This section contains application processes for all MO HealthNet programs that use MAGI Methodology:
To be considered for MO HealthNet benefits an application is required if:
NOTE: If a person is being added to an active case or not receiving benefits but in an active case in MEDES, any action to add a person or request coverage is considered a Change in Circumstance (CiC). (Refer to 1885.000.00 INTERIM CHANGES for information regarding CiC)
Requests for Benefits and Signing the Application provide clarification on who can apply and sign applications.
42 CFR 435.907 under authority of the Social Security Act provides requirements for application, determination of eligibility and furnishing of assistance for MO HealthNet programs.
13 CSR 40-7.015 outlines the state guidelines when applying for a MAGI program including:
Individuals may apply for Family MO HealthNet programs online, by mail, in person, or by telephone.
Applications submitted by mail, drop off, or commonly available electronic means shall be accepted and processed the same as an in-person filing of an application. The application date is the date the SIGNED application is received in the FSD office, or the date that the signed application is received by a contracted agency.
If an electronic or dropped off application is received after normal business hours or on a weekend or holiday, the application date is the next working day, unless the application is taken by a FSD contracted agency such as a Federally Qualified Health Center.
Allow the claimant to apply and make sure the application is signed. Date stamp the application with the date it is received by FSD.
If a request for a Family MO HealthNet application is received by mail, a paper IM-1SSL application must be sent by the next business day. Along with the application, include an Application Request notice and a copy of the IM-4 Finding Help Brochure.
Electronic applications are accepted on-line at https://mydss.mo.gov/ for all Family MO HealthNet programs.
If a request for application is received by telephone and:
If a request is received and the person is unable to file an application in person, on-line, by telephone, or by mail, staff should consult their immediate supervisor. The supervisor should then contact the individual to discuss the need for an in home visit. If the supervisor gives approval, staff should complete the in home visit within one week of the request, if possible. The application date is the day FSD receives asignedapplication.
Refer to manual section 1802.020.00 SIGNING THE APPLICATION when a request for assistance is made through a third party (i.e., hospital, or agency).
NOTE: Always remember that protected information may only be disclosed to someone who is a legal guardian, authorized representative, or Public Administrator.
Applications for the Family MO HealthNet program must be available and accepted at FQHCs and DSHs. If a FQHC or DSH does not have an eligibility specialist on site, the facility's staff is allowed to accept applications and forward them to the local FSD office.
These same procedures apply to other facilities that contract with FSD to accept MO HealthNet applications. All contracted facilities are required to send paper applications to FSD within 5 business days.
The date of the application is the date it is received by the FQHC, DSH, or contracted agency.
Instructions below should be followed in these specialized application procedures:
Necessary verification to determine continued eligibility must be requested using a Request for Information (IM-31A) form. See Income Maintenance Manual section 1805.000.00 for verification requirements.
NOTE:Moving a recipient from one Family MO HealthNet category of assistance to another does not require a new application.
When an individual is a mandatory member of a household with an existing application, the individual will be considered to be included in the application as of the date the individual is required to be included in the assistance group.
A signed application is not required to add a person to an active MO HealthNet case. (Refer to 1885.010.00 ADDING A PERSON)
If an applicant has previously applied for or received assistance from FSD, there should be an existing record. After receiving a new signed application, review the existing pieces of evidence and compare the existing evidence with changes that may have occurred since the case closed.
No further documentation is needed for eligibility factors previously provided or verified. Identity, date of birth, Social Security number, or citizenship that is un-changed should still be available in the applicant's record.
The following individuals may apply for all Family MO HealthNet Programs (as shown in section 1802.000.00 APPLICATIONS) on behalf of a participant:
NOTE: Acting responsibly and signing an application does not qualify the person as an authorized representative. Their authority is limited to making the application valid.
NOTE: Although minors may apply on their own behalf in certain circumstances, their household composition must still follow the household composition rules in MAGI manual sections 1805.030.10 MAGI Household Composition through 1805.030.10.25 Caretakers Relatives,
If the participant is an unaccompanied minor age fifteen (15) or under and applying without a responsible adult, explore the following:
If the child is not living with a responsible adult, report this to Children’s Division through the Mandated Online Reporting site found at https://dss.mo.gov/cd/can.htm. FSD staff must complete the online referral with all known information.
The Family Support Division (FSD) requires that paper applications be made on Family Support Division application forms, and that they are signed under a penalty of perjury.
An application form is not considered a valid application without a customer's signature. The date of application is the date the application is received by FSD or the date that the application is received by a contracted agency and contains a signature.
If a customer is dropping off an application, FSD staff should review the application to ensure all questions are answered and the customer has signed the application before the customer leaves the FSD office.
NOTE: If address information is missing or an invalid mailing address is given, staff should attempt to locate an address through FAMIS, MODL, IIVE or Work Number. If staff are unable to establish a valid address, the application should be desk rejected for reason of “Unable to Locate.”
Return any original unsigned application with the IM-1SSL Signature Request Letter and an FSD addressed envelope to the customer within three business days.
If the signature is by mark, two witnesses are necessary. If the signature is made by mark, the mark should be identified as such and enclosed in parenthesis with the claimant's name written or typed as shown. The signature and address of the two witnesses should be entered in the space provided.
EXAMPLE: First name, middle initial, last name, address.
Witnesses: Jane Smith, 123 Sunrise St. Louis, MO 63108
John Smith, 123 Sunrise St. Louis, MO 63108
Applications received through the on-line process at https://mydss.mo.gov/ include an electronic signature.
When an individual applies by telephone a recording is made of his/her voice. This recording is used as a telephonic signature for that application.
Applications submitted by mail or dropped off at a FSD office should be accepted and processed the same as an in-person application. The application date is the date a signed application is received in a FSD office or by a contracted agency. If a dropped-off application is received after normal business hours, or on a weekend or holiday, the application date will be the next business day.
EXCEPTION:If an application is placed in a FSD drop-box by a contracted agency, the application date will be the date the contracted agency received the application. Examples of a contracted agency are the Department of Mental Health, or a clinic that has a contract with the Department of Social Services to accept MO HealthNet applications.
See Income Maintenance Manual section 0130.020 Authorized Representative(s) for MO HealthNet for information on who can appoint an authorized representative, who can be an authorized representative, duties and responsibilities of the agency and authorized representative, and the duration of the Appointment of Authorized Representative.
If the applicant has an appointed authorized representative, either the applicant or the authorized representative can sign and complete the application.
NOTE:An applicant, age 19 or older, who applies on their own may designate an Authorized Representative at any time to assist them in completing the application process.
The authorized representative may sign the application form and answer any necessary questions during the application process. If further information or documentation is needed, provide a Request for Information (IM-31A) form to the authorized representative, and provide a copy of the form to the applicant. Forms that authorize release of information to FSD must be signed by the applicant or by the individual in the household whose information must be verified. The authorized representative has the responsibility to assist with obtaining the signed release(s) as part of the application process.
If needed, an interview may be conducted with the applicant and/or the authorized representative. The applicant's presence at the interview is not required when an authorized representative has been appointed.
Following current procedure, the ES must add the appointed authorized representative(s) to MEDES within 2 business days of receipt of the designation of an authorized representative on the IM-1SSL or completed IM-6AR. An individual may appoint more than one authorized representative.
NOTE:Death of an applicant who has appointed an authorized representative to apply on his/her behalf voids the appointment of the authorized representative, even when the application has been filed and the eligibility determination has not been completed. See Income Maintenance Manual sections 1802.020.50.05 Death after Application and 1802.020.50.10 Application for Deceased Persons for more information.
If the applicant is not capable of signing an application, due to physical or mental impairment, a relative who meets criteria shown in manual section 1802.020.00 Signing the Application may sign the application. Inform the relative that the applicant is responsible to ensure complete and correct information is provided on the application. Signatures for applications signed by relatives should be in the following format: (applicant first and last name) by (relative first and last name), (relationship)
EXAMPLE:Mary Jones is the mother of Jane Jones who is pregnant. Jane has signed the portion of the application giving her mother permission to be her authorized representative. Mary should sign the application as follows – Jane Jones by Mary Jones, mother of Jane.
NOTE:The designation of an authorized representative on the IM-1SSL or completed Appointment of Authorized Representative (IM6-AR) form must be signed by the applicant. Relatives cannot appoint an authorized representative on behalf of an applicant.
If the applicant has a court appointed conservator, instruct the conservator to sign and complete the application.
If the applicant has a court appointed guardian, either the guardian or the applicant may sign the application.
If participant has legal guardian or conservator, obtain documentation. If needed, conduct the interview with the guardian or conservator. The applicant's presence is not required.
Add the Legal Guardian or Conservator as per current MEDES procedure.
If the applicant is deceased, the application must be signed by a court appointed personal representative, administrator or executor of the deceased applicant's estate, or a surviving spouse who has obtained a refusal of letters or has filed a valid small estate affidavit.
EXCEPTION:A legal representative may file a small estate affidavit to sign an application on behalf of the deceased.
NOTE:If the applicant's date of death occurred before the prior quarter period (the three months immediately before the month of application) the application will be rejected.
Obtain documentation of appointment as administrator or executor of the estate. Add the court appointed administrator or executor of the deceased applicant's estate as per current MEDES procedure.
NOTE:When an applicant is deceased, a relative, legal guardian, or conservator cannot appoint another person or agency to be an authorized representative for the applicant. The court appointed personal representative, administrator, or executor of the estate may appoint an authorized representative. See Authorized Representative(s) below and Income Maintenance Manual section 0130.020 Authorized Representative(s) for MO HealthNet,
See Income Maintenance Manual sections 1802.020.50.05 Death after Application and 1802.020.50.10 Application for Deceased Persons for more information.
If the applicant dies before a determination is made on a pending application, if possible, complete the application. If unable to complete the application, contact a legal guardian, personal representative, administrator, or executor of the deceased applicant's estate to determine if they are willing and able to furnish the information necessary to establish eligibility. If there is a personal representative, administrator, or executor of the estate obtain documentation of court appointment.
Send all requests for information, notices, and other correspondence to the applicant's address, and to any appointed personal representative, administrator, or executor of the deceased applicant's estate.
In the event there is no court appointed personal representative, administrator or executor of the deceased applicant's estate, and the application was received prior to the applicant's death, FSD will follow the application process through to resolution. FSD will make and document efforts to gather information necessary to determine eligibility on the applicant's behalf, but the application must be rejected if it is not possible to obtain information needed to determine eligibility.
NOTE:Death of an applicant who has appointed an authorized representative to apply on his/her behalf voids the appointment of the authorized representative, even when the application has been filed and the eligibility determination has not been completed. A manual Notice of Case Action (IM-33) form must be sent to applicant's address, indicating that applicant is deceased and appointment of authorized representative is no longer valid.
NOTE:A deceased person's application may be approved for MO HealthNet for a time period while they were living.
When a personal representative, administrator, or executor of the estate of a deceased person requests MO HealthNet for the deceased person, the date of request is the date the signed application is received. The date of application determines the months that can be included in the prior quarter, if prior quarter coverage is needed. See Income Maintenance Manual section 0105.010.00 Signing the Application for information on who may sign the application on behalf of the deceased individual.
A court appointed personal representative, administrator, or executor of the deceased applicant's estate has legal authority to apply for and/or follow the application process through to resolution, including the hearing process. Obtain documentation of legal appointed status. Add the court appointed personal representative, administrator, or executor of the deceased applicant's estate as per current MEDES procedure.
NOTE:Death of an applicant who has appointed an authorized representative to apply on his/her behalf voids the appointment of the authorized representative. If an application is presented by an authorized representative after the death of the applicant follow current MEDES procedure for a desk rejection and a Notice of Case Action (IM-33) must be sent to applicant's address, indicating the application is rejected because the applicant is deceased and appointment of authorized representative is no longer valid.
NOTE:When an applicant/participant is deceased, a court appointed personal representative, administrator, or executor of the estate can appoint another person to be an authorized representative for the applicant/participant. See Income Maintenance Manual section 0130.020 Authorized Representative(s) for MO HealthNet,
If all eligibility requirements are met, approve the MO HealthNet coverage. If the deceased individual was eligible for benefits in the month that he/she died, the date of death is the termination date for the MO HealthNet coverage.
Filer consent is required at application and annual renewal. Filer consent is the applicant's or participant's consent which allows FSD to confirm the individual's self-attestation of their circumstance by information obtained electronically through external data sources.
NOTE:The applicant, or an adult member of the MAGI household, may give filer consent for the entire household.
External data sources refer to information from federal data sources (Hub Calls).
Information from state data sources and FSD data sources may be gathered without filer consent.
NOTE: When a received application does not give filer consent for the use of external data sources, this means the applicant does not give FSD permission to contact the Federal Data HUB to verify their self-attested statement. When this occurs, State and FSD data sources should be used to obtain the needed information. If information still cannot be obtained, it is acceptable to request the necessary documentation from the applicant.
When an application is received from either the Federally Facilitated Marketplace (FFM) or through myDSS Client Portal, consent is assumed for the initial application. To complete annual renewals after the first year, filer consent must be obtained. Filer consent may be given for 0 – 5 years.
Consent is given in one of the following ways:
Consent may be changed or removed at any time. This can be done in writing or over-the-phone by the individual or by the authorized representative.
The application date is the date a SIGNED application is received by FSD, or the date that a signed application is received by a contracted agency.
Applications submitted by mail, drop off, or electronic transmission (faxed or on-line) will be accepted and processed the same as an in-person filing of an application.
NOTE: If an electronic or dropped off application is received after normal business hours or on a weekend or holiday, the application date is the next working day, unless the application is taken by a FSD contracted agency such as a Federally Qualified Health Center.
EXCEPTIONS:The date of a MO HealthNet application made at Federally Qualified Health Centers, Disproportionate Share Hospitals, and Rural Health Centers (local Health Departments) contracted with FSD which have no Eligibility Specialists on site, is the date the contracted facility's staff receive the signed application. Therefore, the application date is the same as if it were taken by FSD staff. See Manual Section 1802.010.70,
NOTE:Not all Disproportionate Share Hospitals, FQHC's, and RHC's are contracted with FSD to take or accept applications on behalf of FSD. Send an email through normal supervisory channels to Cole.MHNPolicy@dss.mo.gov when necessary to verify contract status.
All applications must be processed without delay unless unusual or extreme circumstances exist. Complete the eligibility determination to ensure an applicant is mailed his/her notice of approval or denial in a timely manner. Application timeframes are as follows:
If the application cannot be completed promptly due to an extreme circumstance the Eligibility Specialist must enter a comment per current MEDES process.
An application may be rejected prior to the due date if the case is found to be ineligible on one of the following eligibility factors:
The following are examples of eligibility factors staff cannot reject for:
There are limited reasons for cancelling a rejection:
NOTE:Do not cancel a rejection unless ALL requested verification is provided.