Per 42 CFR 435.916, applicants must be able to report a Change In Circumstances (CIC) online, by telephone, by mail, in person or through other electronic means.
A CIC may be received from different sources:
Per 42 CFR 435.912, a CIC is a redetermination of eligibility. When a CIC occurs that could potentially affect eligibility, households have ten (10) calendar days to report the change to FSD. FSD must process the reported change and provide the household with notification of the change within 10 days of the change taking effect on the case.
EXAMPLE: Joe and his son, George, are active MO HealthNet for Families (MHF). Lula, George's mother moved in with Joe and George on March 5th. Joe is required to report the change by March 15th; FSD will process the CIC and provide Joe with all necessary adverse action notices and action notice within 45 days from March 15th (the date the change was reported).
For changes reported timely, within 10 days of the date the change occurred, the action is taken from the date the change occurred. If the change is reported non-timely, more than 10 days after the change occurred, action is taken from the date reported.
NOTE: Do not take away coverage that has already given;, a claim should be established when necessary. When reported untimely, CHIP refunds are not issued.
EXCEPTION: Newborns born to a woman eligible for Title XIX MO HealthNet coverage at the date of the child's birth receive coverage back to the date of birth. This applies regardless if the birth of the child was reported timely or untimely. If there is an individual(s) in the household whose eligibility is impacted due to the birth of the child, the changes are taken as of the report date whether the birth was reported timely or untimely.
EXAMPLE: Darlene's employment at the local factory ended in November 15, 2014. Darlene was laid off due to low work demand. Darlene failed to report this information to FSD timely. She reported the change on April 28, 2015. The change will be effective as of the report date, April 28, 2015. Darlene's two children are on CHIP 73. With the change in Darlene's income her children are eligible for CHIP 0. Since the change was not reported timely she will not be issued a refund for the CHIP payments from December 2014 through April 2015. CHIP 0 coverage for Darlene's two children will begin May 1st. Send an action notice (IM-33C) to notify the household of the changes applied to the case. An adverse action (IM-80) period is not required as this is a better level of coverage and therefore a positive change.
EXAMPLE: Ginger gave birth to her child, Jacob, on June 1st. Ginger was receiving coverage under a Title XIX MO HealthNet program on the date the child was born. The hospital where Jacob was born reported his birth to FSD on June 2nd. Ginger has another child at home, Adam age 5, of whom she is the custodial parent. Adam is currently receiving CHIP 74. FSD processed the CIC on June 7th to add Jacob to Ginger's household, which impacted Adam's coverage. By adding Jacob to the household, Adam's MO HealthNet coverage changed to CHIP 0. Jacob is eligible for Newborn coverage effective with his date of birth, June 1st. The change in Adam's coverage is effective with the date of the change, not the report date, because the CIC was reported timely. Send an action notice (IM-33C) to notify the household of the changes applied to the case. An adverse action (IM-80) period is not required as this is a better level of coverage and therefore a positive change.
EXAMPLE: Mary gave birth to her child, Riley, on February 18th. Mary was receiving coverage under a Title XIX MO HealthNet program on the date Riley was born. Riley's birth was reported to FSD on May 10th. Mary is married to Stewart and they have two other children, Zach (7) and Sam (3). Zach and Sam have both been receiving CHIP 75 MO HealthNet coverage since December. FSD processed the CIC to add Riley to the household on May 15th. Adding Riley to the household caused Zach and Sam's coverage to change from CHIP 75 to CHIP 74. The CIC (Riley's birth) was not reported untimely, and the MO HealthNet level of coverage change for Zach and Sam is effective as of the report date, May 10th. Riley is eligible for Newborn coverage effective February 18th, his date of birth. Send an action notice (IM-33C) to notify the household of the changes applied to the case. An adverse action (IM-80) period is not required as this is a better level of coverage and therefore a positive change.
Interim CIC may result in completion of the Annual Renewal; this is known as a floating review. Changes such as an income change, household composition, or any change that affects the budget, will complete the review. The certification period will be reset according to the date the change was reported.
EXAMPLE: Joe is the father and custodial parent, of George (4). Joe and George are receiving MHF with the certification period of July 1, 2016 to July 31, 2017. Joe reported that George's mother, Lula, moved into the home on March 5, 2017. Adding Lula to the household changed the household composition and budget, therefore completing a "floating" annual review. The new certification period is reset to April 1, 2017 through April 30, 2018; the beginning of the month in which the changes are in effect.
Voluntary closings are only acted upon when a request to close a MO HealthNet case is received from a responsible member of the household or Authorized Representative. Do not accept the request to voluntarily close a case from: a minor child of the household who is not the head of the household, or from any other persons or sources outside of the household.
EXAMPLE: Matilda is the head of the household for herself, her spouse Tyler, and their child Dominick. Tyler submitted in writing that he would like MHN benefits closed for himself only. Since Tyler is not the head of the household, Matilda is sent the 10 day Adverse Action (IM-80) notice. Once the adverse action period expires, Tyler's MHN benefits in Matilda's household hold are closed and she is sent an Action Notice (IM-33C).
NOTE: An individual cannot receive MHN benefits in another household until benefits have completely closed in the original household.
When individuals age out of a MAGI MO HealthNet (MHN) based program, an ex-parte review must be completed to explore eligibility for other MO HealthNet MAGI programs.
NOTE: : When an individual ages out of a MHN program, eligibility ends on the individual’s birthday. Coverage does not extend to the end of the month. For eligibility and coverage begin and end dates refer to the Family Healthcare Processing, Eligibility and Coverage Dates table.
Section 1902 of the Social Security Act provides that at the age of 65 all participants age out of MAGI MO HealthNet Programs (MHN), unless otherwise indicated by the specific MHN program policy.
Section 208.040 RSMo states to be eligible for MO HealthNet for Families (MHF), a child must be under the age of 19 years. However, the child must be a high school student and expected to graduate high school, for the child to receive MHF between the ages of 18 and 19. This is also known as the MHF Student Extension.
NOTE: FSD has 45 days to complete the CIC from the date the change is reported. FSD must input the change, send the adverse action notices (IM-80PRE and the IM-80) as necessary, and the action notice all within the 45 day timeframe. If the child is found not to be a high school student, by the child’s 18th birthday an ex-parte review is completed to explore potential eligibility for other MHN programs. Student status is verified by self-attestation unless questionable.
When a child does not meet the MHF Student Extension and is no longer eligible for MHF, and there are no other MHF eligible children in the parent/caretaker’s household, the parent/caretaker is no longer eligible for MHF. When the student meets the extension criteria, the parent/caretaker can continue to receive MHF during the extension period.
EXAMPLE: Annie's household consists of herself and her mother, Joann. Both Annie and Joann have MHF coverage. Annie graduated high school early, at age 17. Since Annie is not a high school student when she turns 18, an ex-parte review is completed. It is found that Annie is eligible for MO HealthNet for Kids (MHK). Joann no longer has an eligible child in the home and therefore cannot receive MHF;, Joann's eligibility is closed.
NOTE: The MHF Student Extension only applies to MO HealthNet for Families (MHF). A child can receive MO HealthNet for Kids (MHK) until the age of 19 without meeting a student status requirement.
An individual may be added to an existing MAGI MO HealthNet case without the need for a new application. A request to add a person can be received through all current acceptable reporting methods; the request does not have to be in writing.
The request to add a person may be received:
The request to add a person to an existing case can be received at any time: as part of the Annual Renewal, or any time a household reports a new person in the home.
NOTE: The addition of a Newborn (a child born to a women who is receiving or eligible to receive Title XIX coverage at the date of birth including when the birth is during the prior quarter period or when the MPW application is made after the birth) to a household is treated the same as adding an individual to another MO HealthNet program. The birth of the child must be reported prior to adding the child to a case.
Requests to add a person may also be a request to change the status of a person already in the household from included to active.
If sufficient information is already present in the case record to establish eligibility for the person the addition is being requested, add the person. If there is not enough information to establish eligibility for the person being added, request the needed information.
NOTE: It is not necessary to re-verify income of persons currently included in the assistance group unless an income change is reported that is not reasonably compatible with the previously verified income.
If a person has MO HealthNet coverage in another household, or is included in another household, the tax filing status, relationships and custody arrangements must be gathered when adding the individual to the new household.
The individual being added can be included in multiple households; however, s/he cannot receive benefits in more than one household at a time.
EXAMPLE: Billy is the custodial father of Claire (10). Claire currently receives MHK with Billy as the head of the household. Recently, Billy reported that his son, Andy (3), moved into the home with him and Claire on a part-time basis. Andy already receives MHK benefits in his mother's household. Andy's mother continues to be his custodial parent, by exercising more than 50% physical custody. Billy will continue to claim Claire and Andy as tax dependents.
Outcome: Billy is included in one MAGI household (Claire's), Claire is included in one MAGI household (her own), and Andy is included in two MAGI households (his own and Claire's).
NOTE: Andy is included in Claire's MAGI household since they are both Billy's tax dependents even though he does not reside with them more than 50% of the time.
EXAMPLE: Sandy receives MHF with her child, Patrick. Sandy reported she married Bob on April 25th. Prior to Sandy reporting the change, Bob received MHF in another MAGI household with his child, Bailey. Bailey's mother, Karen, remains the custodial parent as she practices more than 50% physical care and control of Bailey. Karen also receives MHF with Bailey as a member of her MAGI household. Sandy and Bob intend to file taxes jointly and to claim Patrick and Bailey as tax dependents.
Outcome: Bob is included in three MAGI households (his own, Sandy's and Patrick's), Sandy is included in three MAGI households (her own, Bob's and Patrick's), Patrick is included in three household compositions (his own, Sandy's and Bob's), and Bailey is included in five MAGI households (her own, Bob's, Sandy's, Patrick's and Karen's).
NOTE: Since Patrick is the tax dependent of Sandy and Bob, all of their tax dependents will be included in Patrick's MAGI household composition. In this case, Bailey should be included in Patrick's MAGI household composition since she is Sandy and Bob's tax dependent, even though she does not reside in their home more than 50% of the time.
NOTE: For more information regarding joint custody situations and household composition, refer to MAGI Manual sections 1805.030.10.20.05 JOINT CUSTODY and 1805.030.10 MAGI HOUSEHOLD COMPOSITION.
Enter a comment to explain the addition of the new individual to the household
When applicable, request information for medical support cooperation. Refer to MAGI Manual section, 1805.040.00 Cooperation in Pursuit of Medical Support.
When it is reported that a household member is leaving action should be taken to remove the person from the home.
Review the tax filing status and relationships. Determine the following:
When the head of the household is the individual being removed from the home, coverage ends for the entire household. Another individual must reapply for the household.
EXAMPLE: Steven and Melissa are actively receiving MHF with their two children. Melissa reported that Steven is now incarcerated and no longer in the home. Melissa attests that Steven intends to continue to claim their children as tax dependents; however, she is exercising more than 50% physical custody and care of the children.
Outcome: The children are being claimed by a non-custodial parent and therefore fall under non-tax filer rules. Melissa can continue to receive MHF with the children as she is the custodial parent (exercising more than 50% physical custody and care of the children). Melissa's household consists of herself and her two children. Since the children now fall under non-tax filer rules, their household composition will consist of themselves, their sibling and Melissa. Steven is ineligible because he is incarcerated/out of the home and the non-custodial parent.
If the individual being removed is the only MO HealthNet for Families (MHF) eligible child in the home, MHF ends for the parent/caretakers as well. This applies regardless of the tax filing status. The parent/caretaker no longer meets an eligible living arrangement. Refer to MAGI Manual section, 1805.030.10.20 JOINT CUSTODY.
NOTE: When the individual being removed is not the only MHF eligible child in the home, coverage may not end for the other household members. Depending on the intended tax filing status and other qualifying criteria,, the individual may continue to be included in someone's household regardless of whether or not they reside in the home. However, an individual may not receive benefits in two homes at the same time.
Inform the household from which the individual is being removed prior to the action to remove the person takes effect. Send an action notice (IM-33C) to the household from which the individual is being removed.
NOTE: If the request to remove a person is received in writing, the 10 day adverse action (IM-80) period does not need to be given. Send the action notice (IM-33C) to inform the household that the individual has been removed.
When an individual is unable to locate, his/her MO HealthNet eligibility ends. Unable to locate can be determined by returned mail from the Post Office.
The Post Office must mark the returned mail one of the following to be determined Unable to Locate:
When returned mail is received, review sources available to FSD, such as FAMIS, for a current address or telephone number. Attempt phone contact with the household to confirm their residency and mailing address.
Notification from the Post Office - 42 CFR 431.213(d) provides an exception to the 10 day Adverse Action (IM-80) period when the individual's whereabouts are unknown and the Post Office returns agency mail. Send an Action Notices (IM-33C) notifying the individual the case has been closed because they are unable to locate.
Missouri residency is a condition of eligibility; MO HealthNet for Pregnant Women (MPW) and Newborn cases are not be treated differently when the individual moves out of state or is unable to locate.
NOTE: A Newborn (a child born to a women who was covered by a Title XIX MO HealthNet program at the child's date of birth) that moves out of Missouri and then move back within his/her first year of life, must have Newborn coverage reopened. Income does not have to be reviewed. The Newborn is guaranteed coverage for the first year of life when he/she is a resident of Missouri.