0920.035.00  REVIEWS (MO HealthNet for Kids)

IM-10 February 13, 2009, IM-#12 January 20, 2000

Complete a review of MO HealthNet for Kids (MHK) eligibility every 12 months. This requirement is the same as for MHF. Refer to Section 0905.025.01.

A MHK reinvestigation can be completed using information from the food stamp application or recertification when all MHK 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 Kids 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.

MO HealthNet for Kids premium cases can only be cancel closed by Family Support Division’s Income Maintenance Program and Policy Unit.  This policy is in effect to prevent loss of coverage for the children.  When a premium case is cancel closed, it only restores eligibility; it does not provide coverage for the children.  Program and Policy staff must coordinate with MO HealthNet Division to ensure that the children receive coverage once a premium case has been cancel closed.  A block in FAMIS prevents cancel closing on premium Eligibility Units when at least one member of the EU was eligible as a CHIP73, CHIP74 or CHIP75. A Family Support Division supervisor will receive the following message, “Premium level of care CCL action, restricted to Program and Policy” when attempting to cancel close a premium case. An eligibility specialist will receive the message, “Security profile not found” when attempting to cancel close a premium case.   Continue to submit requests for cancel closings by e-mail to Program and Policy staff through normal supervisory channels to Jessie Maupin at Jessie.F.Maupin@dss.mo.gov.  Program and Policy will inform supervisory staff when the cancel close is complete.  The eligibility specialist must then complete the reinvestigation in FAMIS.

EXAMPLE: Ms. Green’s reinvestigation is due in February 2009. Ms. Green failed to complete and return her reinvestigation form for her MO HealthNet for Kids premium case by the due date, and the case closed for failure to complete the reinvestigation.  On February 26, 2009, Ms. Green provides her completed reinvestigation form. The eligibility specialist’s supervisor notified Program and Policy, and the case is cancel closed the same day.  The same day the eligibility specialist completes the reinvestigation in FAMIS following current procedures.

0920.040.00  INTERIM CHANGES (MO HealthNet for Kids)

IM-21 March 5, 2008,  IM-#83 August 2, 2005,  IM-#04 January 12, 2001 Changes in income and household composition may cause a family to change to a different eligibility group. The following are the procedures to use when a change in eligibility is reported or discovered.
  1. From no premium to premium (LOC Q (MC+100, MC+133, or MC+185 in FAMIS) or LOC 1 (CHIP0 in FAMIS) to LOC 2 (CHIP73 or CHIP74 in FAMIS) or LOC 3 (CHIP75 IN FAMIS)).
    1. An Adverse Action (FA410) must be sent to notify the participant of the requirement to pay a premium. The Adverse Action informs the participant that current non-premium level of care will end and a premium payment is required to continue to receive MO HealthNet coverage.
    2. Once the Adverse Action (FA410) expires, the Action Notice (FA450) is sent. The Action Notice states coverage continues for 60 days, and that a premium payment is required to receive coverage past the 60th day. If the premium is not received by the end of the 60-day period, coverage in the non-premium LOC ends and eligibility for premium coverage is closed.
  2. From premium to no premium (LOC 2 (CHIP73 or CHIP74 in FAMIS) or LOC 3 (CHIP75 in FAMIS) to LOC Q (MC+100, MC+133, or MC+185 in FAMIS) or LOC 1 (CHIP0 in FAMIS)). When a change is entered into the FAMIS system which results in a change from premium to non premium, FAMIS will change the individual to the appropriate level or care. The eligibility date for the non-premium level of care starts the first of the month of non-premium eligibility. Any refund of premiums will be determined by MO HealthNet Division.

Other level of care changes. Any time there is a change in the level of care, an Action Notice (FA450) it sent to notify the family of the effect of the change. An Adverse Action (FA410) is not required when the LOC changes from a non-premium level of care to another non-premium level (example: family´┐Żs income increases, changing child from MC+133 to CHIP0).

0920.040.05  Adding A Person (MC+ Children, CP)

IM-#12 January 20, 2000

This requirement is the same as for MAF. Refer to Section 0905.025.20.