| 1800.000.00 |
FAMILY MO HEALTHNET PROGRAMS |
| 1800.005.00 |
LEGAL BASIS |
| 1802.000.00 |
APPLICATIONS |
| 1802.005.00 |
LEGAL BASIS |
| 1802.010.00 |
REQUESTS FOR BENEFITS |
| 802.010.10 |
Request in Person |
| 1802.010.20 |
Request by Mail |
| 1802.010.30 |
On-line Application |
| 1802.010.40 |
Request by Telephone |
| 1802.010.50 |
Request for In Home Application |
| 1802.010.60 |
Request Received Through Third Party |
| 1802.010.70 |
MO HealthNet Requests at Federally Qualified Healthcare Centers (FQHC) and Disproportionate Share Hospitals (DSH) |
| 1802.010.80 |
Specialized Application Procedures |
| 1802.010.80.05 |
Adding a Person to an Existing Application |
| 1802.010.80.10 |
Applications on a Closed Case |
| 1802.020.00 |
SIGNING THE APPLICATION |
| 1802.020.05 |
Application with No Signature |
| 1802.020.10 |
Signing By Mark |
| 1802.020.15 |
Electronic Signature |
| 1802.020.20 |
Telephonic Signature |
| 1802.020.25 |
Mail-in or Drop-off Application |
| 1802.020.30 |
Signing by an Authorized Representative |
| 1802.020.35 |
Signing By a Relative |
| 1802.020.40 |
Signing By a Legal Guardian or Conservator |
| 1802.020.45 |
Signing on Behalf of a Deceased Applicant |
| 1802.020.45.05 |
Death after Application |
| 1802.020.45.10 |
Application for Deceased Persons |
| 1802.030.00 |
FILER CONSENT |
| 1802.040.00 |
DATING THE APPLICATION |
| 1802.050.00 |
APPLICATION TIMEFRAMES |
| 1802.050.10 |
Cancel Rejections |
| 1805.000.00 |
ELIGIBILITY AND VERIFICATION |
| 1805.000.02 |
Federal Hub Calls |
| 1805.000.05 |
Reasonable Opportunity |
| 1805.000.05.05 |
Reapplication After 90-Day Reasonable Opportunity |
| 1805.005.00 |
RESIDENT OF MISSOURI |
| 1805.010.00 |
AGE AND DATE OF BIRTH |
| 1805.015.00 |
SOCIAL SECURITY NUMBER |
| 1805.015.05 |
Failure to Complete a SSN Application or Furnish a SSN |
| 1805.020.00 |
CITIZENSHIP AND IMMIGRANT STATUS |
| 1805.020.05 |
Citizenship |
| 1805.020.05.05 |
Documents to Verify Citizenship |
| 1805.020.10 |
Qualified Immigrant |
| 1805.020.10.05 |
Qualified Immigrants Entering Prior To 8/22/96 |
| 1805.020.10.10 |
Qualified Immigrants Entering After 8/22/96 |
| 1805.020.10.10.05 |
Qualified Immigrants with No Waiting Period |
| 1805.020.10.10.10 |
Qualified Immigrants with a Five-Year Period of Ineligibility |
| 1805.020.10.15 |
Non-Qualified Immigrants |
| 1805.020.10.20 |
Immigrants from Micronesia, Palau, and Marshall Islands |
| 1805.020.15 |
Documentation and Verification of Alien or Immigrant Status |
| 1805.025.00 |
PREGNANCY |
| 1805.030.00 |
MODIFIED ADJUSTED GROSS INCOME (MAGI) METHODOLOGY |
| 1805.030.05 |
Income Evidence |
| 1805.030.10 |
MAGI Household Composition |
| 1805.030.10.05 |
Legal Basis |
| 1805.030.10.10 |
MAGI Household Composition for Tax Filers |
| 1805.030.10.15 |
MAGI Household Composition for Non-Tax Filers |
| 1805.030.10.20 |
Exceptions to MAGI Household Composition |
| 1805.030.10.20.05 |
JOINT CUSTODY |
| 1805.030.10.25 |
Caretakers Relatives |
| 1805.030.15 |
Reasonable Compatibility |
| 1805.030.20 |
Income, Deductions, and the Five Percent (5%) Disregard |
| 1805.030.20.05 |
Income Included Under MAGI |
| 1805.030.20.10 |
Income Excluded Under MAGI |
| 1805.030.20.15 |
Allowable Deductions |
| 1805.030.20.20 |
Five Percent Disregard - Legal Basis |
| 1805.030.20.20.05 |
Calculation of the Five Percent Disregard |
| 1805.030.25 |
Determining MAGI |
| 1805.030.25.05 |
Projection of MAGI |
| 1805.030.25.10 |
Patterns of Income |
| 1805.030.25.15 |
Specific Types of Income |
| 1805.035.00 |
ADDING INCOME COMMENTS TO EVIDENCE |
| 1805.040.00 |
COOPERATION IN PURSUIT OF MEDICAL SUPPORT |
| 1805.040.05 |
Referral to FSD-CS |
| 1805.040.10 |
Notice/Good Cause for Refusal to Cooperate |
| 1805.040.10.05 |
Areas of Cooperation |
| 1805.040.10.10 |
Refusal to Cooperate/Claiming Good Cause |
| 1805.040.10.15 |
Good Cause Defined |
| 1805.040.10.15.05 |
Determining Good Cause |
| 1805.040.10.15.10 |
Types of Evidence to Support Good Cause |
| 1805.040.10.20 |
Sanctions for Non-cooperation |
| 1805.040.10.25 |
Cooperation and Referral to Child Support When Adding Children to an Active Case |
| 1805.050.00 |
Former Foster Care Youth |
| 1810.000.00 |
MO HEALTHNET FOR FAMILIES (MHF) |
| 1810.010.00 |
LEGAL BASIS |
| 1810.020.00 |
ELIGIBILITY REQUIREMENTS |
| 1810.020.10 |
Income Maximums/Need |
| 1810.020.20 |
Construction of MAGI Household for MHF |
| 1810.020.20.10 |
Relationship Of Child to Parent or Caretaker Relative |
| 1810.020.20.20 |
Eligibility for 18-year-olds |
| 1810.030.00 |
BEGIN AND END DATES FOR COVERAGE |
| 1810.030.10 |
Prior Quarter (PQ) |
| 1810.030.20 |
Transitional MO HealthNet |
| 1810.040.00 |
HEALTHCARE COVERAGE |
| 1820.000.00 |
TRANSITIONAL MO HEALTHNET (TMH) |
| 1820.010.00 |
LEGAL BASIS |
| 1820.015.00 |
TMH DEFINITIONS |
| 1820.020.00 |
COOPERATION IN PURSUIT OF MEDICAL SUPPORT (TMH) |
| 1820.030.00 |
ELIGIBILITY FOR INITIAL SIX MONTHS |
| 1820.030.10 |
Receipt of MHF in Three of Last Six Months |
| 1820.030.20 |
Notification of Initial TMH Eligibility |
| 1820.030.30 |
Ineligibility in First Six Months |
| 1820.030.40 |
Untimely Report Of Income Change Resulting in Ineligibility for MHF |
| 1820.030.50 |
Untimely Agency Action On Change |
| 1820.030.60 |
Eligible Household Member Leaves Household |
| 1820.040.00 |
ELIGIBILITY DURING THE SECOND SIX MONTH PERIOD |
| 1820.040.10 |
Budgeting For Income Eligibility |
| 1820.050.00 |
QUARTERLY REPORT REQUIREMENTS |
| 1820.050.10 |
Quarterly Report Completeness |
| 1820.050.20 |
Good Cause For Failure To Return Quarterly Report |
| 1820.050.30 |
Loss of TMH Eligibility after First Six Months |
| 1820.050.30.10 |
Reinstatement of TMH Eligibility for Six Month Closings |
| 1820.050.40 |
Suspended TMH Eligibility in Second Six Month Period |
| 1820.050.40.10 |
Reinstatement of Individuals Suspended On TMH |
| 1820.060.00 |
EX PARTE REVIEW WHEN TMH ENDS |
| 1820.060.10 |
Ex Parte Review Results |
| 1820.060.10.10 |
Administrative Hearings |
| 1830.000.00 |
MO HEALTHNET FOR KIDS (MHK) - NON-CHIP COVERAGE |
| 1830.005.00 |
LEGAL BASIS |
| 1830.010.00 |
ELIGIBILITY REQUIREMENTS |
| 1830.010.05 |
Income Maximums / Need |
| 1830.010.10 |
Budget Procedure |
| 1830.010.15 |
Referral to Family Support Division – Child Support (FSD-CS) |
| 1830.015.00 |
HEALTHCARE COVERAGE BEGIN AND END DATES |
| 1830.020.00 |
PRIOR QUARTER |
| 1840.000.00 |
MO HEALTHNET CHILDREN´S HEALTH INSURANCE PROGRAM |
| 1840.005.00 |
LEGAL BASIS (CHIP) |
| 1840.010.00 |
ELIGIBILITY REQUIREMENTS |
| 1840.010.05 |
Need |
| 1840.010.10 |
Uninsured |
| 1840.010.10.05 |
HIPP Effect on Uninsured Status |
| 1840.010.15 |
Access To Affordable Health Insurance |
| 1840.010.15.05 |
Affordable Insurance Definition |
| 1840.010.15.08 |
Affordability Test |
| 1840.010.15.10 |
Employer Sponsored Insurance |
| 1840.010.15.12 |
State Employee Health Insurance |
| 1840.010.15.15 |
Private Insurance |
| 1840.010.15.20 |
Special Healthcare Needs |
| 1840.015.00 |
BEGIN AND END DATES FOR CHIP COVERAGE |
| 1840.020.00 |
INTERIM CHANGES |
| 1840.020.05 |
From no premium to premium |
| 1840.020.10 |
From premium to no premium |
| 1840.020.15 |
Other level of care changes |
| 1840.020.20 |
Adding A Person |
| 1840.025.00 |
PAYMENT OF PREMIUM |
| 1840.025.05 |
Failure to Pay Initial Premium |
| 1840.025.10 |
Failure to Pay Premium After Coverage Begins |
| 1840.030.00 |
MO HEALTHNET DIVISION NOTICES FOR NON-PAYMENT OF PREMIUM |
| 1840.030.05 |
Initial and Recurring Invoices |
| 1840.030.10 |
Failure to Pay Notice |
| 1840.030.15 |
Notice of Case Action |
| 1840.030.20 |
Closing Letter |
| 1850.000.00 |
MO HEALTHNET FOR PREGNANT WOMEN |
| 1850.010.00 |
LEGAL BASIS |
| 1850.020.00 |
ELIGIBILITY REQUIREMENTS |
| 1850.020.10 |
Pregnant |
| 1850.020.20 |
Income Maximum/Need |
| 1850.020.20.10 |
Income Limits |
| 1850.030.00 |
PRIOR QUARTER (PQ) AND MONTH OF APPLICATION ELIGIBILITY |
| 1850.040.00 |
HEALTHCARE COVERAGE |
| 1850.040.10 |
Continuous Eligibility for Pregnant Women |
| 1850.040.20 |
Postpartum Benefit |
| 1850.040.20.10 |
Correction of Postpartum Ending Date |
| 1850.040.30 |
Coverage When Application Is Made After The Birth |
| 1850.040.40 |
Extended Women's Health Services |
| 1850.040.40.10 |
Eligibility for Other MO HealthNet Programs |
| 1850.040.40.20 |
No Longer in Need of Family Planning Services |
| 1850.040.40.30 |
Notification of Ineligibility for Extension Due To Insurance |
| 1850.050.00 |
REVIEWS |
| 1855.000.00 |
SHOW-ME HEALTHY BABIES (SMHB) |
| 1855.010.00 |
LEGAL BASIS |
| 1855.020.00 |
ELIGIBILITY |
| 1855.020.10 |
Unborn Child |
| 1855.020.20 |
Resident of Missouri |
| 1855.020.30 |
Need |
| 1855.020.40 |
Uninsured |
| 1855.020.50 |
Employer Sponsored Insurance |
| 1855.020.60 |
Private Insurance |
| 1855.020.70 |
Ineligible for any other MO HealthNet Programs |
| 1855.020.80 |
Application Processing Timeframe |
| 1855.030.00 |
HEALTHCARE COVERAGE |
| 1855.030.05 |
Coverage for the Child After Birth |
| 1855.030.10 |
Labor and Delivery Coverage for the Mother |
| 1855.030.15 |
Coverage for the Mother after Birth of the Child |
| 1860.000.00 |
NEWBORN -AUTOMATIC MO HEALTHNET ELIGIBILITY |
| 1860.005.00 |
LEGAL BASIS |
| 1860.010.00 |
ELIGIBILITY |
| 1860.010.05 |
Adding the Newborn |
| 1860.010.10 |
Assignment of DCN |
| 1860.010.15 |
Verification Of Birth |
| 1860.010.20 |
Eligibility Dates |
| 1860.015.00 |
NEWBORN’S ELIGIBILTIY FOR OTHER PROGRAMS |
| 1860.020.00 |
REINVESTIGATIONS (NEWBORNS) |
| 1870.000.00 |
UNINSURED WOMEN'S HEALTH SERVICES PROGRAM (UWHS) |
| 1870.005.00 |
LEGAL BASIS |
| 1870.010.00 |
ELIGIBILITY REQUIREMENTS (UWHS) |
| 1870.010.05 |
Age (UWHS) |
| 1870.010.10 |
Social Security Number (UWHS) |
| 1870.010.15 |
Residence (UWHS) |
| 1870.010.20 |
Citizenship and Alien Status (UWHS) |
| 1870.010.25 |
Need (UWHS) |
| 1870.010.25.05 |
Income Limits (UWHS) |
| 1870.010.25.10 |
Household (UWHS) |
| 1870.010.30 |
Uninsured (UWHS) |
| 1870.010.30.05 |
HIPP Effect on Uninsured Status (UWHS) |
| 1870.010.30.10 |
Health Insurance Definition (UWHS) |
| 1870.010.40 |
Ineligible for Any Other MO HealthNet Program (UWHS) |
| 1870.015.00 |
HEALTHCARE COVERAGE (UWHS) |
| 1870.015.05 |
UWHS HealthCare Coverage End Date |
| 1870.020.00 |
PROMPT DISPOSITION (UWHS) |
| 1870.025.00 |
REVIEWS (UWHS) |
| 1870.030.00 |
EX-PARTE PROCESS |
| 1870.035.00 |
EXPLORING UWHS ELIGIBILITY FOR AGE ELIGIBLE WOMEN WHEN NO LONGER ELIGIBLE FOR ANY OTHER MO HEALTHNET PROGRAM |
| 1880.000.00 |
ANNUAL RENEWALS |
| 1880.005.00 |
PRE-POPULATED RENEWAL FORM |
| 1880.010.00 |
FLOATING RENEWAL |
| 1880.015.00 |
CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) ANNUAL RENEWAL |
| 1880.020.00 |
RECONSIDERATION PERIOD |
| 1880.025.00 |
ANNUAL RENEWAL CASE ACTION NOTIFICATIONS |
| 1885.000.00 |
INTERIM CHANGES FOR MAGI CASES |
| 1885.005.00 |
AGE OUT |
| 1885.010.00 |
ADDING A PERSON |
| 1885.015.00 |
REMOVING A PERSON |
| 1885.020.00 |
UNABLE TO LOCATE |
| 1885.025.00 |
1885.025.00 MOVED OUT OF STATE |
| 1885.030.00 |
REOPENING CLOSED CASES |
| 1890.000.00 |
EX PARTE REVIEW PROCESS |
| 1890.010.00 |
PRE-CLOSING ACTIONS |
| 1890.010.10 |
Eligibility Exists Under Another Category |
| 1890.010.20 |
No Other Eligibility Exists |
| Appendix A |
MAGI income with 5% of FPL included and CHIP premium amounts  |
| Appendix B |
Reasonable Compatability Calculator  |
| Appendix D |
Poverty Guidelines |
| Appendix E |
MO HealthNet for Kids - CHIP Premium Chart |
| Appendix F |
CHIP Affordability Test Calculator Instructions |
| Appendix G |
CHIP Affordability Test Calculator |