On approved cases, the family's eligibility for MC+ healthcare coverage begins with the first day of the month of application, provided the family is subsequently found eligible, and was not obviously ineligible for the entire month of application and any subsequent month prior to approval. If a family member was obviously ineligible for the entire month of application and any subsequent months prior to approval, MC+ healthcare coverage begins with the first day of the month in which eligibility is met.
Eligibility determination for prior quarter MC+ healthcare coverage is separate from the eligibility determination of current MC+ healthcare coverage. An individual DOES NOT have to be currently eligible for MC+ healthcare coverage to be eligible for prior quarter coverage and vice versa. The effective dates of prior quarter coverage are no earlier than the first day of the third month prior to the month of application and can extend to but not include the first day of the month of application.
When application is made for a newborn child, the mother can receive coverage for the period prior to the birth if she met eligibility requirements for the MC+ for pregnant women program in the prior quarter. If the MAF case is approved, provide prior quarter coverage in the MAF case even though eligibility is based on the MC+ for pregnant women program. If, however, the mother already receives MC+ for pregnant women coverage, do not show prior quarter eligibility in the MAF case. If the MAF case is rejected but prior quarter eligibility exists, provide prior quarter coverage through a MC+ for pregnant women case rather than MAF. In these instances, register a MC+ for pregnant women application and backdate it to the MAF application date. It is not necessary for the applicant to sign the MC+ for pregnant women application but refer to the signature on the MAF application.
MC+ healthcare coverage (Medicaid) is date-specific for MAF recipients at the time of closing. All individuals on a MAF case are date-specific and can be closed with a future date, up to the last day of the month following the month the closing action is entered into the system.
To remove an individual from a case that remains active, make the following entries in IMU5:
To enter a future date closing of an entire MAF case, make the following entries in IMU5:
When doing a future date closing for either an individual or whole case, if no date is entered in IMU5, coverage will end on the date of the closing. If a date earlier than the current date is entered, the system will end coverage on the date of the closing.
Process MHF applications without undue delay unless unusual or extreme circumstances exist. Complete the eligibility determination to ensure an applicant is mailed his/her notice of approval or denial within a period not to exceed 30 days. If the application can not be completed promptly due to an extreme circumstance the eligibility specialist must enter the appropriate delay code in the Delay Code field on the Application Request (FM0G or REQUEST) screen in FAMIS.
If eligibility is not determined by the 30th day, record the reason for delay on the Eligibility Unit Member Role (EUMEMROL or FM3Z) screen.
An application may be rejected prior to the 30th day if the case is found to be ineligible on a specific eligibility factor.
Applications will be rejected on the 30th day if outstanding verification exists.
MO HealthNet for Families Applications
FAMIS automatically sends a first Request for Information (FA325) for MO HealthNet for Families applications if not printed by the eligibility specialist on the date of application. FAMIS sends a second Request for Information (FA325) on all MO HealthNet for Families applications when verification is still outstanding after expiration of the first FA325.
On the date of application the eligibility specialist must print and distribute the first Request for Information (FA325) to any applicant applying in person. It is not required that the form be printed and mailed for web or mail-in applications received because FAMIS will send one. If the first FA325 is not printed by the eligibility specialist for MO HealthNet for Families applications, FAMIS automatically prints and mails the Request for Information (FA325) in the overnight batch. This allows for timely generation of an automated second Request for Information (FA325) sent by FAMIS for any outstanding verification that still exists following expiration of the first FA325.
NOTE: FAMIS will not print and mail the Request for Information (FA325) if printed by the eligibility specialist on the date of application. It is the responsibility of the eligibility specialist to mail the printed form.
FAMIS automatically prints and mails a second Request for Information (FA325) on MO HealthNet for Families applications whenever a first Request for Information (FA325) has been sent and the information has not been returned and/or entered into FAMIS within 10 days. The second Request for Information (FA325) notice allows the participant an additional 10 days to return requested information. If information is not received and entered into FAMIS the system automatically rejects the application(s) on the 30th day. The second Request for Information (FA325) can be viewed or printed from the Document Queue (FMVM or DOCQUE) screen and is designated as request number "Two".
MO HealthNet for Families Changes reported during application
When changes are reported during the application process another Request for Information (FA325) may be necessary. The eligibility specialist must enter the reported change into the appropriate screens in FAMIS. This creates an outstanding verification for the reported change. The eligibility specialist must print and give the request to the participant (if in person) or mail the request to the participant. The FAMIS system does not automatically generate the Request for Information (FA325) for a reported change. The new (FA325) request for information allows the participant 10 days to provide information verifying the reported change.
EXAMPLE: Ms. Elliott applies for TA and MO HealthNet for Families in person on 10/24/08. The eligibility specialist prints the first FA325 requesting verification of child support income on 10/24/08 with a due date of 11/03/08. Ms. Elliott has not provided or the eligibility specialist has not entered requested verification as of the close of business on 11/03/08. FAMIS automatically generates a second FA325 on 11/03/08 with a due date of 11/13/08. On 11/21/08, Ms. Elliott comes into the FSD office and provides child support verification requested on the first and second FA325 and reports that she has a new job but does not have income information available. The eligibility specialist enters the child support verification and new job information into FAMIS on 11/21/08 and prints a FA325 on the reported change (new job) with a due date of 12/01/08. The eligibility specialist prints the FA325 requesting information to verify the reported change and gives it to Ms. Elliott while she is at the FSD office. The TA and MO HealthNet for Families applications are due on 11/24/08, the first business day following the 30th day after application. Ms. Elliott has reported a change during her application process and is given until 12/01/08 to provide the information needed for that change. FAMIS pends the TA and MO HealthNet applications on 11/24/08 as Ms. Elliott has not had 10 days to supply the new income information necessary to complete her application request.
On 12/01/08 Ms. Elliott does not supply the new income information requested. FAMIS rejects the applications overnight on 12/01/08.