, every other month on the 1st.  To convert Jill's income to monthly divide the bi-monthly amount by 2, $2,400 / 2 = $1,200.  Her monthly income is $1,200. 
• Quarterly – Received every three months.
  • EXAMPLE:  Frank is paid $900 quarterly.  To convert Frank's income to monthly divide the quarterly amount by 3, $900 / 3 = $300.  His monthly income is $300.
• Annually or Yearly – Received once per year.
  • EXAMPLE:  Allen is paid $1,000 annually.  To convert Allen's income to monthly divide the annual amount by 12, $1,000 / 12 = $83.33.  His monthly income is $83.33.

In some instances the pattern of income cannot be determined.  This occurs when the income amount and pattern varies, with no consistency.  In this situation use the past income to determine future earnings.

EXAMPLE:   George sells scrap metal as his source of income.  George attests he sold metal in May for $600, July for $150, and December for $400.  George states he does not plan to sell anymore for the remainder of the year.  Add together all that George has sold ($600 + $150 + 400 = $1,150) and average it for a monthly amount ($1,150 / 12 = $95.83 per month). 

EXAMPLE:  Sue works through a temp agency.  She works various jobs as assigned therefore her monthly income is not consistent.  She applied in November.  In August she earned $1,300, September $150, October $700.  Sue indicates that she is unsure of her future earnings however she plans to continue working for the temp agency.  Average the previous three months to project future monthly earnings ($1,300 + $150 + $700 = $2,150 ) ($2,150 / 3 = $716.66).  Her projected monthly average is $716.66.

To determine how much pay history to use for individuals whose income is inconsistent it is important to ask why the income is inconsistent and if they anticipate any changes.  Gather as much information as possible to make an accurate determination of ongoing income.  Record a detailed comment explaining how the pattern and calculation of income was determined.

1805.030.25.15 Specific Types of Income

IM-#97, November 9, 2015

Use the rules in this section for the specified types of income.

1. INCOME RECEIVED LESS OFTEN THAN MONTHLY: Annualize income regularly received on a recurring basis less frequently than monthly, such as quarterly payments or annual income, (dividends, etc.).
2. TIPS: Consider tips received as wages. Actual tips received may differ from tips reported by the employer for tax purposes.
3. REGULAR PAY DATE NOT OBSERVED: If the participant has regular pay dates, (i.e. Social Security, VA, State Employees, etc.,) but occasionally is paid early or late, consider the income in the month normally received.
4. CONTRACTUAL INCOME: Prorate earned income received by a participant employed on a contractual basis over the contract period. Use the prorated amount in determining eligibility according to regular budgeting procedures. For school employees under contract to receive annual income in a period less than a year, average the income over a 12-month period. This includes teachers, cooks, janitors, and professional administrative staff. This does not apply to contractual income received on an hourly or piecework basis.
5. SELF-EMPLOYMENT INCOME: Determine self-employment income using one of the methods outlined below.
   1. For income received monthly, project an average and budget that average monthly. For example, a hairdresser earns money each month. Project an average of the hairdresser's income and budget that average monthly.
   2. Add and prorate income received only once per year or sporadically throughout the year to determine a monthly amount. EXAMPLE: A farmer raises various crops, livestock, etc. He/She sells produce and livestock at different times during the year.
   3. If the participant is self-employed for one year or more, divide annual income by 12 to determine a monthly amount.
   4. If the participant has been self-employed for less than one year, average the amount of self-employment income over the period of time the business has been in operation to determine a monthly amount.
   5. If the monthly amount determined does not reflect the individual's actual monthly income because of a substantial increase or decrease in business, use a representative period of earnings to determine monthly earnings.
   6. Average income from self-employment using the best information available. This may include, but is not limited to:
      1. Appropriate IRS forms and supporting documentation;
      2. Written statements from a CPA with knowledge of the business;
      3. Written statements from an attorney who handles the affairs of the business; or
      4. Other documents that substantiate the income, such as records, receipts, etc.
   7. Negative self-employment income, or self-employment losses, offsets other household income in determining the MAGI for the household members. Losses are commonly found on IRS Form-1040 identified with the sum amount showing in parenthesis () and may be found on one of the following lines:
      • Line 12 – Business Income or Loss;
      • Line 13 – Capital Gain or Loss;
      • Line 14 – Other Gains or Losses;
      • Line 17 – Rental Real Estate, Royalties, etc.;
      • Line 18 – Farm Income or Loss; and
      • Line 22 – Total Income

1805.035.00 ADDING INCOME COMMENTS TO EVIDENCE

IM-#97, November 9, 2015

Comments must be entered in the Missouri Eligibility Determination and Enrollment System (MEDES) detailing how the income was verified. Comments should be placed on the Application or Integrated Case under Evidence. Click on the green action arrow for the specific evidence you are verifying and select “EDIT”.

Record any information regarding income source, reason ended, or any information pertinent to your calculation of income that requires further explanation. Include percentage for reasonable compatibility (if appropriate). Record any information regarding the income amount and how that was determined.

1805.040.00 COOPERATION IN PURSUIT OF MEDICAL SUPPORT

IM-#13, February 1, 2018, IM-#46, July 15, 2016, IM-#97, November 9, 2015

§ 208.215.15 RSMo makes the assignment of medical support mandatory of the following Title XIX MAGI MO HealthNet programs, when:

• MAGI MO HealthNet for Families (MHF) – at application.
• MAGI MO HealthNet for Kids (MHK) – at application.
• MO HealthNet for Pregnant Women – once the child is born.
• Show Me Healthy Babies (SMHB) – once the child is born.
• Children’s Health Insurance Program (CHIP), non-premium CHIP groups such as CHIP 0, 71 or 72 – at application.

This statute does not make the assignment of medical support mandatory for children eligible under the CHIP premium groups such as CHIP 73, 74 or 75, MPW, or SMHB. For MPW and SMHB cases, once the child is born cooperation in pursuit of medical support is required.

The parent or caretaker must cooperate with the Family Support Division-Child Support (FSD-CS) in the pursuit of medical support, unless there is good cause for refusing to cooperate. Provide the parent/caretaker with the Referral/Information for Child Support Services (CS-201).  The parent/caretaker must complete and return the CS-201 or call the Eligibility Specialist to provide the non-custodial parent’s information.

NOTE: The Notice of Requirement to Cooperate and Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcement (IM-2E Part 1) is no longer needed as the Rights and Responsibilities page of the IM-1SSL covers the information.

If the parent/caretaker claims good cause, provide the Second Notice of Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcement (IM-2E Part 2).

NOTE: If good cause is claimed and acceptable the parent/caretaker does not have to cooperate in seeking medical support.

When a child is added to an active MO HealthNet case, submit a CS-201 to FSD-CS even if the child has the same non-custodial parent as another child who is already active on the case.  Use the CS-201 to inform FSD-CS of the addition of the child and any new information on the non-custodial parent.

1805.040.05 Referral to FSD-CS

IM-#19, February 06, 2019, IM-#46, July 15, 2016, IM-#97, November 9, 2015

The following steps should be taken prior to referring a MO HealthNet case to FSD-CS when a child is deprived of parental support due to the continued absence of the child's parent/s from the home.

A parent or caretaker must complete a Referral/Information for Child Support Services (CS-201) form, but the form is not required prior to approval of the MO HealthNet case. Do not hold an application pending completion of the CS-201.

EXCEPTIONS: Do not refer to FSD-CS when:

• The applicant is a child under the age of 19 who is not living with a caretaker and who applies for Family MO HealthNet in his/her own name
• A non-related caretaker is applying for MO HealthNet benefits for a child in their physical custody for whom they do not have legal guardianship or legal custody

If the MO HealthNet application is made in-person, staff must have the CS-201 completed by the applicant.

If the MO HealthNet application was completed on-line, by telephone, or by mail, the CS-201 may be:

• Completed by the Family Support Division staff during a telephone call with the applicant prior to approving the application.

  NOTE: If completed by telephone call send the CS-201 to FSD-CS and note the information was obtained by telephone in the signature section along with the date of the call.

If unable to contact applicant by telephone, mail a Request for Information (IM-31A) allowing 10 days for the applicant to complete and return the form.

The applicant should provide as much information as possible on the CS-201. However, if the CS-201 is not returned or returned incomplete, FSD staff must fill out the form with at least the following information:

• The name of the custodial parent ;
• There is at least one dependent child listed; and
• The name of the non-custodial parent/alleged parent or mark "unknown"

  NOTE: The applicant's signature is not necessary on the CS-201 for opening the child support case. FSD-CS Intake Center staff has been advised to go ahead and open the case without the signature. Do not hold up sending the document or do anything different due to the lack of a signature.

  NOTE: The FSD must approve the MO HealthNet case before the CS-201 is sent. If MO HealthNet coverage is denied, the CS-201 is sent to the virtual file room. If the parent still wishes to receive Child Support services he/she may apply on-line at dss.mo.gov or request the appropriate form by calling the Child Support Call Center at (866) 313-9960.
  

For all completed CS-201 forms where all parties can be identified (including custodial, non-custodial/alleged parent, and children), please scan and email to:

• FSD.IntakeCenter@dss.mo.gov

For all completed CS-201 forms where the non-custodial/alleged parent is “unknown” and cannot be identified, please scan and email to:

• CS.MEDESLiaison@dss.mo.gov
  • NOTE: For both email accounts, multiple applications may be submitted together

All forms may also be submitted:

• By mail to Family Support Division, PO Box 6790, Jefferson City, MO 65102-6790; or
• Faxed to 573-635-7545
  • NOTE: If birth certificates for children born out-of state are provided by the applicant or available in the case file, attach a copy of the birth certificate to the CS-201 prior to submitting to FSD-CS.

1805.040.10 Notice/Good Cause for Refusal to Cooperate

IM-#97, November 9, 2015
1. Before asking an applicant or MO HealthNet (MHN) participant to cooperate in establishing paternity or in establishing, modifying, or enforcing a medical support order regarding a child advise him/her:
   1. Of the potential benefits derived from establishing paternity and establishing, modifying, or enforcing a support order;
   2. Cooperation in establishing paternity and establishing, modifying or enforcing a support order is a condition of eligibility;
   3. He/she may claim good cause for refusing to cooperate;
   4. Of the sanction applied if he/she refuses to cooperate without good cause;
   5. If it is determined that good cause for failure to cooperate exists, the applicant or participant will not have to cooperate in establishing paternity or in establishing, modifying, or enforcing support; and
   6. Upon request or following a claim of good cause the Family Support Division will provide further notice with additional details concerning good cause.

   The Notice of Requirement to Cooperate and Right to Claim Good Cause for Refusal to Cooperate with Child Support (IM-2E Part One) contain the information that the applicant or participant must be given before being requested to cooperate. Each applicant or participant required to assign medical support rights must signify understanding of the right to claim good cause by completing the form at the time of application.

   When adding a child to an active case, the applicant participant signs another copy of IM-2E Part One. This reminds the applicant or participant that he/she may claim good cause.

2. When an applicant or participant either requests additional information or makes a claim of good cause explain:
   1. The circumstances under which good cause exists;
   2. He/she will be asked to explain the basis of the good cause claim and to supply evidence and any other information necessary to establish the claim;
   3. The Family Support Division will assist in obtaining evidence, if requested;
   4. Based on evidence and investigating information provided by the applicant or participant (if warranted) the Family Support Division will determine if good cause exists;
   5. The Family Support Division-Child Support may review the findings and basis of the good cause determination and may participate in any hearings regarding the issue of good cause; and
   6. The Family Support Division-Child Support will not attempt to establish paternity or secure medical support if the applicant or participant is determined to have good cause.

   The Second Notice of Right to Claim Good Cause for Refusal to Cooperate with Child Support (IM-2E Part Two) contains the additional information that the applicant or participant must be given when requested or when he/she claims good cause for refusal to cooperate. The form provides space for the applicant or participant to make a good cause claim in writing. The applicant or participant and the eligibility specialist must sign and date the form.

1805.040.10.05 Areas of Cooperation

IM-#97, November 9, 2015
1. Identifying Non-custodial Parents

   The applicant or participant is responsible for providing all information available concerning identification of the non-custodial parent of the child for whom benefits have been requested. If the non-custodial parent's identity is unknown, the applicant or participant is responsible for providing all possible sources of information to be used in identifying the parent.

   If the applicant or participant states that the non-custodial parent is unknown, explore the circumstances surrounding the claim thoroughly, and record a comment in FAMIS about the applicant or TA participant's explanation. Ask him/her to submit all information available to verify the claim. Acceptable methods of verification include:

   1. If rape is claimed, request a police report of the incident.
   2. If the applicant or participant claims to not know the identity of the non-custodial parent because they met the non-custodial parent only one time, ask him/her to provide names of other individuals who may know the non-custodial parent.

   If more than one alleged father exists for a child, or if responsibility for medical support is unclear, refer each alleged parent of that child to the Family Support Division - Child Support (FSD-CS). Complete CS-201 for each alleged parent. In cases where someone other than the legal father is alleged to be the biological father, complete a CS-201 for the legal father and one for the alleged biological father.

   When children have been adopted eligibility is determined based on the adoptive parent. Complete a CS-201 when there is a non-custodial adoptive parent.

   In all cases explain to the applicant or participant the importance of cooperating with the identification of the non-custodial parent. A refusal to do this may result in a determination of failure to cooperate and the application of a sanction if the participant fails to claim good cause.

   The earlier paternity and/or support are established the sooner the child may:

   • Have access to the non-custodial parent's medical benefits;
   • Obtain information on the non-custodial parent's medical history; and
   • Receive other benefits resulting from paternity establishment.
2. Locating Non-custodial Parents

   The applicant or participant is responsible for furnishing information to help locate the non-custodial parent. If the location is unknown, the applicant or participant will be asked to provide information that may lead to possible sources for obtaining this information. Assist the applicant or participant to complete the necessary information on the CS-201. The applicant or participant's failure to participate in locating the non-custodial parent without good cause may result in a determination of refusal to cooperate and the application of a sanction.

3. Other Areas of Cooperation

   The applicant or participant may be asked to take a more active role in identifying and locating the non-custodial parent. This may include:

   • Establishing the paternity of a child born out of wedlock;
   • Helping to obtain medical support, or any other payments or property due the applicant or participant on behalf of the child;
   • Going to the FSD-CS office to provide verbal or written information about the non-custodial parent; and
   • Appearing as a witness at court or other hearings or proceedings.

1805.040.10.10 Refusal to Cooperate/Claiming Good Cause

IM-#97, November 9, 2015

Do not deny, delay, or discontinue assistance pending a determination of good cause for refusal to cooperate. When possible, make this determination before case approval. At the time of approval complete a Referral/Information for Services (CS-201) on the non-custodial parent if a final determination of good cause is pending. Inform the child support specialist (CSS) that the applicant or participant claimed good cause and that the final determination is pending.

If an applicant or participant refuses to cooperate, discuss his/her reasons. An applicant or participant may refuse to cooperate in establishing paternity or obtaining child support without sanction if good cause exists.

1805.040.10.15 Good Cause Defined

IM-#97, November 9, 2015

Good cause for refusing to cooperate exists when one or more of the following circumstances exist:

1. Cooperation by the applicant or participant may reasonably be anticipated to result in physical or emotional harm to the:
   1. Child;
   2. Applicant or participant so serious that it reduces his/her capacity to care adequately for the child; or
   3. Applicant or participant as a result of domestic violence.
2. Establishing paternity or securing medical support will be detrimental to the child because:
   1. The child was conceived as a result of forcible, not statutory, rape or incest;
   2. Legal proceedings for adopting the child are pending before a court; or
   3. A public or private social service agency is currently assisting the applicant or participant to resolve the issue of whether to keep the child or relinquish the child for adoption, and the discussions have not gone on for more than three months.

1805.040.10.15.05 Determining Good Cause

IM-#59, May 30, 2017, IM-#97, November 9, 2015
1. Applicant or Participant's Responsibilities:
   1. The applicant or participant requests that a determination be made of his/her good cause claim for failure to cooperate; and
   2. b. The applicant or participant alone or with the Eligibility Specialist assistance provides evidence in support of the good cause claim. Allow the applicant or participant sufficient time to obtain the evidence, especially if it is unusually difficult to obtain. If an applicant or participant claims good cause based on physical harm and no evidence exists to verify the claim, request a written explanation for the record.
2. Income Maintenance Eligibility Specialist Responsibilities:
   1. When the applicant/participant claims Good Cause, give them a copy of the Second Notice of Right to Claim Good Cause For Refusal to Cooperate in Child Support Enforcement (IM-2E Part 2) which gives additional information regarding the good cause claim, his/her responsibilities, and space to make the claim in writing;
   2. Use the Communication Transmittal (IM-16) to notify the child support specialist of a good cause claim when a Referral/Information for Services (CS-201) has already been sent;
   3. Assist the applicant or participant in obtaining evidence when necessary. Advise him/her of methods to obtain documentation. The applicant or participant may be asked to provide sufficient identifying information and pay any fees required to obtain the document.

      EXCEPTION: The Family Support Division will pay for an evaluation from a mental health professional regarding risk of emotional harm when necessary. The applicant or participant's inability to pay a fee will not negatively affect a determination that good cause exists.

   4. Determine within 20 days whether good cause for failure to cooperate exists. The 20 days may be extended for up to 45 days in case of difficulty in obtaining good cause verification under 13 CSR 30-8.010.
   5. Send the IM-16 to the Child Support supervisor for their review. Consider any comments the supervisor has regarding the determination. It is the responsibility of Income Maintenance staff to make the final determination. If no comments are received from the Child Support supervisor within five (5) working days, complete the decision-making process.
   6. Refer all claims of good cause to the Program Manager/County Manager for their review before final determination.
   7. Notify the applicant or participant and the Child Support supervisor in writing of the final determination on all good cause claims.
   8. Notify the Child Support Supervisor of any hearing requests regarding good cause claims and the hearing results.
   9. If it is determined good cause does not exist follow sanction procedures.
   10. Document the decision, findings, and basis for the good cause determination. Keep any hard copy documentation in the case file.
   11. If a refusal to cooperate is determined to be with good cause, re-assess the good cause determination at each review. Circumstances may have changed, and the applicant or participant may wish to establish paternity and/or medical support.

       NOTE: If a participant notifies Income Maintenance in the future that good cause no longer exists, it is necessary to complete a new CS-201 or send an IM-16 notifying FSD-CS that they can reopen the child support case.

   12. Family Support Division-Child Support Responsibilities
       1. The CSS notifies Income Maintenance staff via the IM-16 if an applicant or participant refuses to cooperate with FSD-CS.
       2. The CSS suspends all efforts to establish paternity or secure support when notified of a good cause claim. This suspension continues until the Child Support supervisor receives notification of a final determination.
       3. The Child Support supervisor may participate in a hearing regarding good cause determination either at the applicant/participant's or Income Maintenance staff's request.
       4.  FSD-CS does not begin to establish paternity or secure medical support if Income Maintenance finds good cause for refusal to cooperate. Once Income Maintenance determines good cause and notifies FSD-CS, FSD-CS closes the case.

1805.040.10.15.10 Types of Evidence to Support Good Cause

IM-#97, November 9, 2015

Evidence to support a good cause claim may include the following:

1. Incidents of domestic violence resulting in physical or emotional harm to the child, applicant, or participant.

   Types of Evidence:

   • Court, medical, criminal, child protective services, social services, psychological, or law enforcement records. These records or statements should indicate that the noncustodial parent may inflict physical or emotional harm on the child, applicant, or participant as a result of cooperation
   • Medical records including the emotional health history and present emotional health of the child, applicant, or participant. These may be in the form of a written diagnosis or prognosis from a mental health professional indicating the emotional health of the child, applicant, or participant. These records should indicate that emotional harm to the child, applicant, or participant would result from cooperating
   • Medical and court records indicating that the noncustodial parent caused physical or emotional harm to the applicant or participant as a result of domestic violence

     When documentation is unavailable, accept statements of the child, applicant, or participant. The applicant or participant is responsible for providing enough information to establish good cause and explain why no evidence is available. Make efforts to corroborate the statements by someone familiar with the situation

2. A child is conceived as a result of forcible rape or incest.

   Types of Evidence:

   • Birth certificates
   • Medical or law enforcement records indicating that the child was conceived as a result of forcible rape or incest.

     These records may include a written statement from the applicant or participant if formal documentation is not available.

3. Adoption proceedings pending:

   Types of Evidence:

   • Court documents or other records to indicate that legal adoption proceedings are pending, including written statements from staff of a public/private adoption agency.
4. Counseling regarding relinquishment:

   Types of Evidence:

   • Written statements from public or private social services agencies stating that the applicant or participant is being assisted to resolve the issue of whether to keep the child or relinquish the child for adoption. The good cause for counseling is limited to three months.
5. All above situations (#1-4) with the exception of emotional harm:

   Types of Evidence:

   • Sworn statements from individuals other than the applicant or participant with knowledge of the circumstances on which the good cause claim is based. A statement given under oath to a notary public is the most common and most available type of sworn statement.

     NOTE: If the applicant or participant needs a mental evaluation to prove emotional harm, the evaluation is paid the same as an examination to determine incapacity. The evaluation is valid for two years unless the mental health professional or Income Maintenance staff determines that another evaluation is needed.

Additional evidence may be requested when evidence provided by the applicant or participant does not provide enough information to make a good cause determination.

NOTE: DO NOT CONTACT THE NONCUSTODIAL PARENT UNDER ANY CIRCUMSTANCES.

1805.040.10.20 Sanctions for Non-cooperation

IM-#004, January 04, 2018, IM-#46, July 15, 2016, IM-#97, November 9, 2015

When an individual fails to cooperate with Child Support (CS) in obtaining medical support and good cause does not exist, the individual is sanctioned. Sanctioning an individual ends his/her MO HealthNet (MHN) coverage.

NOTE: Only parents and caretakers can be sanctioned. Do not sanction children.

CS determines if the individual has cooperated or if a sanction should be imposed. If a sanction should be imposed, CS will notify the Family Support Division (FSD). If good cause does not exist, FSD sanctions the individual.

NOTE: FSD determines if good cause exists; refer to 1805.040.10.15.05 Determining Good Cause.

FSD-CS will use the email address FSD.GROUPC@dss.mo.gov when sending a request to enter MO HealthNet sanction due to non-cooperation in pursuit of medical support, or to end a sanction when the individual cooperates with CS.

Emails received from CS requesting entry or ending of a child support sanction will contain “Child Support Sanction" in the subject line. Income Maintenance (IM) must act on the sanction request within ten (10) days of receipt of the request.

NOTE: When an individual cooperates, CS sends a request to FSD to lift a sanction. CS will send an email advising FSD that the individual is now eligible to receive benefits. Follow appropriate procedures to end the sanction and reactivate the caretaker’s MO HealthNet benefits, if they remain otherwise eligible, within ten (10) days.

MAGI Processing Centers must have a process to identify and distribute these email messages to appropriate staff, and to ensure action requested by CS is taken within ten (10) days.

Follow adverse action procedures prior to imposing the sanction. If a hearing is requested within the adverse action period:

• Do not take action until the hearing has been conducted and a decision is rendered, AND
• Allow the caretaker to continue to receive the current level or benefits until the hearing decision is rendered.



1805.040.10.25 Cooperation and Referral to Child Support When Adding Children to an Active Case

IM-#97, November 9, 2015

When a child is added to an active MO HealthNet case submit a CS-201 to FSD-CS even if the child has the same non-custodial parent as another child who is already active on the case. Use the CS-201 to inform FSD-CS of the addition of the child and any new information on the non-custodial parent.

It is a requirement to complete and return the CS-201, or the parent/caretaker must call the eligibility specialist to provide the non-custodial parent information. Even if the parent/caretaker fails to provide the necessary information on the non-custodial parent, add the child to the case.  Refer to section 1805.040.10.20 for sanctioning procedures.

1805.050.00 Former Foster Care Youth

IM-#100, August 04, 2017

RSMo 208.151.1 effective August 28, 2013, allows certain individuals under the age of 26 who were in foster care to be eligible for healthcare coverage through the Children's Division (CD).

To qualify, a person must:

• have been in Foster Care and receiving coverage through the Missouri Children’s Division on, or within 30 days prior to, their 18th birthday; and
• apply for and be determined ineligible for MO HealthNet through the Family Support Division (FSD).

If the applicant is eligible for coverage through FSD and they are currently receiving former foster care youth coverage (ME 38) through the Children’s Division, do not reject the application. Send an email, with a subject line of AC ME 38 - NEEDS TO BE CLOSED to Cole.MHNPolicy@dss.mo.gov. Include:

• the applicant’s name;
• DCN; and
• current address

NOTE: FSD staff must approve MO HealthNet coverage the day that the former foster care coverage shows as closed in MXIX. Due to the overnight batch process and to prevent gaps in coverage, CD will NOT close ME 38 coverage before a weekend or holiday. Requests received on these days will be processed on the following business day.

If the former foster care individual has been determined ineligible for a full coverage Family MO HealthNet or MO HealthNet for the Aged, Blind or Disabled program through FSD, refer the individual to CD for coverage.

NOTE: To allow for continuity of coverage for former foster care individuals, CD currently auto-enrolls participants in Former Foster Care Youth coverage at the time of age-out, however, a gap in coverage may exist.

EXAMPLE: Mr. Carson was given Former Foster Care Youth coverage when he turned 18. At age 20, he moved out of Missouri to attend college in Iowa and his coverage was closed. When he graduated at age 22, Mr. Carson moved back to Missouri, but did not notify CD to have his former foster care youth coverage reopened. He applied for MO HealthNet for Families coverage, but he had too much income to qualify. His case was then referred to CD to have his former foster care youth coverage reopened.

Uninsured Women’s Health Services (UWHS) or Extended Women’s Health Services (EWHS) do not provide full MO HealthNet benefits. When an applicant/participant is eligible for either of these programs, she must be referred for full healthcare coverage through CD.

NOTE: Current system functionality provides qualifying participants with Former Foster Care Youth coverage whenever other FSD coverage is ended without further action by FSD staff. However if the participant failed to report an address change to CD while receiving health coverage, the Former Foster Care Youth coverage will not be automatically reinstated.

EXAMPLE: Ms. O’Brien has active Former Foster Care Youth coverage when she applies for MO HealthNet for Pregnant Women (MPW) and is found eligible. Since the participant must be given full coverage through FSD if eligible, the Eligibility Specialist (ES) sends an email to Cole.MHNPolicy@dss.mo.gov to have the AC ME 38 closed. Once the Former Foster Care Youth coverage is closed, the ES approves the MPW coverage.

After the MPW coverage has ended and before the MPW post-partum coverage has ended, the participant should be given an ex parte review to determine whether or not she meets the eligibility criteria for a full coverage FSD MO HealthNet program. Ms. O’Brien is eligible for EWHS, which is not a full coverage program. The ES takes action to prevent the EWHS coverage from beginning and when the MPW post-partum coverage ends in MEDES, the Former Foster Care Youth coverage will begin automatically preventing a gap in full medical coverage.

If a former foster care individual has been determined ineligible for a Family MO HealthNet full coverage program through FSD, the Eligibility Specialist (ES) will send an email to Cole.MHNPolicy@dss.mo.gov so that the individual may be referred to the CD for coverage as eligibility for the Former Foster Care Youth program may exist.

Individuals who qualify for former foster care youth coverage may also contact the MO HealthNet open enrollment broker by telephone to 800-348-6627, or Children's Division at http://dss.mo.gov/cd/ or by telephone to 573-522-8024.

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