If other eligibility cannot be established from the record, third party verification, or the participant fails to return the necessary paperwork, send the Pre-Closing Review Notice (IM-80PRE) to inquire about pregnancy, blindness, disability, and changes in income.
If the individual responds to the Pre-Closing Review Notice within the ten (10) days indicating other possible eligibility, register the proper application and allow the current benefits to remain open pending the eligibility determination for the other category. A new signed application from the individual is not required to switch categories. If a participant claims disability or blindness, use the IM-1MA when determining eligibility under MHABD/MHDC. Do not end one category of coverage before approval in the other category or until the participant is determined ineligible for any coverage.
If there is no response from the participant within ten (10) days indicating any other possible eligibility, initiate an Adverse Action Notice (IM-80) explaining:
NOTE: If the participant did not respond prior to the expiration of the Pre-Closing Review Notice but does respond indicating other possible eligibility prior to the expiration of the Adverse Action Notice, follow the instructions above for individuals who respond to the Pre-Closing Review Notice.
NOTE: There are no appeal rights with the Pre-Closing Review Notice since this is not an adverse action notice. If the final decision results in an adverse action, the IM-80 is required and normal hearing rights are allowed.
If eligibility exists under another category, close the current active case and approve the other category on the same date.
Notify the participant of approval for MHABD/MHDC or other MO HealthNet program with a statement that eligibility no longer exists under the previous MO HealthNet level of care.
Notify the participant of the switch from one MAGI program to another MAGI program with a statement that eligibility no longer exists for the current program.
If the participant is determined ineligible based on pregnancy, disability, blindness, or change in income criteria, send an Adverse Action Notice (IM-80), specifying the reason eligibility for MO HealthNet does not exist. State the reason for the denial in the new category as well as the reason for loss of eligibility for current MO HealthNet benefits. The Adverse Action Notice provides appeal rights. Close the MO HealthNet active case once the Adverse Action Notice expires and send an IM-33C Action Notice.