Under 42 CFR 435.909, prior to stopping a participant's coverage under most MO HealthNet categories, with the exception of failure to cooperate, it is mandatory to explore possible eligibility under all other MO HealthNet programs. Eligibility criteria or changes in circumstance such as pregnancy, income, age, or household composition may allow a participant to move from one Family MO HealthNet program another without a new application.
NOTE: Possible eligibility for MO HealthNet for Aged, Blind or Disabled (MHABD) must also be explored if the individual claims a disability, is blind or aged (age 65 or older).
This process is called ex parte review.
NOTE: 42 CFR 435.907 specifies that applications or existing coverage moving from MAGI to non-MAGI programs may use new applications or supplemental forms to capture information needed for non-MAGI programs.
NOTE: Some MO HealthNet programs have different program eligibility and verification requirements than MAGI programs. Participants may be required to submit additional paperwork for these programs.
If ending eligibility from one category and approving in another, process both transactions on the same day to prevent any disruption in healthcare coverage.
The following programs are time limited and will not generate Adverse Action Notices at the end of their time period:
The households are informed of the coverage timeframes at the point of approval. When coverage for these programs ends, an ex-parte review is required. If no other eligibility exists when closing these cases, the Eligibility Specialist must send an appropriate IM-33 notice.