When an application for MC+ is received, it may not be clear which type of assistance the family will be eligible to receive. Family members may be eligible for MC+ as a pregnant woman (MPW), one of the four MC+ children's groups, or MAF. It may be necessary to register a MAF/MC+ for Children and a MPW application. Always determine eligibility for the MAF, the MC+ for Children Non-CHIP group, and MPW prior to approving in one of the CHIP groups. Benefit packages are more restrictive for individuals approved in the Premium CHIP groups. A MC+ for children assistance group may include both Non-CHIP and CHIP children due to the higher Non-CHIP income limits for children under age 6 and under age 1.
For children determined ineligible for the Non-CHIP group on income, determine if the child is eligible in one of the CHIP groups based on the additional eligibility factors listed in Section 0920.020.00.
Children on MC+ cases are divided into four groups in the Legacy system identified by different levels of care on IMU5 in Field 13G. In the FAMIS system, they are divided into seven groups. The levels of care (LOC) are:
The beginning eligibility date for premium group children (LOC 2 and LOC 3, CHIP73, CHIP74 and CHIP75) does not reflect coverage for MC+. This date simply indicates the earliest date the individual can become eligible. The children do not have coverage until the premium is paid.
Upon approval, a premium notice is sent to the parent(s) or guardian(s) notifying them the premium payment is due upon receipt of the notice and must be received before coverage can begin. If payment is not received within 15 days, a second and final notice is sent requesting payment. If the initial premium is not paid MHD will notify FSD after 90 days to close the case. Data Processing will close the case and notify the caseworker of the closing. No Adverse Action Notice (IM-80 or FA450) or closing letter is required.
If the premium is paid, the MCII screen will be used to show coverage dates. Persons in fee-for-service will be assigned a pseudo plan number. Persons in managed care counties will be assigned to a pseudo plan number until enrolled in a health plan. To determine if the premium has been paid and the individual is actually eligible, refer to the MCII screen that shows if the individual is locked in. If there is no lock-in, the children are not eligible to receive services.
The time frame for processing all Family Healthcare applications; except MO HealthNet for Pregnant Women, is 30 days. Applications for pregnant women must be processed within 15 days. It is important to process all Family Healthcare applications as quickly as possible. 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 Kids Applications
FAMIS automatically sends a first Request for Information (FA325) for MO HealthNet for Kids 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. If the first FA325 is not printed by the eligibility specialist for MO HealthNet for Kids 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 Kids 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 FA325 Request for Information can be viewed or printed from the Document Queue (FMVM or DOCQUE) screen and is designated as request number "Two".
MO HealthNet for Kids 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.