Complete a review of MAF eligibility every 12 months. The review should be completed through the mail. A face-to-face interview is not required. Every review or change in circumstance requires appropriate action and recording. Types of interim contacts include:
A recipient is required to report changes within ten days. Obtain documentation necessary to process change within ten days.
Reviews of MO HealthNet for Families (MHF) cases are to be done annually. A MHF reinvestigation can be completed using information from the food stamp application or recertification when all MHF household members are part of the food stamp Eligibility Unit. When a reinvestigation of this type occurs, completion of the reinvestigation form is not required.
When a MO HealthNet for Families reinvestigation form (FA402) is received within the same month that the case closed due to failure to complete and return a reinvestigation form, take appropriate action to cancel close the case and process the reinvestigation using current procedures. Refer to FAMIS User Guide, “Completing a Temporary Assistance/Medical Assistance Reinvestigation in FAMIS” for instructions on how to complete a reinvestigation in FAMIS.
NOTE: Failure to enter a reinvestigation in FAMIS when the case was cancel closed during the same month the reinvestigation is due will cause FAMIS to begin the adverse action process again for failure to complete and return the reinvestigation form and results in a delinquent reinvestigation. Therefore, the eligibility specialist must enter the reinvestigation during the same month the reinvestigation is due to avoid the case closing again and to avoid a delinquent reinvestigation.
EXAMPLE: Mr. Ely’s reinvestigation is due in February 2009. Mr. Ely failed to complete and return his reinvestigation form by the due date, and the case closed for failure to complete the reinvestigation. On February 20, 2009, Mr. Ely provides his completed reinvestigation form. The eligibility specialist’s supervisor cancel closes the case. The same day the eligibility specialist completes the reinvestigation in FAMIS following current procedures.
A family receiving a Temporary Assistance cash grant is actually on two separate programs, Temporary Assistance and Medical Assistance for Families (MAF). Since some requirements for Temporary Assistance do not apply to MAF, a family may continue to qualify for MAF when losing eligibility for Temporary Assistance. Simplified eligibility and procedural requirements for MAF include:
When action is being taken on combination MAF/Temporary Assistance cases, recipients need to clearly understand what is required to continue cash and what is required to continue MAF. The difference in the eligibility criteria must be addressed on adverse action notices, correspondence, and information requests. Taking action on MAF at the same time action is being taken on Temporary Assistance is no different than taking action on Food Stamps at the same time. Sometimes it will be possible to take action on Temporary Assistance and MAF at the same time, but there are times when it will be necessary to implement the Temporary Assistance eligibility decision prior to determining what action to take on the MAF. When a recipient fails to complete a reinvestigation for Temporary Assistance, take action to close the cash and change to MAF only. After taking action to close the cash, send an IM-1U if an MAF review is needed.
EXAMPLE: A Temporary Assistance recipient is sent a letter scheduling an appointment for an interview to complete a reinvestigation. If the appointment is not kept, send an IM-80 to discontinue Temporary Assistance. When the IM-80 expires, complete an IMU5 transaction closing the cash and change to MAF. Notify the client accordingly. Since a face-to-face interview is not a requirement for the review of the MAF case, the MC+ healthcare coverage cannot be discontinued. An IM-1U can be mailed to the recipient for completion of the MAF review. The MAF case can only be closed if the recipient fails to complete and return the IM-1U within the prescribed time frames, and a notice of adverse action has been sent advising of the proposed closing of the MAF case.
Prior to taking any action to close MAF, eligibility must always be explored for Transitional Medical Assistance. It is not necessary to verify earnings or beginning date of employment to put the members on Transitional Medical Assistance. Accept the client's statements for both. A new hire match or IMES can be used to confirm the information provided it is within reason. Whenever a new hire report is received, use this information to determine eligibility for Transitional Medical Assistance.
If the client is not placed on TMA and it is discovered later they did qualify; change the case to transitional by reopening as an MAF, then close to transitional.
If ineligible for TMA, explore the children’s eligibility under the MC+ program. An IM-80PRE must be sent allowing the caretakers and children, if applicable, the opportunity to report any other possible eligibility if none is found when completing an ex-parte review. If no other possible eligibility claimed, send an adverse action notice (IM-80).
If a written request for closing says “close my Temporary Assistance case”, the MAF should remain open and the notification to the family should indicate medical coverage will continue. A voluntary withdrawal for MAF/MC+ must be in writing and specify the individual is not interested in pursuing MC+ healthcare coverage. If a client calls and requests their Temporary Assistance and/or MAF be closed the worker must:
Once an individual is determined eligible for MC+/Medicaid, eligibility should continue uninterrupted until the individual is determined ineligible for every category of MC+/Medicaid. A termination without a review for on-going eligibility is improper. Reviews for on-going eligibility must be conducted without the involvement of the recipient, if possible. This is known as an ex parte review. If the ex parte review does not suggest eligibility, the recipient must be given an opportunity to provide any additional information needed to establish eligibility prior to termination.
Prior to discontinuing an individual's coverage under any MC+ category, staff must review the individual's possible eligibility under all MC+ healthcare programs. Possible eligibility for Medical Assistance (MA) must also be explored if the individual has an established disability or is blind or aged. (For example, receiving RSDI or SSI.) Use information from all available records, i.e. Food Stamp or Childcare records, SDX, Bendex, IIVE, IMES, etc. Keep in mind, the individual should be moved to the best healthcare benefits package for which they qualify.
If eligibility exists under another category, switch the individual to the appropriate category (an IM-1 is not necessary). If discontinuing eligibility from one category and approving in another, process both transactions on the same day in order to prevent any disruption in healthcare coverage. Use the IM-33MCC to notify the recipient of changes in their healthcare coverage if moving to another MC+ category. Send an IM-32 if changing to MA.
If other eligibility cannot be established form the record, staff must take the process one step further by sending the Pre-Closing Review Notice (IM-80PRE) to inquire about pregnancy, blindness, disability, currency of child support payments, and changes in income. The individual will be allowed ten (10) days to respond. If there is no response from the individual indicating any other possible eligibility, an IM-80 (Adverse Action Notice) should be initiated explaining:
If the individual responds to the Pre-Closing Review Notice within the ten (10) days indicating other possible eligibility, register the appropriate (MA, MC+ for Pregnant Women, Non- Custodial Parent) application in IAPP and allow the current eligibility for that particular individual to remain open pending the eligibility determination for the other category. No new signed application from the individual is required to switch categories. If disability or blindness is claimed, use the IM-2D when determining eligibility under Medical Assistance. If non- custodial parent eligibility is claimed, use the IM-1UA(NCP) when determining eligibility. One category of coverage should not be stopped before the other category is approved or determined ineligible.
NOTE: If the client did not respond to the expiration of the Pre-Closing Review Notice but does respond indicating other possible eligibility prior to the expiration of the IM-80, follow the same instructions above for the individual who responds to the Pre-Closing Review Notice.
If eligibility is established under another category, close the current active case and approve the other category the same date. Use the IM-32 to notify the client of approval for MA with a statement that eligibility no longer exists under MC+. Use the IM-33MCC to notify the client of the switch to MC+ for Pregnant Women with a statement that eligibility no longer exists for a specified program. Use the IM-32NCP to notify the client of the switch to Non-Custodial Parent with a statement that eligibility no longer exists for a specified program.
If determined ineligible based on reported pregnancy, disability, blindness, change in income or child support payments, send an IM-80 specifying the reason eligibility for MC+/Medicaid does not exists. Address the reason for the denial of the new category as well as the reason for loss of eligibility for current MC+ program. The IM-80 will also serve as the rejection notice and provide appeal rights. Close the MC+ active case once the IM-80 expires.
NOTE: There are no appeal rights with the Pre-Closing Review Notice since this is not an adverse action notice. If the final decision results in an adverse action, the IM-80 is required and normal hearing rights are allowed.
If eligibility exists under another category, switch the individual to the appropriate category (an IM-1 is not necessary). Process both closing and approval transactions on the same day in order to prevent any disruption in healthcare coverage. Use the IM-33MCC to notify the recipient of changes in their healthcare coverage if moving to another MC+ category. Send an IM-32 if changing to MA. Use the IM-32NCP for an individual moved to Non-Custodial Parent. Include a statement that eligibility no longer exists for the specific program you are closing.
If determined ineligible based on reported pregnancy, disability, blindness, change in income or child support payments, send an IM-80 specifying the reason eligibility for MC+/Medicaid does not exist. Address the reason for the denial of the new category as well as the reason for loss of eligibility for current MC+ program. A separate rejection notice for the new category is not required as the IM-80 notifies the client of ineligibility for all MC+/Medicaid categories and provides appeal rights. Close the active MC+ case once the IM-80 expires.
A request to add a person to an existing MAF case can be received through the mail or by phone, it does not have to be in writing. The request to add a person to an existing case can be received as part of the annual review, or any time a caretaker reports a new person in the home. Requests may also be received to change the status of a person already in the home from included to active.
If the information is already present in the case record to establish eligibility for the person in question, add the person. If information is needed to establish eligibility for the person being added, request the needed information. A review is not necessary.
When adding a person to an active MAF case, use the following procedure:
NOTE: Income of a person added to the assistance group must be verified prior to adding the person. However, it is not necessary to reverify income of persons currently included in the assistance group.