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. Reviews for on-going eligibility must be conducted without the involvement of the participant and/or without a new application, if possible.
This process is called ex parte review.
If a change in circumstances results in a determination of ineligibility for an MHABD program, ineligibility for all MO HealthNet programs must be established prior to taking action to close the case. Eligibility criteria or changes in circumstance may allow a participant to move from one MO HealthNet program to another without an application. Do NOT explore eligibility for an MHABD cash grant program without a new, signed application.
NOTE: Possible eligibility for Family MO HealthNet programs using Modified Adjusted Gross Income (MAGI) methodology must also be investigated if the individual claims pregnancy, or a change in household composition.
Complete an ex parte review without requiring an application or additional information from the household unless:
NOTE: 42 CFR 435.907 specifies that applications or existing coverage moving from non-MAGI to MAGI programs may use new applications or supplemental forms to capture information needed for MAGI programs.
Use the data sources listed in 1805.000.00 ELIGIBILITY AND VERIFICATION whenever possible to verify eligibility criteria for MAGI programs.
NOTE: Some MO HealthNet programs have different program eligibility and verification requirements than MHABD programs. Participants may be required to submit additional paperwork for these programs.
Move the participant to the MO HealthNet benefits with the highest level of care for which they qualify.
If ending eligibility from one category and approving in another, process both transactions on the same day to prevent any disruption in healthcare coverage.