us-mo/manual/dss/medicaid

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us-mo/manual/dss/medicaid · Axiom

(magi)(1801-000-00)(1801-010-00)(1801-010-20)(block-1)1801.010.20 Appointing Another Adult Member of the Household as an Authorized Representative – DSS Manuals#

IM-103 July 11, 2022

When an adult (age 18 and older) is required to be included in a household, but is not the head of household (application signer), an Appointing an Authorized Representative (IM-6AR) form may be required to request benefits MO HealthNet (MHN) benefits for the adult member or to release information to the application signer.

EXAMPLE: Nancy applies for Angela. Angela is Nancy’s 22-year-old disabled child (whom she claims as a tax dependent). Nancy is able to sign the application for Angela, but an IM-6AR is required to allow Nancy to receive information regarding Angela’s pending MO HealthNet for the Aged, Blind, and Disabled (MHABD) application.

A valid IM-6AR is required:

To request benefits or receive information for another unrelated adult member who is mandatory in the household.

EXAMPLE: Carl and Joyce are not married, but they live together and have a child, Lyle. Carl applied for MHN benefits. Joyce must be included to determine Lyle’s benefits, but Carl cannot request benefits for Joyce without having a signed IM-6AR.

To request benefits or receive information for any related adult member who is not a spouse or tax dependent.

EXAMPLE: Tori is 27 years old and is living with her parents. Her parents do not claim her as a tax dependent. For her mom to request MHN benefits for Tori, an IM-6AR is required.

To receive information regarding an MHABD case for any other adult member, except a spouse.

EXAMPLE: William applied for MHN his children and his mom, Claire, who he claims as a tax dependent. Claire is 75 years old and an MHABD application was registered to explore eligibility. An IM-6AR is required to release information to William about Claire’s pending MHABD application.

NOTE: An authorized representative form may not be required to sign an application in some circumstances, such as for a minor or incapacitated participant, if certain circumstances are met. However, signing the application does NOT qualify the application signer as an authorized representative. See 1802.020.00 Signing the Application .

(magi)(1801-000-00)(1801-010-00)(block-1)1801.010.00 Appointing an Authorized Representative – DSS Manuals#

IM-103 July 11, 2022

At the time of application or at any other time, a participant may choose to appoint an authorized representative to:

complete and submit an application

assist and/or represent them in the MO HealthNet (MHN) application process, or the redetermination or review of eligibility

act on behalf of the participant in other actions on the MHN case

receive copies of the participant’s notices and other communications from Family Support Division (FSD)

If indicated on the Appointing an Authorized Representative (IM-6AR) form, the authorized representative may act on behalf of the participant to:

apply for benefits and supply information to complete an eligibility determination

complete and submit renewals and reviews

represent the participant in an interview

notify FSD of any changes

examine and obtain any documents or information from the participant’s record. This may require additional release(s), as required by state or federal law or regulation See 0130.005.00 Confidentiality and 0130.005.10 Health Insurance Portability and Accountability Act . If the applicant/participant wants to release protected health information, the MO 650-2616 (HIPAA) Authorization for Disclosure of Consumer Medical/Health Information form must be completed.

request a hearing and participate in the hearing, including representing the participant and providing additional evidence

NOTE: Do not release participant information to another person until verifying that they are an authorized representative.

The participant’s spouse or other related adult member included in the case do not require an IM-6AR. See below for details regarding the participant’s attorney, attorney-in-fact, guardian, conservator, or court appointed public administrator.

Participant’s Rights and Responsibilities

A participant retains all rights to their case, even if an authorized representative is appointed. Participants can still contact FSD, make changes, and apply on their own behalf. FSD retains the right to contact the participant in addition to the authorized representative.

A participant:

cannot appoint an authorized representative if the participant is determined incompetent by a court. In those cases, an authorized representative must be appointed by the guardian or conservator.

must willingly and knowingly appoint an authorized representative. If the designation of an authorized representative was created under duress or undue influence, or was induced by fraud, it is considered void.

will be financially and legally responsible for all information provided or omitted, and all actions taken or omitted by the authorized representative.

must notify FSD of any change in the address and phone number of the authorized representative within 10 days of the known change. The authorized representative may provide this information on behalf of the participant.

Authorized Representative’s Rights and Responsibilities

The authorized representative must not:

make a willfully false statement

misrepresent the participant

willfully conceal information

fail to report or disclose any fact or event required to be reported by any law, regulation, or rule of Missouri or the United States

An appointment of authorized representative is only valid with the Department of Social Services (DSS). It does not permit an authorized representative to represent or appear for the participant in any court of law in the State of Missouri.

Designation Forms

A participant must sign an Appointing an Authorized Representative (IM-6AR) or another designation form to appoint an authorized representative.

The signature can be handwritten, stamped, electronic, telephonically recorded (when available), or by any other method accepted by FSD.

An unsigned IM-6AR or designation form is not a valid appointment of an authorized representative.

The IM-6AR or other designation form must include the name, address, and telephone number of the authorized representative or organization designated to serve as the authorized representative.

The IM-6AR or other designation form can be accepted by mail, fax, or any other commonly available electronic means.

If another designation form is used it must include: The name of the person or organization designated to serve as the authorized representative The address of the authorized representative and the mailing address of the authorized representative (if different) A phone number for the authorized representative An attestation substantially in the following format: “In appointing my authorized representative, I understand that I will be legally bound and responsible for the actions of my appointed representative with respect to my application for or participation in the MO HealthNet program.” The attestation must also contain or be accompanied by a signed authorization compliant with the Health Insurance Portability and Accountability Act (HIPAA) for the Department of Social Services to release protected health information to the authorized representative. The authorized representative status is effective with the date the completed IM-6AR or other designation form is received by FSD. FSD may contact the participant or other individuals signing the IM-6AR or other designation form to verify the appointment of an authorized representative.

NOTE: Upon receipt of a completed IM-6AR, or other designation form, add Authorized Representative information into the eligibility system.

Organizations as an Authorized Representative

Participants can appoint an organization as an authorized representative.

Within ten (10) days, the organization must provide in writing the name, address, and phone number of an individual within the organization serving as a contact person for FSD.

The organization must notify FSD in writing of any change in the name and contact information for the designated contact person within ten (10) days of the change.

Other Types of Representatives

Do NOT require an IM-6AR or other authorized representative designation form when the participant is represented by:

Parent or caretaker relative of MO HealthNet Disabled Child (MHDC) participant (under age 18) An IM-6AR is required for a parent or caretaker relative once the participant reaches age 18.

public administrator, guardian, conservator, or other individual appointed by the court Obtain documentation of the court appointment. A guardian or conservator can appoint a third party as an authorized representative.

person acting as attorney-in-fact or agent under a Power of Attorney (POA), when the participant has given that person written authorization to act on their behalf in financial, business, or legal matters. Review the POA document to determine if the POA is currently in effect and if the participant has given their attorney-in-fact/agent the authority to act in this capacity. The attorney-in-fact/agent may appoint an authorized representative when allowed to act in that capacity.

attorney at law licensed by the State of Missouri. The attorney must file a written entry of appearance with FSD associated with a relevant legal proceeding, such as an administrative hearing. Attorneys who do not file a written entry of appearance, but wish to act on a participant’s behalf must provide other appropriate documentation of their capacity as representative as per 13 CSR 40-2.015(18)(B).

individual or organization to whom a court of competent jurisdiction has issued letters of administration or testamentary on behalf of the deceased participant or a surviving spouse when a valid court order or valid small estate affidavit has been received. The individual, organization, or surviving spouse may appoint an authorized representative

Multiple Authorized Representatives

Participants may appoint more than one individual or organization to serve as the authorized representative at any given time.

If there is conflicting information or instructions from more than one authorized representative, FSD must consult with the participant and/or the authorized representatives to resolve the conflict.

EXCEPTION: When the participant is represented by an attorney, FSD will consult with the attorney before consulting with the participant if conflicting information is received.

(magi)(1801-000-00)(1801-020-00)(block-1)1801.020.00 Duration of Appointment of Representative – DSS Manuals#

IM-103 July 11, 2022

A signed Appointing an Authorized Representative (IM-6AR) form is valid if it is submitted within 90 days of the date of the participant’s signature.

EXAMPLE: An employee of the local hospital submits an IM-6AR on behalf of Aaron, who is applying for MO HealthNet (MHN). The IM-6AR was signed by Aaron 7 months ago. The IM-6AR was not submitted within 90 days of the date Aaron signed it and is not a valid IM-6AR.

Once the signed IM-6AR or other designation form is received, Family Support Division (FSD) shall consider the authorization to remain in effect until:

FSD receives written notice that the participant has revoked the appointment of authorized representative

EXAMPLE: Deandre named his brother, Darryl as his authorized representative when he applied in December 2019. Deandre’s case closed February 2020. In December 2021, Darryl reapplied for MHN for Deandre. This is a valid application as Deandre never revoked the authorized representative appointment of Darryl.

a specified termination date stated on an alternative designation form

the death of the participant The authorized representative may continue to assist with an existing application filed prior to the participant’s death or for payment of benefits owed prior to the participant’s death. For further information, regarding applications for deceased persons, see 1802.020.45.05 Death After Application and 1802.020.45.10 Application for Deceased Persons .

the day after the application date for authorized representatives appointed only for the submission of an application

when the application is complete for authorized representatives appointed only to assist with the application process (this includes the hearing period)

the authorized representative requests in writing to end their appointment

Access to Online Information

Authorized representatives can access information regarding online interactions between the participant and FSD after the participant’s death only if:

the participant has granted access during his or her lifetime

the individual is a court appointed personal representative, administrator or executor of the estate; or

the individual is a surviving spouse who has obtained a refusal of letters or who has filed a valid small estate affidavit

(magi)(1802-000-00)(1802-010-00)(1802-010-80)(1802-010-80-15)(block-1)1802.010.80.15 MO HealthNet Applications for Incarcerated Individuals – DSS Manuals#

IM-69 May 26, 2022 ; IM-27 March 23, 2022

Per guidelines from the Centers for Medicare and Medicaid Services (SHO #16-007), an incarcerated individual at a correctional facility, may submit an application and if found eligible will have their medical benefits suspended. Incarceration status is not an eligibility factor and does not prevent someone from applying and being found eligible for MO HealthNet (MHN), but does prevent MHN from being used, so the participant must be suspended while they are incarcerated.

NOTE: Medical claims will not be paid for the suspended participant by MO HealthNet Division (MHD). MHD may recoup payments made while a participant was incarcerated (42 CFR 435.1009 and RSMo 208.158).

An application should be processed as if the incarcerated participant is living in the home, as long as they are expected to return to the home. When benefits are suspended, the participant would still be included in an eligibility determination or household composition, depending on tax filing status. An incarcerated participant follows the same eligibility unit guidelines as if they are not incarcerated and are living in the home, as long as they are expected to return.

EXAMPLE: Anna and Bill are married and apply for MHN for themselves and their 3 children. Bill is incarcerated at Department of Corrections (DOC), but Anna will file a joint tax return and Bill is expected to return to the home when he is released. The application is approved for all 5 household members. Bill’s MHN is suspended, but he remains a member of the eligibility unit for his own eligibility and other household members’ eligibility.

If an incarcerated participant was not in the home prior to incarceration, or is not expected to return to the home upon release, the application should be completed based on the participant’s eligibility unit at the time of the application.

EXAMPLE: Connie applies for MHN for herself. She is incarcerated at Jackson County Jail. There is a previous eligibility determination that included Connie’s wife, however, she does not include her on the current application. There is no reason to assume that Connie is still living with her wife or will return to her home upon release. Process the application for Connie based on the circumstances that were reported on the application.

If the participant is eligible for MHN but is incarcerated, approve the application and take immediate action to suspend benefits as of the date when the participant is eligible and incarcerated. However, if the incarcerated participant is ineligible for MHN, reject the application.

NOTE: When a suspended participant is released, their medical benefits must be restored, if still eligible, without requiring a new application . See 1885.040.00 Suspension of MAGI Benefits for Incarcerated Individuals .

Inpatient

Incarcerated individuals are eligible for medical claims only for the dates they have an inpatient status in a medical facility. An incarcerated individual must:

Have an inpatient stay of 24 hours or more at a medical facility. Time in the emergency room counts toward the 24-hour total stay when the incarcerated individual is later admitted to inpatient status, AND

Meet all other eligibility factors for the specific program, such as resources, citizenship, age, etc.

If an incarcerated participant is approved for an inpatient stay, suspend the incarcerated participant for all dates of the month except for the period of the inpatient stay. Suspend the participant for ongoing dates once they have returned to the correctional facility.

EXAMPLE: Carl is an incarcerated individual at the Cole County Jail and was admitted to the hospital on December 15. Carl remained in the hospital until December 17 and then returned to Cole County Jail. Carl submitted an application, Inpatient Coverage for Incarcerated Participants (IM-151) and all necessary verification on December 19. Carl was found eligible for MO HealthNet for the Aged, Blind, and Disabled (MHABD).

FSD approved MHABD and MHD entered suspension for December 1 – December 14, allowed the hospital expenses for December 15- December 17, and entered suspension for December 18 and ongoing. A redetermination will be completed when FSD is notified of Carl’s release from the Cole County Jail to determine if he remains eligible for MHABD or another MO HealthNet program. If continued eligibility exists, MHN benefits will be restored, for the program he is eligible for, when he is released.

A suspended participant who has an inpatient stay does NOT need to complete a new application . The participant should complete the Inpatient Coverage for Incarcerated Participants (IM-151) and provide proof within 10 days of the end of the inpatient event. Medical facility staff, jail/prison staff, or the participant (or their representative) may submit the IM-151 to FSD. FSD reviews the information provided and makes a determination if the inpatient event qualifies for MO HealthNet coverage.

NOTE: Suspension is entered for suspended participants by a specialized unit. Refer to 2021 IM Email Memo #9 for instructions to send to the specialized unit for suspension.

FSD will notify MO HealthNet Division (MHD), the participant, and their authorized representative (if applicable) of the eligibility decision. Department of Corrections (DOC) may also receive information regarding eligibility during an inpatient event as allowed by agreements between DOC, FSD, and MHD.

(magi)(1802-000-00)(1802-020-00)(block-1)1802.020.00 Signing the Application – DSS Manuals#

IM-66 May 25, 2022 ; IM-44 May 18, 2018

As provided in 42 CFR 435.907, all MO HealthNet (MHN) applications are signed under penalty of perjury regardless of application method.

Acceptable paper MHN applications can be found in the DSSManuals Forms Manual .

The following individuals may apply for MO HealthNet Programs on behalf of a participant:

The participant

The participant’s spouse

An adult (age 18 or over) who is part of the participant’s tax-filing or non-filing household. Reference 26 U.S.C. 36B(d)(1) and 42 CFR 435.603(f)(1).

EXAMPLE: Carlos is a disabled individual. He is 23 years old, but lives with his mom, Andrea. Andrea claims Carlos as a tax dependent and can sign the application for MHN for Carlos.

EXAMPLE: Tyanna is 15 years old and is living with her mother, Dinah. Dinah does not expect to file taxes or claim Tyanna as a dependent on taxes next year, but Tyanna is living with her and will continue living with her. Dinah can sign the MHN application for Tyanna as she is part of her non-filing household.

An individual with a valid power of attorney to act on behalf of the participant

An authorized representative of the participant

If the participant is a minor or incapacitated person only the following people may apply on their behalf:

A parent, including minor parents on behalf of their minor children or any child in his or her legal custody An authorized representative A guardian or conservator Someone acting responsibly for the applicant. This person must be age 18 or older and have the capacity to enter into a contract and who: Is related to the applicant by blood, marriage, or adoption; OR Is a person who the division reasonably determines has sufficient knowledge of the applicant’s circumstances to accurately complete the application, and has an obligation to act in the best interests of the applicant.

NOTE: Acting responsibly and signing an application does NOT qualify the person as an authorized representative. Their authority is limited to making the application valid.

A minor, regardless of age, can sign the application, if any of the following conditions apply: pregnant lawfully married a parent legally emancipated

A minor who is homeless and/or a victim of domestic violence meeting the criteria below (per RSMo 431.056(1)): age 16 or 17 years old homeless (per RSMo 167.020(1)) sharing housing (couch surfing and/or temporary sharing) living in motels, hotels, or campgrounds living in emergency or transitional shelters living in cars, parks, abandoned building, bus or train stations other night time residences that are not designed for or ordinarily used as a regular sleeping accommodation for people self-supporting (parents and/or guardians are not providing physical or financial support) a parent and/or guardian is unwilling or unable to provide care for the minor. This may be explicit statements or implied by: making statements (written or verbal) that the minor may live independently. barring the minor from the home or otherwise indicating they are not welcome to stay. refusing to provide any financial support. abusing or neglecting the minor or committing acts of domestic violence against the minor.

NOTE: Although minors may apply on their own behalf in certain circumstances, their household composition must still follow the household composition rules in MAGI policy sections 1805.030.10 MAGI Household Composition through 1805.030.10.25 Caretaker Relatives .

Explore a Children’s Division Referral

If the participant is an unaccompanied minor age fifteen (15) or under and applying without a responsible adult, explore the following:

Where is the child living?

Who does the child live with?

Is there a responsible adult living in the child’s household?

If the child is not living with a responsible adult, report this to Children’s Division through the Mandated Online Reporting site found at https://dss.mo.gov/cd/can.htm . FSD staff must complete the online referral with all known information.

(magi)(1805-000-00)(1805-000-02)(block-1)1805.000.02 Federal Hub Calls – DSS Manuals#

IM-128 October 10, 2017

Federal Hub Calls (H-calls) are the electronic services provided by the Secretary of Health and Human Services, which States may use to verify or obtain certain information, 42 CFR 435.949.

H-calls are used by the Marketplace and States to obtain information provided by Federal Agencies, Social Security Administration (SSA), the Department of Treasury, the Department of Homeland Security and other data sources.

H-calls lessen the burden of requiring households to provide verification. Because of H-call and other electronic sources, the individual does not have to provide the same verification(s) to multiple agencies.

NOTE : Family Support Division (FSD) must check the electronic data sources to obtain information regarding the individual or household’s circumstances whenever possible.

As conditions of eligibility, all individuals seeking MO HealthNet (MHN) must provide and verify their Social Security Number, Citizenship and Immigration Status. H-calls should be used instead of requesting the individual to provide the documentation. H-calls can provide the following information:

Income Information

Social Security Number Verification

Citizenship Verification

Immigration Status Verification

Medicare Information

Individuals must not be required to provide additional information or documentation unless electronic data sources cannot provide the information required to determine eligibility. When information received from H-calls or other electronic data source cannot be used to determine eligibility, clarification should be requested. Clarification should be requested when:

Self-attested income is not reasonably compatible with electronic data sources. NOTE : MAGI Policy manual section 1805.030.15 Reasonable Compatibility explains how to treat income that is not compatible.

Self-attested non-financial information is inconsistent with electronic data sources. EXAMPLE : Xavier attested that he is a lawful permanent resident and has been in the United States legally for over five years. The H-call for citizenship returned conflicting information; it showed that Xavier has only been in the United States for three years. Xavier must have been in the United States legally for five years to receive MHN benefits. An IM-31A Request for Information is sent to Xavier requesting he provide clarifying documentation regarding his immigration status.

In the event that H-call services are down and not working, or an error or no response is received, and other electronic data sources cannot provide the information, request the individual provide the required information.

(magi)(1805-000-00)(1805-000-05)(block-1)1805.000.05 Reasonable Opportunity (RO) – DSS Manuals#

IM-22 April 11, 2024 ; IM-108 July 19, 2022 ; IM-146 November 27, 2017 ; IM-71 June 15, 2017 ; IM-43 May 11, 2017 ; IM-13 February 1, 2017

42 CFR 435.956 states Family Support Division (FSD) must provide participants a reasonable opportunity to provide documentation of citizenship, national, or qualified immigrant status, (hereafter, referred to as “status”). The RO is a period of time participants are given to provide documentation of status, if status cannot be verified at application or before approval.

The RO period is 90 days, plus 5 days to allow time for the participant to receive notices by mail, making the total RO period 95 days.

See manual sections 1805.020.05.05 Documents to Verify Citizenship and/or 1805.020.10 Qualified Immigrant for information describing documentation of status.

Allow Reasonable Opportunity

Allow RO when:

The participant is requesting MO HealthNet (MHN) benefits, status cannot be verified with information available to FSD, and the participant has submitted a signed MHN application OR signed a Citizen/National/Eligible Immigrant Attestation (IM-40) form to declare his or her status.

Signed MHN Application Form

Note: As phone applications are recorded, these are considered signed applications.

Allow declarations of status from previous applications, unless questionable.

Example: Rayna reports a change and requests coverage by phone for her son, Lane. Lane is already included in her household, but she’s never requested coverage for him before. A review of Rayna’s case record reveals when she applied 2 years ago for herself, Lane was on the application and Rayna declared he was a citizen at the time, but didn’t request coverage for him. FSD sends her a Request for Information to provide documentation of his citizenship, and approves his coverage with an RO period.

Signed Citizen/National/Eligible Immigrant Attestation (IM-40) form to declare status Send a Request for Information along with this form and allow 10 days to return it. Reject the request for coverage if the participant fails to return the completed, signed form .

Example: Rayna completes a change report to request coverage for her new spouse, Kyle. Kyle was not included on the original MHN application Rayna filed. FSD sends Rayna a Request for Information along with form IM-40 Citizen/Eligible Immigrant Attestation Form. The Request for Information explains that she can provide proof of Kyle’s citizenship by providing an item listed on the request OR she can complete the form to declare his citizenship and possibly qualify for 95 days to obtain documentation of Kyle’s citizenship. She fails to respond to the Request for Information and FSD rejects her request for Kyle’s coverage.

Proof of Identity

If proof of identity is needed to verify citizenship, allow an RO period for the participant to provide the proof of identity.

Example: Becky requests coverage for herself and provides a copy of her birth certificate. As a birth certificate is not a document that verifies both citizenship and identity, FSD sends a request for proof of identity and grants an RO period for Becky to provide the proof.

Request Information

Send a Request for Information to participants who must provide verification of status. On the request, detail the information that can be provided to verify this factor. System generated Requests for Information include this information automatically.

Approval

After sending a Request for Information to request verification of status, immediately approve coverage for participants if:

The participant has declared his/her citizenship/immigrant status on a signed application or IM-40 Citizen/Eligible Immigrant Attestation form, and

All other eligibility factors are met.

Do not wait for the Request for Information to expire. Begin the RO period on the date of approval for MHN benefits, when possible, or the next day if an overnight batch process is required to generate the request systematically.

For households in which at least one member was allowed RO to verify status, include the following statement on the Approval Notice:

Proof of [Choose one of the following] Citizenship/national/qualified immigration status was requested for ___________and was not provided. _________was approved for MO HealthNet, but may lose coverage if his/her [choose one of the following] proof of citizenship/national/qualified immigration status is not provided within 95 days of this letter. Contact Family Support Division if you have a delay in obtaining this verification.

Prior Quarter (PQ)

Allow RO for PQ months. If the citizenship or qualified immigrant status is not verified at application, approve the PQ with RO when the ongoing benefit is approved.

RO Extensions

RO ends the 95 th day after approval, or when the participant provides acceptable documentation to verify status.

If the participant indicates difficulty providing documentation by the end of the RO, but demonstrates a good faith effort to provide it, extend the RO period by 90 days on an as-needed basis. Verify the good faith effort and document details including any decision to extend the RO.

Example: Harley’s RO period expires on 10/31. On 10/20, Harley mails FSD a copy of a letter he received from the state of California. It states they have received his request for a copy of his birth certificate, but will be unable to fulfill the request before 11/10. Harley’s RO period is extended to 1/31. On 11/17, Harley provides the documentation and his RO ends.

Closings

If the participant has not provided the requested documentation of status by the end of the RO and any extensions, send an Adverse Action notice and discontinue MHN coverage after it expires.

RO and 1805.070.00 Continuous Eligibility for Children (CEC)

When RO is granted, the continuous eligibility begin date for the child is made retroactive to the date benefits were first approved during the RO period if the individual’s U.S. citizenship or satisfactory immigration status is ultimately verified.

Continuous eligibility is not in effect until verification has been provided. If verification is not provided during the RO timeframe, eligibility can be ended.

(magi)(1805-000-00)(1805-015-00)(block-1)1805.015.00 Social Security Number (SSN) – DSS Manuals#

IM-108 July 19, 2022 ; IM-75 July 7, 2021 ; IM-47 May 12, 2017 ; IM-13 February 1, 2017 ; IM-97 November 9, 2015

Section 1902(a) of the Social Security Act requires participants to apply for and provide a Social Security Number (SSN) to the Family Support Division (FSD) as a condition of eligibility for MO HealthNet.

This requirement does not apply to:

Parents or children included in the household who are not requesting benefits

the participant’s spouse, unless coverage has been requested for the spouse

the parents of a disabled child

newborns born to women with active Title XIX coverage at the time of the baby’s birth

aliens seeking MO HealthNet for the treatment of an emergency medical condition

Obtain a SSN for all participants including children under age one requesting benefits at the time of the initial application whenever possible. Accept self-attestation for verification of SSN.

An exception may be given to applicants who:

are not eligible to receive an SSN

do not have an SSN and may only be issued an SSN for a valid non-work reason in accordance with applicable law 20 C.F.R. 422.104; or

do not have, or do not agree to apply for, a SSN due to a well-established religious belief. A well-established religious belief means that the participant is a member of and abides by the belief of the religious organization. Self-attestation is accepted unless it is questionable.

Note: Do not deny coverage in the event the issuance or verification of an SSN is delayed due to SSA.

If a participant has a SSN but does not know it, provide a Request for Information and allow ten days to provide the SSN. When a participant attests to having a SSN but fails to provide the number to FSD, reject the participant’s coverage after the Request for Information expires.

If the applicant is required to provide an SSN and does not already have one, they must apply for a number as a condition for program eligibility. Assist the individual in making an application for an SSN. Ensure the participant understands:

FSD is limited to using the participant’s SSN to verify income from federal sources, and to verify eligibility data from other required sources

FSD is obligated to request the applicant’s SSN under the authority of Section 1902 (a) of the Social Security Act

Provide the applicant with the Social Security Administration Application for a Social Security Card (SS-5) form. The SS-5 form can be found on the Social Security website at www.ssa.gov . The participant can complete the form online or by hand.

Assist in completion of the SS-5 and mail it to the Social Security office whenever necessary. The SSN applicant MUST sign the SS-5 prior to submission to the Social Security office.

Whenever the completed SS-5 form is mailed to the Social Security office by FSD on behalf of the SSN applicant, provide the participant with a copy of the completed SS-5.

Inform the participant that the Social Security office requires original documents as verification, such as birth certificates, marriage certificates, etc.

Inform the participant that the completed and signed form must be either mailed or carried into the nearest Social Security office.

To find the local Social Security office for an SSN applicant, go to the Social Security website and utilize the Social Security Office Locator tool. Use this tool when determining which office to direct the participant or to mail the SS-5 for the participant.

Document how FSD assisted with the application for an SSN, when the SSN application was made, etc. At next review, require the SSN if the participant has not already provided it.

Newborns

Missouri Rule 13 CSR 40-2.260 provides that Newborns born to women with active Title XIX coverage at the time of the baby’s birth continue to be eligible for Newborn coverage up to age one whether or not they have an SSN on file with FSD.

Review MAGI Manual 1860.010.00 Eligibility for a list of MHN Programs that are Title XIX. Refer to Appendix H – ME Codes Chart .

Within 60 days of Newborns (babies born to women actively receiving Title XIX coverage on the baby’s date of birth) turning one year old, a review of their coverage will be completed. Obtain any missing case information, along with SSN, at that time.

When FSD does not have the Newborn’s SSN by the baby’s first birthday, request the SSN. If the SSN is not provided, the baby cannot continue to receive MO HealthNet after the first birthday.

Note: Applications for children under age 1 (MHK under 1) whose mother was not receiving Title XIX coverage on the baby’s date of birth are not automatically eligible for Newborn coverage during the first year of life. Request the baby’s SSN when processing an application for MHK under 1.

(magi)(1805-000-00)(1805-020-00)(1805-020-05)(1805-020-05-05)(block-1)1805.020.05.05 Documents to Verify Citizenship – DSS Manuals#

IM-31 May 28, 2024 ; IM-88 October 24, 2023 ; IM-110 July 17, 2020 ; IM-32 April 23, 2018 ; IM-147 November 27, 2017 ; IM-70 June 15, 2017 ; IM-94 December 28, 2016

42 CFR §435.407 and §436.407 describe the documents needed to verify citizenship and identity.

As of January 20, 2017, a photocopy, facsimile, scanned or other copy of a document must be accepted to the same extent as an original document under this section, unless information on the copy submitted is inconsistent with other information available to the agency or the agency otherwise has reason to question the validity of, or the information in, the document.

Citizenship and Identity Documentation

Acceptable forms of documentation that verify both citizenship and identity are:

U.S. passport

Certificate of Naturalization (N-550 or N-570)

Certificate of Citizenship (N-560 or N-561) — issued to individuals who derive citizenship through a parent (see Child Citizenship Act of 2000 below)

A valid State-issued driver’s license as follows:

Missouri Driver’s License Inquiry (MODL) system where the Detail Identification Inquiry screen (upper right side) indicates that the person is a verified U.S. citizen.

Note : MODL cannot be used to verify relationships, as it does not capture coding details for why a name has been changed.

For driver’s licenses/state ID’s from states other than Missouri, the license is proof of citizenship and identity when the state issuing the license requires: proof of U.S. citizenship before issuance of such license, or obtains and verifies the Social Security Number (SSN) from the applicant

Staff will need to check with the issuing state to verify the state’s process.

A data match with the Social Security Administration (SSA). Using the State Verification and Exchange System (SVES), SSA will compare an individual’s name, SSN, and citizenship declaration with data in its Master File of SSN Holders.

Note : A verified SSN is NOT verification of citizenship. Citizenship may be verified through a Bendex, SDX or IIVE alien indicator. Refer to the CITIZENSHIP DOCUMENT ENTRY FOR APPLICATIONS guide in IM Resources for more information.

Note: Do NOT file IIVE screens in the case record.

Documentary evidence issued by a federally-recognized Indian Tribe identified in the Federal Register by the Bureau of Indian Affairs within the U.S. Department of the Interior, and including Tribes located in a State that has an international border, which:

Identifies the federally-recognized Indian Tribe that issued the document

Identifies the individual by name; and

Confirms the individual’s membership, enrollment, or affiliation with the Tribe

Note: The documents listed above may include, but are not limited to:

A Tribal enrollment card

American Indian Card ( I-872)

A Certificate of Degree of Indian Blood

A Tribal census document

Documents on Tribal letterhead, issued under the signature of the appropriate Tribal official, that meet the requirements of paragraph (a)(5)(i) of this section

Section 1903(x) of the Social Security Act states that individuals who are eligible for MO HealthNet or CHIP as “deemed newborns” are considered to have provided satisfactory documentation of citizenship and identity (by virtue of being born in the United States) and will not be required to further document citizenship or nationality at any subsequent MO HealthNet or CHIP eligibility determination or redetermination.

Note: In Missouri, LOC of “G” (newborn coverage) on the MXIX screen verifies this factor.

IBTH, if born in Missouri.

Note: Do NOT print IBTH screens or file in the case record

A data match with the Systematic Alien Verification for Entitlements (SAVE) system or any other process established by Department of Homeland Security (DHS) to verify that an individual is a natural born, naturalized or derived citizen

Note : MEDES verifies a participant’s citizenship and immigration status by:

Sending a request to the Hub (Federal Data Services Hub) to verify citizenship or immigration status. If additional verification is needed, the Hub will automatically submit additional data to SAVE requesting DHS verify the status of the case. No action is taken by staff to verify status. If citizenship cannot be established, staff must take appropriate action to gather citizenship and immigration documentation for the participant by following the steps outlined in the Verify Lawful Presence guide in IM Resources .

Citizenship Documentation

If one of the above forms is not available, you must obtain one of the following documents to verify citizenship and a second source to verify identity. The following documents may be used to verify citizenship for MO HealthNet programs:

A U.S. public birth certificate showing birth in one of the 50 States, the District of Columbia, Guam, American Samoa, Swain’s Island, Puerto Rico (if born on or after January 13, 1941), the Virgin Islands of the U.S. or the CNMI (if born after November 4, 1986, [CNMI local time]).

NOTE: Evidence of birth in Puerto Rico and the applicant’s statement that he or she was residing in the U.S., a U.S. possession, or Puerto Rico on January 13, 1941 is acceptable.

Certification of Birth (DS-1350)

Consular Report of Birth (FS-240)

Certificate of Birth Abroad (FS-545)

S. Citizen ID Card (I-197 or I-179)

Northern Marianas Identification (NMI) card (I-873)

Final adoption decree

Evidence of U.S. Civil Service employment before June 1, 1976

S. Military Record showing a U.S. place of birth

Hospital record on hospital letterhead

Note : For children under five, must be at or near time of birth.

Statement signed by physician or midwife present at time of birth

Medical (clinic, doctor, or hospital) records that created at least five years before application

Life or health insurance record showing a U.S. place of birth created at least five years prior to application

Official religious record recorded in the U.S. showing that the birth occurred in the U.S.

School records, including pre-school, Head Start and daycare, showing the child’s name and U.S. place of birth

Federal or state census record showing U.S. citizenship or a U.S. place of birth

S. State Vital Statistics official notification of birth registration

Institutional admission papers created at least five years prior to application date that includes a U.S. place of birth

If the applicant does not have one of the citizenship documents listed above, they may submit an affidavit signed by another individual under penalty of perjury who can reasonably attest to the applicant’s citizenship, and that contains the applicant’s name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized.

Per the Child Citizenship Act of 2000 (Pub. L. 1006-295), consider a biological or adopted person born outside of the United States a citizen if the following conditions were met on or after February 27, 2001:

One of the person’s parents is a United States citizen (whether by birth or naturalization; verified by the standards of citizenship verification listed in this section) and

The person was legally residing in the United States, in the custody of a citizen parent, while under the age of 18

Note: A participant with documentation verifying a legal status other than citizenship, such as Lawful Permanent Resident, may meet the conditions of this act. Despite documentation that indicates a status other than citizenship, if evidence suggests a parent of a participant is a citizen, explore citizenship eligibility for the participant under the conditions of the Child Citizenship Act of 2000.

Participants can provide a Certificate of U.S. Citizenship as proof that these conditions have been met. However, do not require participants to obtain or provide a Certificate of U.S. Citizenship if it can be proven by other means that the participant meets the conditions of the Child Citizenship Act of 2000.

Record details of verification used to prove how each condition was met.

Identity Documentation

FSD must accept the following as proof of identity for MO HealthNet cases, provided such document has a photograph or other identifying information sufficient to establish identity, including, but not limited to, name, age, sex, race, height, weight, eye color, or address:

Driver’s license issued by the State or U.S. Territory

School identification card

S. military card or draft card with photograph

Identification card issued by the Federal, State, or Local government

Military dependent’s identification card

S. Coast Guard Merchant Mariner card

For children under age 19, a clinic, doctor, hospital, or school record, including preschool or day care records

For children newborn up to but not including age 16, identity can be verified by the signature of a parent/related caretaker/legal guardian on the application or reinvestigation forms. This signature is considered an affidavit to the child’s identity.

Note: Do not request verification of identity again when the child turns 16 years old as long as there is continuous eligibility for that child and there is the prior affidavit signature of the parent/related caretaker/legal guardian.

A finding of identity from the following FSD programs as defined in section 1902(e)(13)(F) of the Social Security Act:

Supplemental Nutrition Assistance Program (SNAP) Temporary Assistance program Any MO HealthNet program

A finding of identity from specific public agencies and Indian Tribes and Tribal organizations such as:

The Head Start Act The Richard B. Russell National School Lunch Act The Child Nutrition Act of 1966 The Child Care and Development Block Grant Act of 1990 The Stewart B. McKinney Homeless Assistance Act The United States Housing Act of 1937 The Native American Housing Assistance and Self-Determination Act of 1996 The Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization

Two other documents containing consistent information that corroborates an applicant’s identity. Such documents include, but are not limited to:

employer identification cards high school, high school equivalency and college diplomas marriage certificates divorce decrees property deeds or titles

FSD may accept as proof of identity for MO HealthNet programs a finding of identity from a federal agency or another state agency, including but not limited to, a law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual.

If the applicant does not have any documents specified above, the agency must accept an affidavit signed, under penalty of perjury, by a person other than the applicant who can reasonably attest to the applicant’s identity. Such statements must contain the applicant’s name and other identifying information establishing identity including but not limited to, name, age, sex, race, height, weight, eye color, or address. The affidavit does not have to be notarized.

FSD may rely, without further documentation of citizenship or identity, on a verification of citizenship made by a federal agency or another state agency, if such verification was done on or after July 1, 2006.

FSD must provide assistance to individuals who need assistance in securing satisfactory documentary evidence of citizenship and/or identity in a timely manner. If the individual is unable to obtain documentation listed above for either citizenship or identity, contact the MHN Program and Policy Unit for further assistance.

(magi)(1805-000-00)(1805-020-00)(1805-020-10)(1805-020-10-10)(1805-020-10-10-10)(block-1)1805.020.10.10.10 Qualified Immigrants With a Five-Year Period of Ineligibility – DSS Manuals#

IM-97 November 9, 2015

Qualified immigrants entering the U.S. on or after August 22, 1996 who are not eligible for MO HealthNet for five years following their date of entry are listed below. Once the five-year period of ineligibility has expired, these qualified immigrants who otherwise meet MO HealthNet eligibility criteria can receive MO HealthNet:

Lawful Permanent Resident

An immigrant granted parole for at least one year by the INS under 212(d)(5) of INA

An immigrant granted conditional entry under 203(a)(7) of INA in effect before April 1, 1980

A battered immigrant, as defined by P.L. 104-208 is an immigrant: Who has been battered or subjected to extreme cruelty in the U.S. by a spouse or parent; or a member of the spouse of parent’s family residing in the same household as the immigrant if the spouse or parent consented to, or acquiesced in, such battery or cruelty Whose child has been subjected to same by a spouse or a parent or the immigrant (without the active participation of the alien), or by a member of the spouse or parents family residing in the same household if the spouse or parent consented to, or acquiesced in, such battery or cruelty; or Child who resides in the same household as a parent who has been battered or subjected to extreme cruelty in the U.S. by that parent s spouse or by a member of the spouse s family residing in the same household as the parent and the spouse consented or acquiesced to such battery or cruelty, but only if there is substantial connection between such battery or cruelty and the need for benefits to be provided.

EXCEPTION : The five-year ineligibility period DOES NOT APPLY to the immigrants listed above if they are:

on active duty in the U.S. Armed Forces

a veteran of the U.S. Armed Forces

the spouse or dependent child of a veteran or active duty U. S. Armed Forces personnel (A dependent child is an unmarried child under age 18 or a child claimed as a dependent on the active duty person’s or veteran’s income tax form.); or

the unmarried surviving spouse of a veteran

NOTE : Qualified immigrants subject to the five-year period of ineligibility may be eligible for emergency medical care for ineligible immigrants, see 1700.000.00 Emergency MO HealthNet Care for Ineligible Aliens (EMCIA) .

(magi)(1805-000-00)(1805-020-00)(1805-020-15)(block-1)1805.020.15 Documentation and Verification of Alien or Immigrant Status – DSS Manuals#

IM-32 April 23, 2018 ; IM-47 July 18, 2016 ; IM-97 November 9, 2015

All non-citizen applicants for MO HealthNet who declare they are qualified immigrants must provide Department of Homeland Security (DHS) documents to establish immigration status.

If the applicant provides the requested documentation, verify the documentation with the DHS using the SAVE System.

NOTE : MEDES verifies a participant’s citizenship and immigration status by:

Sending a request to the Hub (Federal Data Services Hub) to verify citizenship or immigration status.

If additional verification is needed, the Hub will automatically submit additional data to SAVE requesting DHS verify the status of the case. No action is taken by the ES to verify status.

If citizenship cannot be established, the ES will need to take appropriate action to gather citizenship and immigration documentation for the participant by following the steps outlined in the Verify Lawful Presence guide.

EXCEPTION: The DHS SAVE system does not contain information about victims of severe forms of trafficking. Until further notice, do not contact SAVE concerning these individuals. See 1510.020.00 for more information on victims of trafficking.

If the applicant presents an expired DHS document or is unable to present any documentation of his or her immigration status, refer the person to the local DHS District Office to obtain evidence of status unless he or she can provide an immigrant registration number.

If the applicant provides documentation with an immigrant registration number, use the VLP Scan and Upload process to send documentation to the DHS to verify immigration status. DHS will determine the authenticity of the document and determine whether immigration status is met. If the applicant presents verification he or she has applied to DHS for a replacement document, contact the DHS to verify status by using the SAVE System.

When verification of qualified immigrant status is not available through paper documentation when Step 3 is triggered, and the individual meets all other eligibility requirements, approve the MO HealthNet application based on the applicant’s statement. A period of 90 days from the date of approval is allowed as a reasonable opportunity to provide documentary evidence for individuals stating they are lawfully present in the United States and:

Have been lawfully present for at least five years, or

Meet an exception to the five-year period of ineligibility.

See 1805.020.10.10.05 Qualified Immigrants With No Waiting Period and 1805.020.10.10.10 Qualified Immigrants With a Five-Year Period of Ineligibility for policy on the five-year ineligibility period and exceptions to the five year period of ineligibility.

If requested verification is not provided within 90 days, close the applicant’s benefits by manually sending a Notice of Adverse Action (IM-80) using the code CTV- failed to provide citizenship/alien documentation. At the end of the IM-80 period, manually send a Case Action Notice (IM-33C) using the CTV code and send an email to the COLE.MHNPOLICY@dss.mo.gov for a Program Development Specialist (PDS) to enter an override to end the individuals MO HealthNet benefit.

Each office must manually track the 90-day reasonable opportunity period using the same method offices use today for tracking citizenship reasonable opportunity periods.

Acceptable documentation of qualified immigrant status:

Immigration Status Verification Document (Department of Homeland Security (DHS) U.S. Citizenship and Immigration Services (USCIS) forms unless otherwise noted. Access the Systematic Alien Verification for Entitlements (SAVE) database to verify USCIS documents.) Lawful Permanent Resident (LPR) USCIS Form I-551 (Permanent Resident Card or Alien Registration Receipt Card (Form I-551 also known as a green card) Temporary I-551 stamp in a foreign passport or on Form I-94 for recent arrivals or immigrants who have applied for a replacement I-551 Refugees U.S Customs and Border Protection (CBP) electronic I-94 that can be obtained by the participant at www.cbp.gov/I94 ; and U.S Department of State’s Transportation Boarding Letter with CBP date stamp noting the person has been admitted as a refugee under section 207 NOTE : Newly arriving refugees (as of 8/7/15) are required to provide the Department of Homeland Security electronic I-94 form and the Transportation Boarding letter with a date stamp showing entry as a refugee. A paper USCIS Form I-94 for refugees arriving to the U.S. prior to the use of the electronic format, indicating the person has been admitted as a refugee under section 207 USCIS Form I-766 (Employment Authorization Document) annotated “Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole” USCIS Form I-571 (Refugee Travel Document) NOTE: Refugees usually adjust to Lawful Permanent Resident LPR status after 12 months in the U.S., but are still considered refugees for eligibility purposes. Review the coding on the I-551 for codes RE-6, RE-7, RE-8, or RE-9. Asylee USCIS Form I-94 annotated with stamp showing grant of asylum under 208 of the INA Grant letter from the Asylum Office of the INS Form I-766 annotated “Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole”, with an eligible status code of A05 Afghan Special Immigrants Refer to Documentation for Special Immigrants chart Iraqi Special Immigrants Refer to Documentation for Special Immigrants chart Immigrant with Deportation or Removal Withheld Order of an Immigration Judge showing deportation withheld under 243(h) or 241(b)(3) of the INA and date of the grant Form I-766 annotated “Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole” Immigrant Granted Parole for at Least One Year Form I-94 annotated with stamp showing grant of parole under 212(d)(5) of the INA and a date showing granting of parole for at least one year Immigrant Granted Conditional Entry Form I-94 with stamp showing admission under 203(a)(7) of the INA, refugee-conditional entry Form I-766 annotated “Valid for Re-entry to the U.S. or Serves as I-512 Advance Parole” Cubans and Haitians Form I-94 annotated parole into the U.S. on or after April 21, 1980 or parole at any time as a “Cuban/Haitian Entrant (status pending)” NOTE : The stamp may also include variations of the following (usually handwritten) notations, and may also be stamped in an individual’s passport: Public interest or Lottery To file I-589 Pending final asylum hearing Exclusion proceeding Pending removal hearing CM or CMPP – Cuban parolee processed under medical professional program CP – Cuban Parolee processed under special migration program USCIS Form I-551 with the code CU6, CH6, HA6, or HB6 Cuban or Haitian passport with a 212(d)(5) stamp dated after October 10, 1980 DHS Form I-221; DHS Form I-862; DHS Form I-220A; DHS I-122; DHS Form I-221S; Copy of DHS Form I-589 date stamped by the Executive Office for Immigration Review (EOIR); Copy of DHS Form I-485 date stamped by EOIR; or EOIR-26;Other applications for relief that have been date stamped by EOIR; or Other documentation pertaining to an applicant’s removal, exclusion or deportation proceedings USCIS Form I-766 with an eligible status code C08, C10 or C11 DHS receipt for filing Form I-589 (Application for Asylum and Withhold of Removal) U.S. Visa (with the subheading “Not a Visa” and annotation of “Special Parole for noncurrent Haitian IV Beneficiaries” and USCIS Form I-94 stamped “Parole” with the written code of HF/HPI NOTE: Persons admitted on B2 visas are not qualified immigrants, or lawfully residing in the U.S. under section 214 of CHIPRA and are not eligible for benefits as a Cuban/Haitian Entrant. Battered Immigrant Contact Income Maintenance (IM) Program and Policy for further instructions. EXCEPTION: The battered immigrant will not be a qualified immigrant during any period in which the individual responsible for such battery or cruelty resides in the same household as the individual subjected to such battery or cruelty. American Indian born in Canada (Cross-border Native American) Birth or baptismal certificate issued on a reservation Tribal records Letter from the Canadian Department of Indian Affairs; or School records NOTE: This does not include a spouse or child of such Indian, or a non-citizen whose membership in an Indian tribe or family is created by adoption unless such person is of at least fifty percent (50%) or more Indian by descent. Amerasian Immigrant USCIS Form I-551 coded AM6, AM7, or AM8 Unexpired temporary I-551 stamp in foreign passport or on Form I-94 with the code AM1, AM2, or AM3 Trafficking Victim Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR) original certification letter or eligibility letter for children. Verify the letter by calling Trafficking Verification 202-401-5510 and notify ORR of the benefits for which the individual has applied. Trafficking victims are not required to provide any additional documentation of their identity or immigration status. U.S. Military Veteran Original or notarized copy of Department of Defense DD Form 214 Separation Document showing at least 2 years of active-duty service and honorable discharge. A character of discharge “Under Honorable Conditions” is not an “Honorable” discharge for these purposes. NOTE: If the applicant cannot provide the DD-214, send a signed authorization requesting a copy of the DD-214 to the Military Personnel Record Center, 9700 Page, St. Louis, MO 63132. U.S. Military Active Duty Personnel (Army, Air Force, Marine Corp, or Coast Guard) Current military ID card (DD Form 2 (Active)) that lists an expiration date of more than one year from the date of issue. If the card will expire within one year, use a copy of his/her military order to document active-duty status. A member of a reserve component shall establish active-duty status by showing a current DD Form 2 (Reserve){red} and military active-duty orders showing such persons is on active duty, but NOT on active duty for training. No other method of verifying this status is currently available. NOTE: If the individual is unable to furnish either of the above, active duty may be verified through the nearest RAPD (Real Time Automated Personnel Identification System) located at many military installations or by requesting verification in writing (which can be transmitted by facsimile) from the DEERS Support Office: DEERS Support Office ATTN: Research and Analysis 400 Gigling Road Seaside, California 93944-6771 FAX Number: 408-655-8317 Spouse, Unmarried Surviving Spouse ,or Child of a Veteran or Active Duty Armed Forces Military Unexpired Uniformed Services Identification and Privilege Card DD1173 showing: the individual is married to a veteran or active-duty member, the individual is a non-married surviving spouse a child is dependent on the veteran or active-duty member of the Armed Forces for his/her support and is under the age of eighteen (18) or if a full-time student, under age twenty-two (22). NOTE: If the Military ID Card is unavailable or further documentation is needed, refer the individual to the Veterans Administration (VA) regional office.

(magi)(1805-000-00)(1805-030-00)(1805-030-05)(block-1)1805.030.05 Income Evidence – DSS Manuals#

IM-61 November 12, 2024 ; IM-20 April 1, 2024 ; IM-30 April 3, 2023 ; IM-89 June 27, 2022 ; IM-14 March 8, 2021 ; IM-169 December 2, 2019 ; IM-96 July 13, 2017 ; IM-17 February 21, 2017 ; IM-97 November 9, 2015

Countable self-attested income must be confirmed or verified by utilizing the methods below; see 1805.030.20.05 Income Included Under MAGI .

Reasonable Compatibility

Reasonable Compatibility (RC) is applied to electronic data sources and the self-attested income to determine if additional verification is needed; see 1805.030.15 Reasonable Compatibility .

Electronic Data Sources

Federal regulations require FSD to attempt to confirm the self-attested income using available EOI from all applicable electronic data sources in conjunction with reasonable compatibility (RC) to determine if additional clarification on the self-attested income is needed from the participant.

Available electronic data sources include, but are not limited to the following:

the Federal Data Hub, also known as the hub

Verification received for other FSD programs

Verification of Earnings (VOE)

IIVE from Social Security Administration

IMES* or information from Department of Labor and Industrial Relations (DOLIR)

*IMES provides state level information from Department of Labor and Industrial Relations (DOLIR). IMES is required in the electronic case record if it is accessed to review income information, and it reflects something other than “no data”. An IMES is considered to contain “no data” when the IMES:

is completely blank; or

has no earned income data for the last 12 months, and displays no unemployment compensation received for the last 12 months

When IMES displays “no data”, document in the eligibility system the date the IMES was viewed and why the IMES was not considered useful in an income determination.

Refer to the Electronic Verification System (EVS) Manual for information on electronic data sources.

Employer or Income Source Discrepancies

Update the name of the employer when the participant reports a change in employers. If the self-attested name of the employer does not match the employer’s name from the EOI do not request additional information. RC compares the income amounts, not the name of the employer.

Zero Income

Confirm income of participants or households attesting zero income if EOI reflects eligibility in a different threshold.

When zero income is self-attested and:

the electronic data source shows zero income:

Their attestation is reasonably compatible, no further clarification is needed.

the electronic data source shows income:

Determine if their attestation of zero income and EOI result in eligibility in the same threshold. If so, the amounts are RC; accept their attestation of zero income. If their statement of zero income and EOI result in eligibility in different thresholds, contact the participant for clarification. If the participant clarifies when the income ended and they did not receive income during a month their household is requesting coverage, accept their statement of zero income. If they report their income has ended but they did receive income in a month they are requesting coverage, update the system with the new information. Determine if their explanation is reasonable based on the information available. If so, verify the income. If more information is needed to determine eligibility, send a Request for Information specifically asking for clarification of the income discrepancy and verification of income received during the application timeframe.

Note: Quarterly wage information from IMES may not be current enough to cause a participant’s statement of zero income to be questionable. Clarification should only be requested if eligibility is impacted.

When wages are attested, and the electronic data source shows zero or no income:

Request verification of income. Reasonable compatibility cannot be determined without EOI.

Income Verification

Paystubs and Award Letters

Request enough income verification to accurately reflect a projection of ongoing income. The most recent 30 days of income verification is often sufficient. Request more documentation if a longer period will provide a more accurate average. Seasonal occupations, medical leave, or fluctuating hours may result in a need for more income verification.

Income verification may include, but is not limited to:

paystubs, such as from a job or unemployment compensation

award letters for the current pay period

bank statements to verify current interest

When the participant provides current pay verification, whether with an application or in response to a request for information, the pay verification functions in 2 ways. Use the verification to:

update the self-attested income amount(s)

verify the updated self-attested income amount

Self-Employment and Farm Income

Verification of self-employment or farm income is required in rare circumstances when the self-attested income amount is questionable. See 1805.030.15 Reasonable Compatibility for more. If self-employment or farm income is questionable, request verification. To verify self-employment or farm income, request taxes, along with all schedules, for the previous tax year. If the participant has not filed taxes, request the last 3 months of business ledgers or enough business ledgers to adequately project an amount of self-employment income for 12 months. Use the verification to budget the amount of income remaining after all allowable self-employment or farm expenses are deducted from gross income.

(magi)(1805-000-00)(1805-030-00)(1805-030-10)(1805-030-10-10)(block-1)1805.030.10.10 MAGI Household Composition for Tax Filers – DSS Manuals#

IM-149 October 30, 2020 ; IM-44 May 11, 2017 ; IM-97 November 9, 2015

For tax filing households, the tax filer and individuals to be claimed as dependents on a taxpayer’s federal income tax return are included when determining household size, (with some exceptions).

The household for a tax filer consists of the following individuals:

The tax filer

The tax filer’s spouse if living together NOTE: Do not count spouses who are separated, but filing taxes jointly in one another’s MAGI household.

All of the tax filer’s dependents (a tax dependent can be a person of any age), which may include: Children and siblings including stepchildren Children over age 19 (when claimed as dependents)

EXAMPLE: Jessie and Marley are separated, but filing taxes jointly. They have two kids, Maci and Logan, who are tax dependents. Jessie is applying for herself and the kids. Jessie’s MAGI household consists of herself, Maci, and Logan. Marley is not included in her MAGI household as he does not live in the home.

EXAMPLE: Chris is an over the road truck driver. Although he is only home every 6 weeks or so, he and his wife, Amy, are not separated. They file taxes jointly and claim one dependent child, Quin. Amy applies for coverage for herself and Quin. Amy’s MAGI household consists herself, Chris, and Quin.

The household of the tax dependent is the same as the tax filer’s household; unless the tax dependent meets one of the exceptions in 1805.030.10.20 Exceptions to MAGI Household Composition . When a tax dependent meets an exception, tax non-filer rules apply.

Exception: For Family MO HealthNet programs, a “Child” or “Children” means a person or persons who are under nineteen (19) years of age” under 13 CSR 40-7.010(B). Therefore, the parents of a person under age 19 must be included in the household composition and the parents’ income is counted even if the child claims he is a non-dependent tax filer. These individuals fall under non-filer rules because they are children who are not claimed as tax dependents.

Example: Mary is age 18 and she applies for MO HealthNet for Pregnant Women (MPW). She is working part-time and lives with her parents and younger brother. She states that she is a tax filer and that her parents do not claim her as a tax dependent. Mary is under age 19, but does not claim to be a tax dependent, so her household falls under non-filer rules. Her household must include her parents, her younger brother, and her unborn child. Example: Linda is age 18 and she applies for MO HealthNet for Pregnant Women (MPW). She is married to Bob and they have a son, Larry, who is 6 months old. Linda lives with her parents, her spouse, and her son. Bob is working part-time. Linda states that she and Bob are joint tax filers who claim Larry as a tax dependent. Linda is under age 19, but does not claim to be a tax dependent, so her household falls under non-filer rules. Her household must include her spouse, her son, her unborn child, and her parents.

Refer to the Household Composition-MAGI chart in MEDES Resources for more information.

(magi)(1805-000-00)(1805-030-00)(1805-030-10)(1805-030-10-20)(1805-030-10-20-05)(block-1)1805.030.10.20.05 Joint Custody – DSS Manuals#

IM-120 September 11, 2017 ; IM-45 May 12, 2017 ; IM-82 December 6, 2016

True joint 50/50 custody occurs when the child(ren) spend an equal number of overnight visits with each parent. Per Missouri Rule 13 CSR 40-7.010 the non-custodial parent is defined as the parent who does not have physical custody of the child.

The parent with whom the child spends more than 50% of their overnight visits with is considered to be the parent exercising the majority of the child’s care and control and therefore is the custodial parent regardless of tax filing status.

NOTE: 42 CFR 435.4 provides that parents must reside in the home of the eligible child(ren) in order for the parent to be eligible for MAGI MO HealthNet for Families (MHF).

NOTE: Parents who claim the child(ren) as a tax dependent but do not practice true 50/50 joint custody (they have the child(ren) less than 50% of the time) are not eligible for MHF due to ineligible living arrangements.

EXAMPLE: John and Linda have a divorce decree stating they have joint physical custody of their child, Lauren. John claims Lauren as a tax dependent on his taxes. Linda applied for benefits on Lauren. Linda states she has Lauren more than 50% of the time. Linda provided a revised parenting plan, signed by John and Linda, which states Lauren stays with Linda 4 nights per week. Lauren is physically with Linda more than she is with John, therefore Linda may apply for benefits for Lauren.

The custodial parent must carry health care coverage for the child. The custodial parent is the parent that applies for MO HealthNet (MHN) benefits.

EXAMPLE: Mom and dad exercise true 50/50 joint custody, dad claims the child as a tax dependent each year and must carry coverage for the child. Mom is a tax filer but does not claim any dependents and does not have any other household members. Mom applies for MHF coverage on herself and reports the child in her home 50% of the time. Mom does not qualify for MHF because she is the non-custodial parent. The mom’s household size is one: herself. The child’s household size is two: the child and dad.

If the custodial parent is in question, follow the steps below to determine which parent is considered the custodial parent for the purpose of making a MHN application.

Determine which parent intends to claim the child(ren) as a tax dependent. When the custodial parent cannot be determined by the tax filing status continue to step 2 of this section.

Review court orders, legally binding separation orders, divorce decrees, parenting plans, and/or custody agreements to determine which parent is the custodial parent. If the custodial parent cannot be determined by steps 1 or 2 of this section, continue to step 3.

Determine which parent the child(ren) expects to spend more overnight visits with during the period for which eligibility is being determined. NOTE: It may be necessary to count the overnight stays with each parent to determine where the child is more often. When the custodial parent cannot be determined by steps 1, 2 or 3, continue to step 4 of this section.

When steps 1-3 of this section do not determine who the custodial parent is, the first parent to apply for MHN benefits is considered the custodial parent for the purpose of the MHN application. NOTE: It may be necessary to count the overnight stays with each parent to determine where the child is more often. If step 4 does not solve who the custodial parent is, move to step 5.

Determine which parent has the higher MAGI (Modified Adjusted Gross Income), The parent with the higher MAGI is considered the custodial parent for MHN purposes and is the parent that can apply/receive MHN benefits on behalf of the child(ren). If both parents are tax filers, and true 50/50 joint custody is practiced, count the child in the household of the parent with the higher adjusted gross income. NOTE: If the parents alternate each year claiming the children as part of their tax filing household, the non-custodial parent is considered the parent who does not plan to claim the child as a tax dependent for the period MHN benefits are being requested. The parents must alternate years they each apply for MHN for the child.

Refer to the Household Composition Flow Chart to help determine household composition.

(magi)(1805-000-00)(1805-030-00)(1805-030-10)(1805-030-10-20)(block-1)1805.030.10.20 Exceptions to MAGI Household Composition – DSS Manuals#

IM-97 November 9, 2015

Apply tax non-filer rules if the individual meets any of the following exceptions:

The individual expects to be claimed as a tax dependent of someone other than a spouse or a biological, adopted or stepparent

The individual is a child under age 19 living with both parents, but will be claimed as a tax dependent by only one parent

The individual is a child under age 19 who expects to be claimed by a non-custodial parent

EXAMPLE ONE: Mom and Dad, not married, both over age 19, live together, and have a child (age 3). Mom and Dad each file taxes separately. Dad claims their child as his tax dependent. The MAGI households for each applicant would be as follows:

Dad is a tax filer. He is not married to Mom. Dad is claiming the child as his dependent. Dad is a MAGI household of 2 (Dad and Child). Dad receives MHF if he and the child meet all eligibility factors.

Child is not expected to file a tax return. Child will be claimed as a tax dependent by Dad. Child meets the exception: “The individual is a child under age 19 living with both parents, but will be claimed as a tax dependent by only one parent.” Non-filer rules apply to the child. Child is a MAGI household of three (Child, Dad and Mom). Child receives MHF if he/she meets all eligibility factors.

Mom is filing taxes, she is not claiming dependents nor does she expect to be claimed as a dependent herself. Mom is not married to Dad. Mom is a MAGI household of one (Mom only) using tax filer rules. Mom meets the definition of caretaker relative as she has care of the child. Mom receives MHF if she and her child meet all eligibility factors.

EXAMPLE TWO: Mom and Dad, not married, both over age 19, live together, and have a child (age 3). Mom is a non-filer and Dad is a tax filer. Dad claims their child as his tax dependent. The MAGI households for each applicant would be as follows:

The MAGI households for Dad and Child are the same as in Example One. Dad is filing taxes. He is not married to Mom. Dad is claiming the child as his dependent. Dad is a MAGI household of 2 (Dad and Child). Dad receives MHF if he and the child meet all eligibility factors.

Mom is not a tax filer and does not expect to be claimed as a tax dependent. Mom is not married to Dad. Using non-filer rules, Mom is a MAGI household of 2 (Mom and Child). Mom meets the definition of caretaker relative as she has care of the child Mom receives MHF if she and her child meet all eligibility factors.

EXAMPLE THREE: Grandmother and two granddaughters (both under age 19 and sisters) live together. Grandmother is a non-filer . The households for each applicant would be as follows:

The granddaughters are not tax filers and do not expect to be claimed as tax dependents by anyone. Using non-filer rules, the granddaughters are a MAGI household of 2 (grandmother is not counted). The granddaughters would have potential eligibility for MHK if they meet all other eligibility factors.

Grandmother is not a tax filer and does not expect to be claimed as a tax dependent. Using non-filing rules, Grandmother is a MAGI household of 1. Grandmother is a non-parent caretaker who receives MHF if she and at least one of the granddaughters meet all eligibility factors.

(magi)(1805-000-00)(1805-030-00)(1805-030-10)(1805-030-10-25)(block-1)1805.030.10.25 Caretaker Relatives – DSS Manuals#

IM-65 June 14, 2017 ; IM-75 November 4, 2016

Caretaker relatives are an exception to the MAGI Household Composition. Caretaker relatives can make application for a dependent child and themselves if the caretaker relative is assuming primary responsibility of the child. The caretaker relative must meet income guidelines for MHN (see Appendix A – MAGI Income With 5% of FPL Included and CHIP Premium Amounts ).

Claiming the child as a tax dependent can demonstrate an assumption of primary responsibility, however it is not the sole determining factor. A caretaker relative must live in the same household as the dependent child, assume primary responsibility, and be related to the dependent child.

NOTE: The caretaker relative assuming primary responsibility of the child does not have to be claiming the child as a tax dependent.

A caretaker relative relationship can be defined as the child’s parent, or as:

Any blood relative including those of half-blood and including first cousins, first cousins of parents, nephews, or nieces

Relationships to persons of preceding generations as denoted by prefixes of grand, great, or great-great

Relationship to a person through marriage such as stepfather, stepmother, stepbrother, and stepsister

A relationship to a person through legally adopting a child or adopting the parent of a child, and other relatives by adoption that meets the criteria established for blood relatives NOTE: Caretaker relatives by marriage are still to be included even if the marriage has been terminated, either by death or divorce. The caretaker relative must be assuming primary responsibility for the dependent child as defined above. EXAMPLE: Jon lives with, and is the uncle to, Gavin, age 10. Jon is the caretaker relative to Gavin. Jon is not a tax filer and Gavin is not expected to be claimed as a tax dependent by anyone else. Jon applies for MHN for himself and Gavin. Jon’s MAGI household size is 1 for himself and Gavin’s MAGI household is 1 for himself. Tax non-filer rules apply for the dependent child.

The tax filer of the dependent child may reside in the same home as the caretaker relative and the dependent child, when the tax-dependent child is an in-common child of the tax filer and the caretaker relative.

EXAMPLE: Melissa applied for MHN for herself and her two children. She lives with the father of her children but she is not married to the father. The father claims the children as tax dependents. Melissa does not work and does not file taxes. Melissa’s household would follow tax non-filer rules. She would be eligible for MHF as a household size of 3 (herself and two children), if all other eligible criteria are met. The children’s household size is four: the two children, the mother and the father.

Client’s statement is acceptable when a person is claiming to be a caretaker relative of a child. If the situation is questionable or if the tax filer disputes the caretaker relative’s statement, request further documentation.

(magi)(1805-000-00)(1805-030-00)(1805-030-15)(1805-030-15-10)(block-1)1805.030.15.10 Reasonable Compatibility (RC) With More Than One Income in the Household – DSS Manuals#

IM-30 April 3, 2023 ; IM-09 January 25, 2019

To determine RC for households with more than one income:

Combine all of the self-attested income amounts in the MAGI household

Combine all of the electronically obtained income (EOI) in the MAGI household

Compare both amounts to the program threshold If they are both under the program threshold, the income is reasonably compatible. If they are not both under the program threshold, but are within 10%, the income is reasonably compatible. Refer to Appendix B – Reasonable Compatibility Calculator .

Example: Marilee and Jacob have applied for their two children. Jacob self-attested to $1500 in wages and Marilee self-attested to $1400 in wages. The combined income is $2900.00 per month. Jacob’s EOI shows $1700 and Marilee’s shows $1550, or $3250 combined. Their income is RC because the combined self-attested income and the combined EOI are both under the Title XIX program threshold.

If the combined MAGI household income is not RC, complete an RC determination using income of the individual participants:

Determine the self-attested income amount of the first participant

Determine the EOI amount of the same participant

Determine if the incomes are within 10% of each other (refer to Appendix B – Reasonable Compatibility Calculator ) If the incomes are within 10%, the income is RC. If the incomes are not within 10%, contact the participant for more information.

Repeat steps 1-3 for each participant with income

Example: Marcy and Joe apply for AEG and self-attest income of $2000, which is under the Title XIX program threshold for their household size. The combined EOI for both is $2400 which is over the threshold. The amounts are also not within 10%. However, Marcy’s self-attested amount is $1000 and her EOI shows $1074 which is within 10% of her self-attested, so her income is RC. Joe’s self-attested is $1000, but his EOI shows $1326, which is not within 10% of his self-attested. Clarification is needed for Joe’s income.

(magi)(1805-000-00)(1805-030-00)(1805-030-15)(block-1)1805.030.15 Reasonable Compatibility – DSS Manuals#

IM-30 April 3, 2023 ; IM-100 July 11, 2022 ; IM-94 June 30, 2022 ; IM-39 March 15, 2019 ; IM-96 July 13, 2017 ; IM-46 May 12, 2017 ; IM-07 January 27, 2017 ; IM-97 November 9, 2015

Definitions

Reasonable Compatibility (RC) is defined as the allowable difference between the self-attested income and the income reported by the electronically obtained information (EOI). RC is used to determine if further clarification is required from the participant to verify the self-attested income.

A program threshold is the maximum income limit for the Title XIX or CHIP program.

An eligibility level is a point of eligibility within a program threshold. For example, CHIP 73 and 74 are eligibility levels within the CHIP program threshold. MO HealthNet for Families (MHF) and Adult Expansion Group (AEG) are eligibility levels within the Title XIX Medicaid program threshold.

RC Process

Reasonable Compatibility policy is only applied when the attested income is below the threshold and the electronic verification is above the threshold. All other scenarios do not require additional clarification.

Below is an illustration of the process for applying RC in a Medicaid-Title XIX eligibility determination. Scenario #4 below explains when to apply the 10% RC test.

Below is an illustration of the process for Applying RC in a CHIP eligibility determination. Scenario #4 below explains when to apply the 10% RC test.

Applying Reasonable Compatibility

To determine if the income is RC, gather the following information:

household size

MHN program’s income eligibility levels and program thresholds

self-attested income

electronic data source income

Determine which program thresholds apply to the participant.

Apply the highest threshold level based on potential program eligibility.

Example: Mary applied for MHN and reports a pregnancy. Explore eligibility for MO HealthNet for Pregnant Women (MPW); if ineligible for MPW, explore eligibility for Show Me Healthy Babies (SMHB) in the CHIP threshold.

Example: Mary applied for MO HealthNet (MHN). She is the only person in the home and would only be eligible for AEG. Explore eligibility for AEG coverage in the Title XIX Program Threshold.

Example: Scott applied for MHN for his two uninsured children. Eligibility for them is explored in both the Title XIX and CHIP program thresholds.

Compare self-attested income to available EOI.

Refer to the RC flow charts above for Title XIX Medicaid or CHIP .

Income is not RC

Incomes are not RC when:

The self-attested income is below the program threshold and EOI is higher than the program threshold. See scenario #4 in the RC flow chart. Determine if the difference between the attested income and the EOI is less than or greater than 10% If the difference is less than 10% accept the attested income and determine eligibility. If the difference is greater than 10% attempt a phone call to clarify the information. If the explanation is reasonable, comment in the system and determine eligibility. If the explanation is not reasonable, or you cannot reach the person by phone, a Request for Information should be sent asking for clarification of the difference between the attested and EOI incomes.

Clarifying Statement from the Participant and Verification

A clarifying statement can consist of a phone, face to face or written statement that reasonably explains the difference in the income amounts between self-attested and EOI. Reasonable explanations might include overtime, raises or bonuses not included in the self-attested income but reported by the employer and shows in the EOI data. Refer to 1805.030.05 Income Evidence for acceptable verification.

EOI is not Available

Some income types do not have an electronic data source to search for EOI, other than income verified for another assistance program such as SNAP. After checking other assistance programs for verification, accept the self-attested amount of income for the following income types:

Self-employment (including farm income)

Pensions

Short or long-term disability

MHN Thresholds and Eligibility Levels

Title XIX Program Threshold CHIP Program Threshold State-Only Program Threshold Adult-Eligibility Levels Adult-Eligibility Levels Adult MHF-MHF income limit for household size. SMHB-150%–300% of the FPL UWHS—201% of the FPL AEG for adults 19 through age 64-133% of the FPL Kids-Eligibility Levels MPW-196% of the FPL CHIP 4M-age 1 through age 18—153% of the FPL Eligibility for CHIP 4M for ages 6 through 18 starts at 110% of the FPL Kids-Eligibility Levels CHIP 71/72—150% of the FPL Children under the age of 1-196% of the FPL CHIP 73-185% of the FPL MHK for children age 1 through age 18 148% of the FPL CHIP 74-225% of the FPL CHIP 75-300% of the FPL

(magi)(1805-000-00)(1805-030-00)(1805-030-20)(1805-030-20-05)(block-1)1805.030.20.05 Income Included Under MAGI – DSS Manuals#

IM-18 March 1, 2022 ; IM-14 March 8, 2021 ; IM-148 October 30, 2020 ; IM-92 June 18, 2020 ; IM-146 September 27, 2019 ; IM-101 July 3, 2019 ; IM-91 June 7, 2019 ; IM-124 September 12, 2017 ; IM-73 November 4, 2016 ; IM-45 July 18, 2016 ; IM-32 June 7. 2016 ; IM-97 November 9, 2015

Enter all income types into the eligibility system. Enter gross amounts of most income types into the eligibility system. Some exceptions* are listed below.

Types of included or countable income under MAGI methodology include but are not limited to:

Wages, salaries and tips use eligibility system functionality to consider pre-tax deductions. Refer to 1805.030.20.15 Allowable Deductions and IM Resources for additional information.

NOTE: Cryptocurrencies and digital currencies such as Bitcoin received as payment are treated in the same manner as wages

Severance pay

Foreign earned income

Interest, including tax-exempt interest

Interest and dividends

Unemployment compensation

Rental or royalty income

Other taxable income such as canceled debts, court awards, jury duty pay not given to an employer, and cash support

Alimony (including arrears) from divorces and separations finalized before January 1, 2019

Most retirement benefits , including Railroad Retirement and other pensions; also see “Domestic Relations Orders” below

Grants and Scholarships for living expenses

Disability Benefits from short or long-term disability plans If plan premiums are paid by the covered individual, payments from the plan to the covered individual are not countable/excluded income. If plan premiums are paid by the covered individual’s employer, payments from the plan are countable/included income.

Income from boarders or lodgers

*Self-employment income (minus allowable expenses, including depreciation)

*Farm income (minus allowable expenses, including depreciation)

*Fishing Income (minus allowable deductions, including depreciation) Fishing income is income from commercial fishing or from farming fish and/or other aquatic life. Fishing income is reported on a Schedule C, Profit or Loss from Business.

*Net capital gains (profit after subtracting capital losses)

*Some investment income , such as trusts and annuities.

NOTE: These will be reviewed by MHN Program and Policy and/or Division of Legal Services staff and the response will include a decision on whether or not the income is countable for MAGI programs. Prior to processing the eligibility determination, the following must be sent with a Request for Interpretation of Policy (IM-14) through the normal supervisory channels:

All trusts, including the “Schedule A” and an itemization of the assets used to fund the trust. All annuity contracts, including the annuity contract application.

Lottery and Gambling Winnings Winnings paid in installments are treated as any other recurring income “Qualified lottery winnings” which are paid out in a single payout are counted in the month received for any possible spouse and/or child of the individual who received the winnings. See Appendix J – Lottery and Gambling Winnings for how this is counted for the individual who received the winnings.

NOTE: Self-attestation is an acceptable verification for lottery and gambling winnings.

EXAMPLE : DeAnn, her husband Larry, and son Daniel are all receiving MO HealthNet for Families when DeAnn receives a qualified lottery winning in the amount of $125,000 paid out all at once in June. This amount will be countable for Larry and Daniel in June. Per Appendix J – Lottery and Gambling Winnings , this amount will be countable for DeAnn for 6 months.

NOTE : Individuals may qualify for an exemption for lottery or gambling winnings due to “undue medical or financial hardship” – send these cases on an IM-14 for MHN Program and Policy to determine whether an exemption exists.

Income from a child when the child is the only person in his/her MAGI-based household regardless of whether or not the child’s income exceeds the filing threshold.

EXAMPLE: Sally, who works a part time job and has income under the tax filing threshold, lives with her grandmother, Judith. Her parents are not living in the home, nor do they claim her as a tax dependent. Sally’s income is countable for her MAGI household.

EXAMPLE: Riley receives $1,405 in SSA a month and lives with her grandfather, Bill. Her parents are not living in the home, nor do they claim her as a tax dependent. Riley’s SSA is countable for her MAGI household.

Social Security benefits for an adult (19 or older), regardless of whether they are considered taxable or non-taxable income for federal tax purposes. Do not include any amount that is recouped by Social Security Administration due to an overpayment of Social Security benefits.

NOTE: Supplemental Security Income (SSI) is not the same as Social Security Administration benefits (SSA). SSI is not included as income.

Social Security benefits for a child (18 or younger) when the calculated taxable SSA income of the child is greater than the threshold. The thresholds are: $25,000 for unmarried child $32,000 for married child; prior to processing the eligibility determination, the following must be sent with a Request for Interpretation of Policy (IM-14) through normal supervisory channels.

The Internal Revenue Service (IRS) excludes SSA income for children until it reaches a formulaic threshold in combination with the child’s other income sources (IRS Publication 915; Social Security and Equivalent Railroad Retirement Benefits).

The current formula for calculating taxable SSA income of a child is:

Start with the amount from box 5 of a child’s Form(s) SSA-1099 and RRB-1099 (if more than one form is received, combine the amounts from box 5). This amount can also be calculated by multiplying the monthly SSA amount by the number of months SSA was received in that tax year. Include the full amount of any lump-sum SSA benefit payments received in current tax year. Total 1 and 2 above, then divide in half. Add any taxable pensions, wages, interest, dividends, and other taxable income. Compare this total to the thresholds depending on the child’s marital status. include child’s SSA income if greater exclude child’s SSA income if equal to or less than

EXAMPLE: An unmarried child receives SSA of $1405 per month. The child started receiving SSA two years ago, and did not receive a lump sum during the tax year. The family was not able to provide the SSA-1099. The child has no other income.

Determine annual SSA income $1,405 x12 = $16,860 Include the full amount of any lump-sum SSA benefit payments received in current tax year. + $0 zero (No lump sum received in tax year.) Divide in half. ($16,860 + 0)/2=$8,430 Add any taxable pensions, wages, interest, dividends, and other taxable income. + $0 zero (No additional pensions, wages, interest, etc. received in tax year.) Compare to $25,000 $8,430 is under $25,000 so the child’s SSA income is EXCLUDED in MEDES.

Compensation in lieu of wages/bartering defined as an exchange of property or services. Include as income the fair market value of property or services received in bartering at the time received. The value of the services must be agreed on ahead of time. The value will be accepted as fair market value unless the value can be shown to be otherwise. Generally, this income is reported on a Schedule C or Schedule C-EZ (Form 1040).

EXAMPLE: Applicant works at the front desk of a hotel in exchange for a room to stay in at the hotel. The applicant and the manager of the hotel agreed that the weekly rate for the hotel room was $380.00 and that the applicant was to work 40 hours per week in exchange for the room. The $380.00 is considered compensation in lieu of wages/bartering and is included as the weekly income source for the applicant.

Domestic Relations Orders (DRO)-A DRO is not a type of income, but a court ordered division of property granting an alternate payee ownership of certain property or portions of property, such as a pension or retirement plan. See 0805.015.30 Unearned Income for more information.

Net Operating Loss (NOL) and carryover as a negative income: The NOL is a loss from operating a business that can be carried over to future years. This is considered a negative income and it can be applied to future years indefinitely (as allowed by the IRS, see IRS Publication 536 ). This is shown as a negative figure on the “Other income” line on IRS Form 1040, Schedule 1 and must include an attached statement regarding how the NOL was determined. The NOL can be claimed as negative income for multiple years until the loss amount is exhausted. This can carryover to future years, even if the self-employment income has ended, and should be verified annually with IRS Schedule 1 and a statement regarding the year of the NOL, how the NOL was computed for the current tax year, the amounts that have been claimed for previous tax years, and the amount that will be remaining. If multiple NOL negative incomes are being claimed, statements must be included for each one.

EXAMPLE: Mr. Spears owns a farming business and has a $5,000 NOL for 2016. Mr. Spears claims negative income on his tax return: $1,300 NOL for 2017, $980 NOL for 2018, and $1,125 NOL for 2019. Mr. Spears has $1,595 NOL that he can apply as a deduction for future years. Mr. Spears closed his farming business in 2018, but he continues to claim this NOL as a carryover negative income for future tax years until the NOL is exhausted. Mr. Spear must provide verification of the NOL negative income.

If evidence exists to indicate an income should not be taxable, submit a Request for Interpretation of Policy (IM-14) with supporting documents through normal supervisory channels.

Refer to the Electronic Verification System (EVS) Manual for information on electronic data sources.

(magi)(1805-000-00)(1805-030-00)(1805-030-20)(1805-030-20-15)(block-1)1805.030.20.15 Allowable Deductions – DSS Manuals#

IM-146 December 16, 2022 ; IM-96 July 11, 2022 ; IM-14 March 8, 2021 ; IM-92 June 18, 2020 ; IM-147 September 27, 2019 ; IM-103 July 22, 2019 ; IM-164 December 27, 2017 ; IM-94 July 13, 2017 ; IM-50 May 12, 2017 ; IM-97 November 9, 2015

Deductions are expenses that lower taxable income. Because MAGI MO HealthNet (MHN) is based on taxable income, deductions must be incorporated in the calculation of the MAGI-based income.

Accept self-attestation for deductions allowed in the calculation of MAGI income. Enter deductions as attested by the participant. The self-attested income and deductions must be found Reasonably Compatible (RC) with electronic data sources. If the self-attested amount is not RC, request additional information. If the additional information is not provided, do not deny or reject the application or case. Determine eligibility without including the deductions.

EXAMPLE : John applied for benefits on his 10-year-old son, Brad. John claims Brad as a tax dependent and is the custodial parent. John attests to gross wages of $1038 bi-weekly. John does not attest to pre-taxed deductions . However, John provided three paystubs with his application showing pre-taxed deductions of: health insurance of $250 semi-monthly, contributions to a Health Savings Account of $47 semi-monthly and contributions to a 401(k) of $55 semi-monthly. John’s pre-taxed deductions are added to the eligibility system . All other eligibility factors were met. The application is approved with the allowable pre-taxed deductions using the frequency of semi-monthly. Eligibility determination is made on John’s gross wages minus the pre-taxed deductions.

NOTE: When the participant’s eligibility is reviewed again, the attestation of pre-taxed deductions needs to be reconsidered, unless, auto renewed.

EXAMPLE : Bill’s daughter, Mary, is currently receiving coverage under MO HealthNet for Kids non-premium (MHK). Bill claims Mary as a tax dependent and is the custodial parent. Bill is now attesting to gross wages of $1300 per month. Bill also now attesting to pre-taxed deductions : health insurance for himself of $250 per month and contributions to a 401(k) of $1,300 per year. Electronic data sources confirm and are reasonably compatible with Bill’s attestation of gross wages minus pre-taxed deductions. Therefore, Bill does NOT need to provide verification of his deductions . All other eligibility factors were met and Mary remains eligible for MHK (no change in level of care). The change is finalized. The eligibility system will determine Mary’s eligibility based on Bill’s attestation of gross wages minus his attestation of pre-taxed deductions.

NOTE: When the participant’s eligibility is reviewed again, the attestation of pre-taxed deductions needs to be reconsidered, unless, auto renewed.

EXAMPLE : Bob applied for benefits on his 11-year-old son, Steven. Bob claims Steven as a tax dependent and is the custodial parent. Bob attests to gross wages of $2,300 semi-monthly. Bob does attest to pre-taxed deductions of : health insurance of $250 semi-monthly (employee only), contributions to a Health Savings Account of $47 semi-monthly and contributions to a 401(k) of $55 semi-monthly. Electronic data sources confirms Bob’s attestation of gross wages, however, the EOI is not reasonably compatible when the pre-taxed deductions are subtracted from his gross wages. Therefore, Bob does need to provide verification of his deductions . Bob is sent an IM-31A requesting verification of his pre-taxed deductions (paystubs or employer statement). Bob fails to return the requested verification in the allotted time, therefore, his deductions are NOT allowed. All other eligibility factors were met. Steven was found ineligible for all MO HealthNet programs under MAGI because Bob’s attestation of pre-taxed deductions are not allowed and his attestation of gross wages is over the income maximum for a household of two.

NOTE: Depending on the pay frequency and the frequency of the pre-taxed deductions, the participant may have pay periods without pre-taxed deductions.

(magi)(1805-000-00)(1805-030-00)(1805-030-20)(1805-030-20-15)(block-3)Other Allowable Income Deductions (Adjustments to Gross Income)#

In addition to pre-tax deductions, MAGI allows other income deductions which are “adjustments” to the individual’s gross income. These adjustments allow certain types of expenses to be deducted from the income after taxes are paid. Meaning, income taxes have already been paid prior to incurring these expenses. These deductions are claimed as a deduction on the Federal Income Tax Return at the end of the tax year.

These deductions can be found on IRS Schedules (1-6) form 1040. However, the individual does not have to file a tax return to get the deduction, for instance someone who is not required to file income taxes or new self-employment, therefore, the past three months of business ledgers detailing revenue and expenses is acceptable.

Only enter deductions allowable under MAGI guidelines

Not all schedules are applicable to MAGI guidelines

Other types of the IRS forms that are acceptable and may replace the need for IRS Form 1040: IRS Form 1040-SR – U.S. tax return for seniors Alternative to using Form 1040 For taxpayers age 65 or older Uses the same schedules and instructions as Form 1040 1040-X – Amended U.S. Individual Income Tax return Now can be filed electronically starting in tax year 2019 Mail in option is still available Used to make adjustments to an already filed 1040 or 1040-SR IRS Form 1040-ES – Estimated Tax Payments

NOTE: For more information on IRS forms, instructions, and publications, see irs.gov/forms-instructions .

When other allowable deductions are not reported or they are unknown, make an eligibility determination without applying the deduction. Do not deny or close an application or case for verification of deductions.

Deductions may exceed the MAGI based household income. When this occurs, the MAGI household income would be less than zero. To compare household budget to MAGI income maximums (FPL), use $0 as the MAGI household income.

NOTE: Income and deductions should be entered as reported by the individual. Allow the system to calculate the $0 budget; do not manually enter a $0 budget.

Allow the following expenses as deductions from an individual’s Adjusted Gross Income:

Educator Expenses Information can be found on IRS Schedule 1 (Form 1040) in Part II Adjustments to Income. To receive the educator expense the individual must be an eligible educator. An eligible educator is a full time teacher of kindergarten through twelfth grade. Half-time, part-time, or homeschool teachers do not qualify for an educator expense deduction. An eligible educator can deduct up to $250 per tax year of qualified expenses. If married and both spouses are eligible educators, they can deduct up to $500 per tax year of qualified expenses. However, neither spouse can deduct more than their own expense, up to $250. Qualified educator expenses include materials used in a classroom such as: books, supplies, and equipment (computers, software and services). Home schooling supplies and non-athletic supplies for physical education or health classes are not qualified expenses.

Certain Business Expenses of Reservists, Performing Artists, and Free-Basis Government Officials Information can be found on IRS Schedule 1 (Form-1040) in Part II Adjustments to Income. Certain business expenses of National Guard and reserve members who traveled more than 100 miles from home (one-way) and stayed overnight to perform services as a National Guard or reserve member; Performing arts-related expenses as a qualified performing artist; and Business expenses of fee-basis state or local government officials.

Health Savings Account (HSA) Deduction Information can be found on IRS Schedule 1 (Form-1040) in Part II Adjustments to Income.

NOTE : This is different from the HSA pre-tax deduction. This amount is based on Form 8889, not the individual’s pay stub.

A deduction for contributions made from a person’s income to a qualified HSA during the year. Contribution maximum amounts made to an HSA are limited by the IRS and vary depending on if the coverage is self-only or family coverage. In common situations: Maximum Annual HSA Contributions 2020 2021 2022 Self-Only Coverage $3550 $3600 $3650 Family Coverage $7100 $7200 $7300 Individuals age of 55 or older at the end of the tax year are allowed a higher limit, the contribution limit based on type (self or family) of coverage will increase by $1000 annually. Reminder: limits change annually and should be reviewed based on the particular tax year limit. See: Publications 969 for the particular tax year .

Archer Medical Spending Account (MSA) Deduction

Send an IM-14 using the appropriate supervisory channels

Moving Expense (ONLY for certain Armed Forces Members) Information can be found on IRS Schedule 1 (Form-1040) in Part II Adjustments to Income. Costs of moving can be deducted if the individual is a member of the Armed Forces on active duty and due to a military order move because of a permanent change of station. The standard mileage rate for using your vehicle to move to a new home is 18 cents a mile. The deduction is for reasonable unreimbursed expenses of moving Moving household goods and personal effects, and Travel

Self-Employed SEP, SIMPLE, and Qualified Plans Information can be found on IRS Schedule 1 (Form-1040) in Part II Adjustments to Income. A deduction for contributions to a qualified retirement plan for the self-employed and clergy members. Send an IM-14 through normal supervisory channels if deductions are questionable.

Self-Employed Health Insurance Deduction Information can be found on IRS Schedule 1 (Form-1040) in Part II Adjustments to Income.

NOTE : This is based on forms; Schedule C, C-EZ, or F

Amount paid for health insurance when an individual is self-employed. This deduction may include the expense paid for the self-employed individual, and the individual’s; spouse, children (under the age of 27 at the end of the tax year) and tax dependents. The insurance plan must be established under the self-employment business.

NOTE : If the self-employed individual is enrolled under a spouse’s health insurance plan (or any other health insurance plan other than under the business), do not use the amount paid for health insurance.

Penalties on Early Withdrawal of Savings

Information can be found on IRS Schedule 1 (Form-1040) in Part II Adjustments to Income. A deduction for penalties paid for early withdrawal of savings from certain financial accounts.

Alimony Paid Information can be found on IRS Schedule 1 (Form-1040) in Part II Adjustments to Income. A deduction for payments to or for a spouse or former spouse under a divorce or separation agreement finalized prior to January 01, 2019 and no changes made to the agreement after January 01, 2019.

Contributions to Individual Retirement Accounts (IRA’s) Information can be found on IRS Schedule 1 (Form-1040) in Part II Adjustments to Income. Contributions made to a traditional IRA during the taxable year may be deducted. The person must have earnings in the year to qualify for the deduction.

NOTE : This does not include contributions to Roth IRAs.

General limit: $5,500 ($6,500 if age 50 or older) annual contribution

Student Loan Interest Deduction A qualified student loan is defined as any loan taken out to pay qualified higher education expenses for any of the following people: The individual or their spouse. The individual’s tax dependent. Any person the individual could have claimed as a tax dependent but did not because of one of the following: The person filed a joint tax return with someone other than the tax filer paying the qualified student loan interest. The person had gross income that was equal to or more than the exemption amount for that particular tax year. The individual or their spouse could be claimed as a tax dependent by another person. A student loan is not considered qualified when: Any of the proceeds of the loan were used for purposes other than the qualified higher education expenses, The loan proceeds were borrowed from a relative, or The loan proceeds were borrowed from a qualified employer plan. The individual does not have to be a student in the current tax year. Information can be found on IRS Schedule 1 (Form-1040)(Form-1040) in Part II Adjustments to Income. A person may take this deduction if all of the following apply: The person paid interest in the taxable year on a qualified student loan; The person’s filing status is any status except married filing separately; The person’s modified adjusted gross income is less than the allowable amount as listed in the instructions for Form 1040. This amount is subject to change each year. Review the Form 1040 Instructions to find the allowable amount for the applicable year. The instructions can be found at www.irs.gov , Forms, Instructions & Publications . The person is not claimed as a dependent on someone else’s tax return.

Deductible Part of Self-Employment Tax

Information can be found on IRS Form 1040, – of Schedule 1. The deductible amount of self-employment tax owed by an individual for their self-employment business.

NOTE: This is based on the IRS Schedule SE (Self-Employment Tax) Form-1040.

(magi)(1805-000-00)(1805-030-00)(1805-030-20)(1805-030-20-15)(block-4)Manual Income Calculations with Deductions#

For both pre-tax and deductions that are adjustments to income:

Enter in gross wages, and

Use available selections within the eligibility system to enter deductions

Only enter deductions allowable under MAGI guidelines

The eligibility system will subtract the deductions from the gross income If circumstances require a manual calculation of deductions, include notes to explain all manual calculations.

Although the eligibility system calculates the income after subtracting deductions, it is necessary to understand how to manually calculate income with deductions.

EXAMPLE : Jan is employed and is paid semi-monthly (twice per month) a salaried amount of $1,716.00. Jan’s pre-tax deductions were not RC with the electronic sources. She provided her pay stubs to verify her pre-tax deductions which include: health, vision, and dental insurance for herself, her spouse and children, and contributions to her deferred compensation plan. Jan does not claim any other deductions. To calculate Jan’s MAGI income, convert her income and deductions into monthly amounts and then subtract her deductions from her gross pay. Review Jan’s pay stub below to identify her gross pay and pre-tax deductions.

Convert Jan’s income to reflect her monthly gross salary. $1,716.00 x 2 = $3,432.00

Convert Jan’s pre-tax deductions to monthly amounts. Dental Insurance $43.94 x 2 = $87.88 Health Insurance $44.50 x 2 = $89.00 Vision Insurance $7.89 x 2 = 15.78 Medical Cafeteria Plan $75.00 x 2 = $150.00 Deferred Comp Contribution $37.50 x 2 = $75.00 Total Monthly Deductions = $417.66

Outcome: Jan’s household MAGI income, after pre-tax deductions, is $3,014.34 ($3,432.00 – $417.66 = $3,014.34)

EXAMPLE : Jon applies for MAGI Family MO HealthNet (MHN) for his 8-year-old daughter, Hazel, who he expects to claim as a dependent. Jon is an elementary school teacher. His monthly gross income is $2,250. He spent $240 on supplies for his classroom (Educator Expense Deduction) in the taxable year. Hazel’s MAGI-based household size is herself and her father, Jon. To manually calculate Jon’s income, and Hazel’s MAGI household income, divide the Educator Expense by 12 months ($240 / 12 = $20), and subtract that amount from the MAGI household income ($2,250 – $20 = $2,230). The monthly MAGI household income is $2,230.

(magi)(1805-000-00)(1805-030-00)(1805-030-25)(1805-030-25-05)(block-1)1805.030.25.05 Projection of MAGI – DSS Manuals#

IM-92 June 18, 2020 ; IM-103 July 28, 2017 ; IM-17 February 21, 2017 ; IM-97 November 9, 2015

Projection of income is an estimate of income that is expected to continue through the certification period. This estimate is based on expectation and knowledge of the participant’s current, past, or future circumstances. In estimating the amount of included income, consider all factors that most accurately estimate and reflect the amount received.

Use current monthly income to evaluate eligibility for MO HealthNet. Current monthly income is an average of income received within the past 30 days.

Follow the hierarchy of income evidence to use in the MAGI Policy Manual section, 1805.030.05 Income Evidence .

For instructions on converting income to a monthly amount see the MAGI Policy section, 1805.030.25.10 Patterns of Income .

If income fluctuates to the extent that a 30-day period does not accurately reflect projected income, choose a method that accurately indicates or reflects future income. Enter a detailed comment to record the reason for the time-period used.

A participant works the same number of hours each pay period but began working various amounts of overtime prior to the application. If overtime is expected to continue, average the income that includes overtime to determine the monthly income amount to budget. EXAMPLE: Ms. Johnson works as a clerk in an insurance firm. Her regular hourly rate is $10.00. However, for the past four months she has been working overtime during each weekly pay period. Her gross weekly earnings with overtime is $460. Convert this to monthly income by multiplying $460 x 4.333 = $1993.18. Ms. Johnson’s projected monthly income is $1993.18. Since she has been working overtime consistently for over 30 days it is appropriate to include the overtime in her budget.

If the overtime is to stop, complete the budget for the month the overtime pay will not be received without considering the overtime. EXAMPLE: Two months after approval, Ms. Johnson reports she is no longer working overtime. Complete the budget based on Ms. Johnson’s normal wages of $10.00 per hour for 40 hours per week. Convert her income to monthly, $10.00 x 40 hours = $400 x 4.333 weeks = $1,733.20. Ms. Johnson’s expected monthly income amount is now $1,733.20.

The participant’s income varies with no set pattern. Average past earnings to determine the representative monthly amount to project income. EXAMPLE: Ms. Smith has worked at the local factory for the past three years doing piece work. She regularly works 40 hours per week. Her income varies from pay period to pay period depending on her production. No changes are expected in the piece work rate Ms. Smith is paid, nor in the hours worked. After discussing with Ms. Smith variations in her earnings over the past several months, the most recent 30 days are not an adequate representation of her earnings. After evaluating information provided by Ms. Smith, the past 12 weeks yield the most accurate estimate of her average earnings. Total earnings for this period are $1,200, averaging $100 per week. Convert this to monthly income of 4.333 x $100 = $433.33. Project $433.33 as the monthly earnings on the budget. “Actual income” is the income that was actually received in a particular month. Actual income is not considered a projection of income or used for ongoing projection of income. In the following situations actual income is used: Month in which income begins. EXAMPLE: Amy reports she began working at a department store in February. She expects to receive her first two pay checks within February. The first pay check will include training hours and does not accurately reflect ongoing income. Amy attests that her second paycheck accurately reflects what she anticipates for her ongoing income. The budget for February will be an actual budget combining the two paychecks she receives during the month, her first and second checks. Use her second paycheck amount to budget for March and ongoing. Month in which income ends. EXAMPLE: Sawyer reports he was fired from ABC, Inc. in April. Enter an actual budget for April with the income that was actually received in April. End the income source. A future budget reflecting ongoing income is not needed. Month in which a pay period is zero. EXAMPLE: Kayla works at Break Time and is paid weekly. She missed two weeks of work in June due to an illness. Kayla does not have sick time therefore she was on leave without pay. The budget for June is actual and will include the income actually received by Kayla within June. The July and ongoing budget should be an accurate reflection of expected ongoing income. Lump Sum Payments. EXAMPLE: Henry applied for MO HealthNet benefits for himself and his daughter Kennedy on June 20th. Henry received a one-time inheritance payment on June 5th in the amount of $5,500. Since lump sum payments are only counted in the month received, an actual budget should be used. Henry’s inheritance is entered for June as actual income. An ongoing budget is not needed since this was a one-time payment.

Claims that are established based on the projection of income are because one of the following applies:

The participant failed to report income or circumstances he/she was aware of

The eligibility specialist made an error considering information that was available

Always record a comment regarding the projections of income. The comment should include what was used to determine the projected income, why it was used, how it was calculated, and any other pertinent information.

(magi)(1805-000-00)(1805-030-00)(1805-030-25)(1805-030-25-10)(block-1)1805.030.25.10 Patterns of Income – DSS Manuals#

IM-14 March 8, 2021 ; IM-92 June 18, 2020 ; IM-37 April 25, 2017 ; IM-17 February 21, 2017 ; IM-97 November 9, 2015

A pattern of income is used to indicate or predict future income. Income patterns are typically identified as consistent and recurring.

When determining income eligibility, use the eligibility system to convert income to a monthly amount, whenever possible.

Before income is converted to a monthly amount, determine the average pay period amount. To determine an average, total all of the pay amounts and divide by the number of paychecks used in the total.

EXAMPLE : Brittany provided 5 paystubs that total $1860. $1860/5 paychecks=$372 average pay amount.

Pay Date Gross Amount 1/1 400.00 1/8 380.00 1/15 360.00 1/22 340.00 1/29 380.00 1860.00 Total

After calculating the average income received per pay period, enter the income with the correct pay frequency selection (such as weekly, biweekly, etc.) in the eligibility system. Use the eligibility system to convert the averaged income to a monthly amount.

Despite the ability of the eligibility system to calculate monthly income based on average pay and pay frequency, it is necessary to understand how monthly income is calculated manually. The examples below illustrate the manual calculation process for many income frequencies.

Weekly – Received once a week. EXAMPLE: Brittany is paid $320 weekly unemployment. To convert Brittany’s income to monthly multiply the weekly amount by 4.333, $320 x 4.333 = $1,386.56. Her monthly income amount is $1,386.56. Bi-Weekly – Received every two weeks. EXAMPLE : Sammy is paid every other Friday, or bi-weekly. He is paid $8.00 per hour and paid for 80 hours each pay period, or $640 every two weeks, $8.00 x 80 = $640. To convert Sammy’s income to monthly multiply the bi-weekly amount by 2.166, $640 x 2.166 = $1,386.24. His monthly income amount is $1,386.24. Monthly – Received once a month. Semi-Monthly – Received twice per month. EXAMPLE: Ben attests to being paid $940 semi-monthly, on the 15th and 30th. He is salaried and does not anticipate any changes. To convert Ben’s income to monthly multiply the semi-monthly amount by 2, $940 x 2 = $1,880. His monthly income amount is $1,880. Bi-Monthly – Received once every two months. EXAMPLE: Jill is paid $2,400 bi-monthly, every other month on the 1st. To convert Jill’s income to monthly divide the bi-monthly amount by 2, $2,400 / 2 = $1,200. Her monthly income is $1,200. Quarterly – Received every three months. EXAMPLE: Frank is paid $900 quarterly. To convert Frank’s income to monthly divide the quarterly amount by 3, $900 / 3 = $300. His monthly income is $300. Annually or Yearly – Received once per year. EXAMPLE: Allen is paid $1,000 annually. To convert Allen’s income to monthly divide the annual amount by 12, $1,000 / 12 = $83.33. His monthly income is $83.33.

In some instances, the pattern of income cannot be determined. This occurs when the income amount and pattern varies, with no consistency. In this situation, use the past income to determine future earnings.

EXAMPLE: George sells scrap metal as his source of income. George attests he sold metal in May for $600, July for $150, and December for $400. George states he does not plan to sell anymore for the remainder of the year. George states this is a typical annual pattern for this income. Add together all that George has sold ($600 + $150 + 400 = $1,150) and average it for a monthly amount ($1,150 / 12 = $95.83 per month).

EXAMPLE: Sue works through a temp agency. She works various jobs as assigned therefore her monthly income is not consistent. She applied in November. In August she earned $1,300, September $150, October $700. Sue indicates that she is unsure of her future earnings however she plans to continue working for the temp agency. Average the previous three months to project future monthly earnings ($1,300 + $150 + $700 = $2,150 ) ($2,150 / 3 = $716.66). Her projected monthly average is $716.66.

If the income has an inconsistent pattern, contact the participant to determine the reason and any anticipated changes. Gather as much information as necessary to make an accurate determination of ongoing income. Record a detailed comment explaining how the pattern and calculation of income was determined.

See the Create Ongoing Income on an Integrated Case user guide for more about income frequencies and averaging income.

(magi)(1805-000-00)(1805-030-00)(1805-030-25)(1805-030-25-15)(block-1)1805.030.25.15 Specific Types of Income – DSS Manuals#

IM-96 July 11, 2022 ; IM-92 June 18, 2020 ; IM-103 July 22, 2019 ; IM-97 November 9, 2015

Use the rules in this section for the specified types of income.

INCOME RECEIVED LESS OFTEN THAN MONTHLY : Annualize income regularly received on a recurring basis less frequently than monthly, such as quarterly payments or annual income, (dividends, etc.).

TIPS : Consider tips received as wages. Actual tips received may differ from tips reported by the employer for tax purposes.

REGULAR PAY DATE NOT OBSERVED : If the participant has regular pay dates, (i.e. Social Security, VA, State Employees, etc.,) but occasionally is paid early or late, consider the income in the month normally received.

CONTRACTUAL INCOME : Prorate earned income received by a participant employed on a contractual basis over the contract period. Use the prorated amount in determining eligibility according to regular budgeting procedures. For school employees under contract to receive annual income in a period less than a year, average the income over a 12-month period. This includes teachers, cooks, janitors, and professional administrative staff. This does not apply to contractual income received on an hourly or piecework basis.

SELF-EMPLOYMENT INCOME : Determine self-employment income using one of the methods outlined below. For income received monthly, project an average and budget that average monthly (e.g. a hairdresser earns money each month; project an average of the hairdresser’s monthly income and budget). Add and prorate income received only once per year or sporadically throughout the year to determine a monthly amount (e.g. a farmer who raises and sells various crops, produce, and livestock at different times during the year). If the participant is self-employed for one year or more, divide annual income by 12 to determine a monthly amount. If the participant has been self-employed for less than one year, average the amount of self-employment income over the period of time the business has been in operation to determine a monthly amount. If the monthly amount determined does not reflect the individual’s actual monthly income because of a substantial increase or decrease in business, use a representative period of earnings to determine monthly earnings. Average income from self-employment using the best information available. This may include, but is not limited to: Appropriate IRS forms and supporting documentation Written statements from a CPA with knowledge of the business Written statements from an attorney who handles the affairs of the business Other documents that substantiate the income, such as records, receipts, etc. Negative self-employment income, or self-employment losses, offsets other household income in determining the MAGI for the household members. Losses are commonly found on IRS Form-1040 or IRS Schedule 1 (Form-1040) identified with the sum amount showing in parenthesis and may be found on one of the following lines:

IRS Form 1040 – Capital Gain or Loss IRS Schedule 1 – Business Income or Loss IRS Schedule 1 – Other Gains or Losses IRS Schedule 1 – Rental Real Estate, Royalties, etc. IRS Schedule 1 – Farm Income or Loss

(magi)(1805-000-00)(1805-030-00)(1805-030-25)(block-1)1805.030.25 Determining MAGI – DSS Manuals#

IM-92 June 18, 2020 ; IM-97 November 9, 2015

In determining eligibility based on MAGI methodology, use the following calculations:

Total adjusted gross income (earned and unearned income) PLUS Foreign earned income, tax-exempt interest, or tax-exempt Social Security income MINUS Allowable deductions EQUALS Modified Adjusted Gross Income (MAGI)

NOTE: See sections on included income ( 1805.030.20 Income, Deductions, and the Five Percent (5%) Disregard ), excluded income ( 1805.030.20.10 Income Excluded Under MAGI ), and allowable deductions ( 1805.030.20.15 Allowable Deductions ) for examples.

Once the MAGI is determined, compare the MAGI to income guidelines for the specific program. Refer to Appendix A – MAGI Income With 5% of FPL Included and CHIP Premium Amounts in the Family Healthcare Manual (MAGI) for the MAGI Income with 5% of FPL included chart.

Determine the amount of earned income the household will receive in present and future months. Discuss employment with them, including:

Length of employment and employment status such as full-time permanent, part-time permanent, full-time temporary, etc. with present employer

Hours worked (regular or irregular hours, overtime, etc.)

Wages received (steady rate, piecework, commission, etc.)

Recent raises or promotions

Anticipated raises or promotions

Recent layoffs, or anticipated layoffs, etc.

Obtain an accurate account of the participant’s employment. Start by using the past thirty (30) days to evaluate income stability. If a 30-day history is not adequate to determine future earnings, explore a longer period of income and document facts to support the decision.

Infrequent and unpredictable overtime, or conversely, infrequent and unpredictable absences do not alter the certainty of the employment situation.

If income varies from pay period to pay period, determine the likely pattern of future income to calculate a monthly average. Use past patterns of income if these patterns will continue.

In some situations, recent past earnings records serve only as a partial guide for determining monthly income. Instances in which the employee or employer indicates a change in hourly wage rates, hours of work, job responsibilities, etc., can require additional verification in order to calculate an accurate prediction of future earnings.

In other situations such as new employment, no recent past earnings records exist to use as a guide. In these situations, carefully evaluate the information available from the employee, in comparison with known past earnings records and work patterns, if any, to determine a monthly income amount. It may be necessary to set a priority to verify accuracy of monthly income.

When unearned income fluctuates, compute it on an annual or other representative period and convert it to a monthly amount. Combine countable unearned income with other countable income.

Once the household employment situation is determined, budget projected monthly income. Use the following guidelines to determine a monthly income amount. See 1805.030.25.10 Patterns of Income for more information.

If income is paid other than monthly, convert it to a monthly amount:

If paid weekly, multiply by 4.333 weeks

If paid every two weeks, multiply by 2.166

If paid semi-monthly, multiply by 2

NOTE: Utilize the income frequency selections within the eligibility system to convert income to monthly amounts. See the Create Ongoing Income on an Integrated Case guide for more about income frequencies and averaging income.

(magi)(1805-000-00)(1805-040-00)(1805-040-05)(block-1)1805.040.05 Referral to FSD-CS – DSS Manuals#

IM-19 February 6, 2019 ; IM-46 July 15, 2016 ; IM-97 November 9, 2015

The following steps should be taken prior to referring a MO HealthNet case to FSD-CS when a child is deprived of parental support due to the continued absence of the child’s parent/s from the home.

A parent or caretaker must complete a Referral/Information for Child Support Services (CS-201) form, but the form is not required prior to approval of the MO HealthNet case. Do not hold an application pending completion of the CS-201.

EXCEPTIONS: Do not refer to FSD-CS when:

The applicant is a child under the age of 19 who is not living with a caretaker and who applies for Family MO HealthNet in his/her own name

A non-related caretaker is applying for MO HealthNet benefits for a child in their physical custody for whom they do not have legal guardianship or legal custody

If the MO HealthNet application is made in-person, staff must have the CS-201 completed by the applicant.

If the MO HealthNet application was completed online, by telephone, or by mail, the CS-201 may be:

Completed by the Family Support Division staff during a telephone call with the applicant prior to approving the application. NOTE: If completed by telephone call send the CS-201 to FSD-CS and note the information was obtained by telephone in the signature section along with the date of the call.

If unable to contact applicant by telephone, mail a Request for Information (IM-31A) allowing 10 days for the applicant to complete and return the form.

The applicant should provide as much information as possible on the CS-201. However, if the CS-201 is not returned or returned incomplete, FSD staff must fill out the form with at least the following information:

The name of the custodial parent;

There is at least one dependent child listed; and

The name of the non-custodial parent/alleged parent or mark “unknown” NOTE: The applicant’s signature is not necessary on the CS-201 for opening the child support case. FSD-CS Intake Center staff has been advised to go ahead and open the case without the signature. Do not hold up sending the document or do anything different due to the lack of a signature. NOTE: The FSD must approve the MO HealthNet case before the CS-201 is sent. If MO HealthNet coverage is denied, the CS-201 is sent to the virtual file room. If the parent still wishes to receive Child Support services he/she may apply online at dss.mo.gov or request the appropriate form by calling the Child Support Call Center at 866-313-9960.

For all completed CS-201 forms where all parties can be identified (including custodial, non-custodial/alleged parent, and children), scan and email to:

FSD.IntakeCenter@dss.mo.gov

For all completed CS-201 forms where the non-custodial/alleged parent is “unknown” and cannot be identified, scan and email to:

CS.MEDESLiaison@dss.mo.gov NOTE: For both email accounts, multiple applications may be submitted together

All forms may also be submitted:

By mail to Family Support Division, PO Box 6790, Jefferson City, MO 65102-6790; or

Faxed to 573-635-7545 NOTE: If birth certificates for children born out-of state are provided by the applicant or available in the case file, attach a copy of the birth certificate to the CS-201 prior to submitting to FSD-CS.

(magi)(1805-000-00)(1805-040-00)(1805-040-10)(1805-040-10-05)(block-1)1805.040.10.05 Areas of Cooperation – DSS Manuals#

IM-97 November 9, 2015

Identifying Non-custodial Parents: The applicant or participant is responsible for providing all information available concerning identification of the non-custodial parent of the child for whom benefits have been requested. If the non-custodial parent’s identity is unknown, the applicant or participant is responsible for providing all possible sources of information to be used in identifying the parent. If the applicant or participant states that the non-custodial parent is unknown, explore the circumstances surrounding the claim thoroughly, and record a comment in FAMIS about the applicant or TA participant’s explanation. Ask him/her to submit all information available to verify the claim. Acceptable methods of verification include: If rape is claimed, request a police report of the incident. If the applicant or participant claims to not know the identity of the non-custodial parent because they met the non-custodial parent only one time, ask him/her to provide names of other individuals who may know the non-custodial parent. If more than one alleged father exists for a child, or if responsibility for medical support is unclear, refer each alleged parent of that child to the Family Support Division – Child Support (FSD-CS). Complete CS-201 for each alleged parent. In cases where someone other than the legal father is alleged to be the biological father, complete a CS-201 for the legal father and one for the alleged biological father. When children have been adopted eligibility is determined based on the adoptive parent. Complete a CS-201 when there is a non-custodial adoptive parent. In all cases explain to the applicant or participant the importance of cooperating with the identification of the non-custodial parent. A refusal to do this may result in a determination of failure to cooperate and the application of a sanction if the participant fails to claim good cause. The earlier paternity and/or support are established the sooner the child may: have access to the non-custodial parent’s medical benefits obtain information on the non-custodial parent’s medical history receive other benefits resulting from paternity establishment

Locating Non-custodial Parents: The applicant or participant is responsible for furnishing information to help locate the non-custodial parent. If the location is unknown, the applicant or participant will be asked to provide information that may lead to possible sources for obtaining this information. Assist the applicant or participant to complete the necessary information on the CS-201. The applicant or participant’s failure to participate in locating the non-custodial parent without good cause may result in a determination of refusal to cooperate and the application of a sanction.

Other Areas of Cooperation: The applicant or participant may be asked to take a more active role in identifying and locating the non-custodial parent. This may include: establishing the paternity of a child born out of wedlock helping to obtain medical support, or any other payments or property due the applicant or participant on behalf of the child going to the FSD-CS office to provide verbal or written information about the non-custodial parent appearing as a witness at court or other hearings or proceedings

(magi)(1805-000-00)(1805-040-00)(1805-040-10)(1805-040-10-15)(1805-040-10-15-05)(block-1)1805.040.10.15.05 Determining Good Cause – DSS Manuals#

IM-30 March 6, 2019 ; IM-59 May 30, 2017 ; IM-97 November 9, 2015

Applicant or Participant’s Responsibilities

The applicant or participant requests that a determination be made of his/her good cause claim for failure to cooperate; and

The applicant or participant alone or with the Eligibility Specialist assistance provides evidence in support of the good cause claim. Allow the applicant or participant sufficient time to obtain the evidence, especially if it is unusually difficult to obtain. If an applicant or participant claims good cause based on physical harm and no evidence exists to verify the claim, request a written explanation for the record.

Income Maintenance Eligibility Specialist Responsibilities

When the applicant/participant claims Good Cause, give them a copy of the Second Notice of Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcement (IM-2E Part 2) which gives additional information regarding the good cause claim, his/her responsibilities, and space to make the claim in writing;

Use the Communication Transmittal (IM-16) to notify the child support specialist of a good cause claim when a Referral/Information for Services (CS-201) has already been sent;

Assist the applicant or participant in obtaining evidence when necessary. Advise him/her of methods to obtain documentation. The applicant or participant may be asked to provide sufficient identifying information and pay any fees required to obtain the document. EXCEPTION: The Family Support Division will pay for an evaluation from a mental health professional regarding risk of emotional harm when necessary. The applicant or participant’s inability to pay a fee will not negatively affect a determination that good cause exists.

Determine within 20 days whether good cause for failure to cooperate exists. The 20 days may be extended for up to 45 days in case of difficulty in obtaining good cause verification under 13 CSR 30-8.010.

IM-16s should be submitted in one of the following ways: Email: FSD.IntakeCenter@dss.mo.gov Fax: 573-635-7545; or Mail: P O Box 6790, Jefferson City, MO 65102-6790 Consider any comments Child Support has regarding the determination. It is the responsibility of Income Maintenance staff to make the final determination. If no comments are received from Child Support within five (5) working days, complete the decision-making process.

Refer all claims of good cause to the Program Manager/County Manager for their review before final determination.

Notify the applicant or participant and the Child Support supervisor in writing of the final determination on all good cause claims.

Notify the Child Support Supervisor of any hearing requests regarding good cause claims and the hearing results.

If determined that good cause does not exist follow sanction procedures.

Document the decision, findings, and basis for the good cause determination. Keep any hard copy documentation in the case file.

If a refusal to cooperate is determined to be with good cause, reassess the good cause determination at each review. Circumstances may have changed, and the applicant or participant may wish to establish paternity and/or medical support. NOTE: If a participant notifies Income Maintenance in the future that good cause no longer exists, it is necessary to complete a new CS-201 or send an IM-16 notifying FSD-CS that they can reopen the child support case.

Family Support Division-Child Support Responsibilities

The CSS notifies Income Maintenance staff via the IM-16 if an applicant or participant refuses to cooperate with FSD-CS.

The CSS suspends all efforts to establish paternity or secure support when notified of a good cause claim. This suspension continues until the Child Support supervisor receives notification of a final determination.

The Child Support supervisor may participate in a hearing regarding good cause determination either at the applicant/participant’s or Income Maintenance staff’s request.

FSD-CS does not begin to establish paternity or secure medical support if Income Maintenance finds good cause for refusal to cooperate. Once Income Maintenance determines good cause and notifies FSD-CS, FSD-CS closes the case.

(magi)(1805-000-00)(1805-040-00)(1805-040-10)(1805-040-10-15)(1805-040-10-15-10)(block-1)1805.040.10.15.10 Types of Evidence to Support Good Cause – DSS Manuals#

IM-97 November 9, 2015

Evidence to support a good cause claim may include the following:

Incidents of domestic violence resulting in physical or emotional harm to the child, applicant, or participant. Types of Evidence: Court, medical, criminal, child protective services, social services, psychological, or law enforcement records. These records or statements should indicate that the noncustodial parent may inflict physical or emotional harm on the child, applicant, or participant as a result of cooperation Medical records including the emotional health history and present emotional health of the child, applicant, or participant. These may be in the form of a written diagnosis or prognosis from a mental health professional indicating the emotional health of the child, applicant, or participant. These records should indicate that emotional harm to the child, applicant, or participant would result from cooperating Medical and court records indicating that the noncustodial parent caused physical or emotional harm to the applicant or participant as a result of domestic violence. When documentation is unavailable, accept statements of the child, applicant, or participant. The applicant or participant is responsible for providing enough information to establish good cause and explain why no evidence is available. Make efforts to corroborate the statements by someone familiar with the situation.

A child is conceived as a result of forcible rape or incest. Types of Evidence: Birth certificates Medical or law enforcement records indicating that the child was conceived as a result of forcible rape or incest. These records may include a written statement from the applicant or participant if formal documentation is not available.

Adoption proceedings pending: Types of Evidence: Court documents or other records to indicate that legal adoption proceedings are pending, including written statements from staff of a public/private adoption agency.

Counseling regarding relinquishment: Types of Evidence: Written statements from public or private social services agencies stating that the applicant or participant is being assisted to resolve the issue of whether to keep the child or relinquish the child for adoption. The good cause for counseling is limited to three months.

All above situations (#1-4) with the exception of emotional harm: Types of Evidence: Sworn statements from individuals other than the applicant or participant with knowledge of the circumstances on which the good cause claim is based. A statement given under oath to a notary public is the most common and most available type of sworn statement.

NOTE: If the applicant or participant needs a mental evaluation to prove emotional harm, the evaluation is paid the same as an examination to determine incapacity. The evaluation is valid for two years unless the mental health professional or Income Maintenance staff determines that another evaluation is needed.

Additional evidence may be requested when evidence provided by the applicant or participant does not provide enough information to make a good cause determination.

NOTE: DO NOT CONTACT THE NONCUSTODIAL PARENT UNDER ANY CIRCUMSTANCES.

(magi)(1805-000-00)(1805-040-00)(1805-040-10)(1805-040-10-20)(block-1)1805.040.10.20 Sanctions for Non-cooperation – DSS Manuals#

IM-33 March 29, 2022 ; IM-04 January 4, 2018 ; IM-46 July 15, 2016 ; IM-97 November 9, 2015

When a parent/non-parent caretaker relative (caretaker relative) fails to cooperate with Child Support (CS) in obtaining medical support and good cause does not exist, the parent/caretaker relative is sanctioned. Sanctioning a parent/caretaker relative ends his/her MO HealthNet (MHN) eligibility.

NOTE: Only parents and caretaker relatives can be sanctioned. Do not sanction children.

CS determines if the parent/caretaker relative has cooperated or if a sanction should be imposed. If a sanction should be imposed, CS will notify Income Maintenance (IM), and if good cause does not exist, IM sanctions the parent/caretaker relative’s MHN eligibility. CS will also notify IM if a sanction should be lifted.

NOTE: IM determines if good cause exists; refer to 1805.040.10.15.05 Determining Good Cause .

MAGI Processing Centers must have a process to identify and distribute CS requests to appropriate staff, and to ensure action is taken within ten (10) days to impose or lift the sanction on the parent/caretaker relative’s MHN eligibility.

When a parent/caretaker relative fails to cooperate , CS will notify IM when to impose a MHN sanction due to non-cooperation in pursuit of medical support. IM must act on the sanction request within ten (10) days of receipt of the request.

Follow adverse action procedures prior to imposing the sanction. If a hearing is requested within the adverse action period:

Do not take action until the hearing has been conducted and a decision is rendered

Allow the parent/caretaker relative to continue to receive the current level of benefits until the hearing decision is rendered

When a parent/caretaker relative cooperates , CS sends a request to IM to lift a MHN sanction . Follow appropriate procedures to end the sanction and reactivate the parent/caretaker relative’s MHN eligibility within ten (10) days if they remain otherwise eligible for MHN .

(magi)(1805-000-00)(1805-040-00)(1805-040-10)(block-1)1805.040.10 Notice/Good Cause for Refusal to Cooperate – DSS Manuals#

IM-97 November 9, 2015

Before asking an applicant or MO HealthNet (MHN) participant to cooperate in establishing paternity or in establishing, modifying, or enforcing a medical support order regarding a child advise him/her: of the potential benefits derived from establishing paternity and establishing, modifying, or enforcing a support order that cooperation in establishing paternity and establishing, modifying or enforcing a support order is a condition of eligibility that he/she may claim good cause for refusing to cooperate of the sanction applied if he/she refuses to cooperate without good cause that if it is determined that good cause for failure to cooperate exists, the applicant or participant will not have to cooperate in establishing paternity or in establishing, modifying, or enforcing support; and that upon request or following a claim of good cause the Family Support Division (FSD) will provide further notice with additional details concerning good cause The Notice of Requirement to Cooperate and Right to Claim Good Cause for Refusal to Cooperate with Child Support (IM-2E Part One) contain the information that the applicant or participant must be given before being requested to cooperate. Each applicant or participant required to assign medical support rights must signify understanding of the right to claim good cause by completing the form at the time of application. When adding a child to an active case, the applicant participant signs another copy of IM-2E Part One. This reminds the applicant or participant that he/she may claim good cause.

When an applicant or participant either requests additional information or makes a claim of good cause, explain: the circumstances under which good cause exists that he/she will be asked to explain the basis of the good cause claim and to supply evidence and any other information necessary to establish the claim that FSD will assist in obtaining evidence, if requested that based on evidence and investigating information provided by the applicant or participant (if warranted), FSD will determine if good cause exists that FSD-Child Support may review the findings and basis of the good cause determination and may participate in any hearings regarding the issue of good cause; and that FSD-Child Support will not attempt to establish paternity or secure medical support if the applicant or participant is determined to have good cause The Second Notice of Right to Claim Good Cause for Refusal to Cooperate with Child Support (IM-2E Part Two) contains the additional information that the applicant or participant must be given when requested or when he/she claims good cause for refusal to cooperate. The form provides space for the applicant or participant to make a good cause claim in writing. The applicant or participant and the eligibility specialist must sign and date the form.

(magi)(1805-000-00)(1805-040-00)(block-1)1805.040.00 Cooperation in Pursuit of Medical Support – DSS Manuals#

IM-94 June 30, 2022 ; IM-13 February 1, 2018 ; IM-46 July 15, 2016 ; IM-97 November 9, 2015

RSMo 208.215 makes the assignment of medical support mandatory of the following Title XIX MAGI MO HealthNet programs, when:

MAGI MO HealthNet for Families (MHF) – at application

MAGI MO HealthNet for Kids (MHK) – at application

MO HealthNet for Pregnant Women – once the child is born

Show Me Healthy Babies (SMHB) – once the child is born

Children’s Health Insurance Program (CHIP), non-premium CHIP groups such as 71 or 72 – at application

CHIP 4M – although this program is CHIP, because its income guidelines overlap with non-CHIP, a referral is necessary

This statute does not make the assignment of medical support mandatory for children eligible under the CHIP premium groups such as CHIP 73, 74 or 75, MPW, or SMHB. For MPW and SMHB cases, once the child is born cooperation in pursuit of medical support is required.

The parent or caretaker must cooperate with the Family Support Division-Child Support (FSD-CS) in the pursuit of medical support, unless there is good cause for refusing to cooperate. Provide the parent/caretaker with the Referral/Information for Child Support Services (CS-201). The parent/caretaker must complete and return the CS-201 or call the Eligibility Specialist to provide the non-custodial parent’s information.

NOTE: The Notice of Requirement to Cooperate and Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcement (IM-2E Part 1) is no longer needed as the Rights and Responsibilities page of the IM-1SSL covers the information.

If the parent/caretaker claims good cause, provide the Second Notice of Right to Claim Good Cause for Refusal to Cooperate in Child Support Enforcement (IM-2E Part 2).

NOTE: If good cause is claimed and acceptable the parent/caretaker does not have to cooperate in seeking medical support.

When a child is added to an active MO HealthNet case, submit a CS-201 to FSD-CS even if the child has the same non-custodial parent as another child who is already active on the case. Use the CS-201 to inform FSD-CS of the addition of the child and any new information on the non-custodial parent.

(magi)(1805-000-00)(1805-045-00)(block-1)1805.045.00 Third Party Liability (TPL) – DSS Manuals#

IM-64 June 29, 2021 ; IM-80 June 11, 2020

Per RSMo 208.215 , MO HealthNet is the payer of last resort. MO HealthNet is not obligated to pay for a participant’s medical expenses until other resources, such as private or employer-sponsored health insurance, have been considered. This concept is referred to as Third Party Liability (TPL). Health insurers and other payers are referred to as Third Party Resources (TPRs).

The purpose of TPL is to offset or recover costs to Missouri. In order to do this, TPRs must be properly reported and documented on behalf of participants. When a participant indicates a TPR, gather all necessary information regarding the policy. Review the participant’s MTPR screen to check for existing health insurance. If the reported health insurance is not present, complete a TPL-1 form to capture necessary details about the policy.

Information required on a TPL-1 includes, but may not be limited to:

insurance company name and address

employer name and address

policyholder name

policy number

social security number of the policyholder

Complete a TPL-1 for each insurance policy. Report the following types of health insurance on the TPL-1:

employer-sponsored insurance

self-insured labor unions and welfare funds

commercial health insurance policies (policies not provided/administered by a government program)

Medicare supplements

hospital indemnity policies

nursing care or long-term care policies

TRICARE

Veterans Administration

accident insurance that covers medical care necessary due to an accident

critical care/cancer policies Policies can include medical benefits and income payments

vision, dental, and pharmacy policies

healthcare sharing ministries such as Christian Healthcare Ministries.

Note: Though all of these plans do provide some health benefits, not all of the plans meet the federal minimum essential coverage requirement.

Do not report the following types of health insurance on a TPL-1 form:

Medicare

MO HealthNet or managed care plans

income replacement or disability policies these can be individual or group policies

life and burial insurance

school accident insurance

automobile insurance

Additional information on completing the TPL-1 form can be found in the TPL-1 Instructions .

A TPL form can be used to report changes to an existing TPR such as a policy end-date or additional policy members. Review the MTPR screen to determine if changes are needed.

Issues due to outdated TPR information can be reported using the process found in the Adding/Updating Private Insurance Information Using the TPL-1 Form user guide. Forward TPL-1 forms to the TPL Unit using the process outlined in the guide and maintain a copy in the electronic record.

Do not deny or close coverage because a participant failed to provide complete information regarding a TPR.

EXAMPLE: Andrea files an application on which she claims health insurance. She is eligible for MO HealthNet for Pregnant Women (MPW), but did not provide the details of her health insurance. Her case is approved and a request for information is sent to gather the insurance information, but she fails to respond. A staff member completes a TPL-1 with information known about Andrea and forwards it to the TPL Unit.

Uninsured status is an eligibility factor for certain types of coverage, such as Children’s Health Insurance Programs (CHIP). To determine eligibility for one of these coverage types, insured status cannot be questionable.

EXAMPLE: Amy files an application and attests to income in the Uninsured Women’s Health Services (UWHS) level. She claims no insurance; however, she supplies paystubs that reflect a health insurance deduction. Her insured status is questionable and she must be contacted to resolve the issue before she can be determined eligible for UWHS.

If a participant indicates a reluctance to provide TPR information due to a fear of domestic violence or abuse, include this information on the TPL-1 form. The TPL Unit will determine if good cause exists and if payment should be sought from the TPR.

NOTE: Heath insurance (including vision, dental, etc.) membership and premiums can affect other types of assistance. Document insurance policies and the cost, if applicable, in the appropriate area of the electronic eligibility system(s) to ensure correct eligibility for other programs.

(magi)(1805-000-00)(1805-050-00)(block-1)1805.050.00 Former Foster Care Youth (FFCY) – DSS Manuals#

IM-95 November 22, 2023 ; IM-125 July 28, 2020 ; IM-100 August 4, 2017

RSMo 208.151.1 was updated August 28, 2019, to allow individuals under the age of 26 who were in foster care and receiving coverage through the Missouri Children’s Division (CD), on or within 30 days prior to, their 18 th birthday to be eligible for healthcare coverage under FFCY. Missouri CD automatically enrolls eligible participants in FFCY coverage at the time they age-out of foster care.

Section 1002(a)(2) of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act became effective January 1, 2023 changing the way eligibility is determined for individuals who aged out of foster care in a state other than Missouri . These individuals fall into two separate groups based on when they reach the age of 18:

Individuals who turned 18 before January 1, 2023

Are under age 26;

Declare they were in foster care in a state other than Missouri for at least 6 months prior to aging out of care; and

Must be found ineligible for MO HealthNet coverage in all other applicable mandatory eligibility groups prior to being approved for coverage under the FFCY program.

Individuals who turned 18 on or after January 1, 2023

Are under age 26;

Declare they were in foster care in a state other than Missouri at the time they turned 18;

Are not required to be found ineligible for MO HealthNet coverage prior to being enrolled in FFCY coverage; and

Are ineligible for FFCY coverage if they are already covered under a mandatory level of Medicaid through the state of Missouri.

NOTE: Citizenship / Immigration Status and Social Security Number criteria do not have to be met for an individual to qualify for FFCY coverage.

Coverage for FFCY individuals who age out of foster care in Missouri is managed by CD in their eligibility system. Coverage for FFCY individuals who age out of foster care in a state other than Missouri will be processed by Family Support Division (FSD) through their eligibility system. The level of care for both groups is ME 38.

If an individual who is active on FFCY (ME 38) requests and is found eligible for MO HealthNet for Pregnant Women (MPW) or Non-MAGI coverage through FSD, do not reject the application . Until system updates are complete to FSD’s eligibility systems, send an email to COLE.MHNPOLICY@dss.mo.gov with “Former foster care state other than Missouri” in the subject line. For individuals covered through CD send an email, with a subject line of “AC ME 38 – NEEDS TO BE CLOSED” to COLE.MHNPOLICY@dss.mo.gov . Include the following information in the email:

Applicant’s Name

DCN

Current Address

Mailing Address (if different)

Phone Number

Level of Coverage Ready to Approve

Date of Application

Head of Household Name and DCN (if different than the applicant)

FSD staff will be notified when the coverage through CD is closed. Coverage through FSD must be approved the day that the former foster care coverage shows as closed on MXIX.

If it is unclear if a participant should be screened for Former Foster Care Youth, or if an individual who aged out of foster care in Missouri needs coverage reinstated, send an email to COLE.MHNPOLICY@dss.mo.gov to request a determination.

Individuals who qualify for former foster care youth coverage may also contact the MO HealthNet open enrollment broker by telephone to 800-348-6627, or Children’s Division at http://dss.mo.gov/cd/ or by telephone to 573-522-8024.

(magi)(1805-000-00)(1805-070-00)(block-1)1805.070.00 Continuous Eligibility for Children (CEC) – DSS Manuals#

IM-22 April 11, 2024

The Consolidated Appropriations Act, 2023, requires Medicaid and Children’s Health Insurance Programs (CHIP) to implement 12 months of Continuous Eligibility for Children (CEC).

Effective January 1, 2024 all children active on MO HealthNet (MHN) have continuous eligibility at their current level of care (LOC) or better until the household is due for an annual renewal. At the annual renewal, staff will make a new eligibility determination and a new CEC period will begin if the child remains eligible. Children are defined as being under 19 years of age. A child’s CEC period ends at 11:59 pm the day before the child’s 19 th birthday.

CEC Period

Once an initial application is approved for MHN benefits, the CEC period begins. Children granted a Reasonable Opportunity period are the exception, please see 1805.000.05 Reasonable Opportunity (RO) for more information.

CEC periods last 12 months and prevent children from closing and/or eligibility from reducing. At the end of the CEC period, Family Support Division (FSD) must complete an annual renewal to determine eligibility. MHN eligibility may only be closed prior to the end of the CEC period if the child:

Turns 19,

Is no longer a Missouri resident,

Child or child’s representative requests a voluntary termination of eligibility,

Child dies,

Eligibility was incorrectly granted at the most recent determination, redetermination, or renewal due to agency error or fraud, abuse, or perjury attributed to the child or child’s representative.

Change in Circumstance

In addition to preventing eligibility from closing, except when required, CEC also requires that benefits cannot be negatively affected due to changes reported by the household or discovered by FSD during the CEC period. Changes reported are entered into the eligibility system during the CEC period but can only be acted on if there is a valid closing reason (listed above) or the determination results in a better LOC.

(magi)(1820-000-00)(1820-010-00)(block-1)1820.010.00 Legal Basis – DSS Manuals#

IM-19 February 7, 2018

Federal law (42 U.S.C. 1396r-6) makes Transitional MO HealthNet mandatory for states.

RSMo 208.151 (1990) provides for Transitional MO HealthNet as follows: After April 1, 1990, any family receiving aid pursuant to 42 U.S.C. 601 et seq, as amended, in at least three of the six months immediately preceding the month in which such family becomes ineligible for such aid, because of hours of employment or income from the parent/caretaker relative’s employment, remains eligible for medical assistance for six calendar months following the month of ineligibility as long as such family includes a child as provided in 42 U.S.C. 1396r-6. Each family receiving such medical assistance during the entire six-month period described in this section and that meets reporting requirements and income tests established by the division and continues to include a child as provided in 42 U.S.C. 1396r-6 receives medical assistance without a fee for an additional six months. MO HealthNet Division (MHD) may provide by rule the scope of MO HealthNet coverage granted to such families.

Effective February 1, 1999, Missouri began providing two years of extended TXIX coverage to uninsured adults who successfully complete the 12 months of Transitional MO HealthNet (TMH) on or after January 31, 1999. A Medicaid waiver under Section 1115 of the Social Security Act authorizes this coverage.

Effective July 1, 2002, Missouri House Bill 1111 reduced the extended TXIX coverage for uninsured adults to 12 months.

Effective July 1, 2005, Missouri House Bill 11 eliminated the extended TXIX coverage for uninsured adults.

In June of 1999, Missouri began referring to the Medicaid program for all family eligibility groups as MC+.

Effective September 1, 2007, the Missouri Health Improvement act of 2007, Senate Bill 577 changed the name of Missouri Medicaid to MO HealthNet.

Effective April 16, 2015, the federal government approved Public Law 114-10 section 212 which granted a permanent extension of transitional medical assistance.

(magi)(1820-000-00)(1820-015-00)(block-1)1820.015.00 TMH Definitions – DSS Manuals#

IM-19 February 7, 2018

The following definitions apply to Transitional MO HealthNet:

Parent or Caretaker Relative – a relative by blood, adoption, or marriage who assumes primary responsibility for a child living in their home, and who is one of the following: The child’s father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew, or niece The spouse of such parent or relative, even after the marriage is terminated by death or divorce. The parent or caretaker relative may claim the child as a dependent on income taxes, but is not required to do so

Eligible Household Member – an individual who was member of the MHF household at the time the coverage was changed to TMH. If a parent/caretaker relative or dependent child who is not an original household member moves into the household during the Transitional MO HealthNet eligibility period, that person is not eligible for TMH (even though their needs and earned income are used to complete the budget in the second six months). NOTE: If a household member receiving TMH gives birth during the Transitional MO HealthNet period, that member’s child is eligible for automatic newborn coverage.

Good Cause – when a Parent/Caretaker Relative states an acceptable reason for why something occurred. If a parent/caretaker relative contacts FSD claiming good cause, allow whenever possible. Good Cause must be claimed within 30 days of the notice due date. Below are two uses of Good Cause with TMH and the acceptable reasons: Good cause for failure to return a Quarterly Report timely is limited to: serious illness or death of the participant or a member of the participant’s household a household emergency or household disaster, such as a fire, flood, or tornado other good cause beyond the participant’s control (discuss such cases with the supervisor to determine if a participant has good cause and if unable to decide, obtain clearance through normal supervisory channels); or The participant did not receive a quarterly report form for a reason not attributable to the participant (failure to furnish Family Support Division (FSD) with a current address is attributable to the participant) Good cause when the parent/caretaker relative had no earnings in one or more of the three report months (on the second or third quarterly reports only), and lack of earnings resulted from: The parent/caretaker relative personally provides care for a child under age six and their employer requires them to work more hours than they are able Childcare is necessary for the parent/caretaker relative to continue employment and is not available Self-employment income which results in the family experiencing a net loss of cash income. (i.e., if the claimant reports self-employment expenses higher than the self-employment income); or Circumstances occur beyond the parent/caretaker relative’s control such as a serious illness, hospitalization, or a natural disaster

(magi)(1820-000-00)(1820-030-00)(1820-030-10)(block-1)1820.030.10 Receipt of MHF in Three of Last Six Months – DSS Manuals#

IM-19 February 7, 2018

Households must have been eligible and received MHF in at least three of the last six months immediately preceding the first month of MHF ineligibility. The household must have met all MHF eligibility criteria in the three months and been approved for MO HealthNet coverage on that basis.

NOTE : Because TMH can start on any given day of the month, partial months may be counted towards BOTH the 3 out of 6 required months of MHF AND the first month of TMH. For example, TMH begins on April 17th. April counts as a MHF month and a TMH month.

Months of prior quarter MHF may be included in the three months needed to establish eligibility for Transitional MO HealthNet. Households ineligible for MHF in the month of application due to the reasons in manual section 1820.030.00 Eligibility for Initial Six Months , but eligible for all three Prior Quarter months may receive Transitional MO HealthNet. In this situation, approve the application beginning MHF coverage at the earliest date eligibility existed in the prior quarter.

EXAMPLE 1 : Mr. White applied for benefits on March 4th and requested Prior Quarter coverage. He started a new job on February 20th and received his first check on March 1st. After reviewing his income, Mr. White is not eligible for MHF coverage in March. Mr. White did not have any income in the months of December, January, and February, and is eligible for MHF in those months. Because he is eligible in at least three of the last six months, his household qualifies for TMH starting March 1st. Approve MHF beginning on December 1st.

Transitional MO HealthNet eligibility begins as soon as the adverse action period stating ineligibility for MHF expires.

EXAMPLE 2 : On July 25th Ms. Green reported she went to work on July 21st. Ms. Green is a parent/caretaker relative whose earnings cause ineligibility for MHF. To stop MHF eligibility a 10-day adverse action notice is necessary. If Ms. Green received MHF in three months during the period of March through August, she is eligible for TMH. Change was reported July 25th and FSD mailed the adverse Action Notice the same day. The Adverse action period ends on August 4th. Ms. Green begins receiving TMH the day after the Adverse Action expires – August 5th.

EXAMPLE 3 : Ms. Brown and her family have received MHF since April of the previous year. They were due for a review a year later in April. The review was attempted without contact with the participant. Income verification via electronic data was inconclusive and an IM-31A Request for Information was sent requesting income verification. Verification was not provided and MHF closed April 30th. Ms. Brown reapplied May 10 and provided the necessary income verification. Because she provided the verification within 30 days of the closing date we can reopen her original case and process it for TMH (refer to 1885.030.00 Reopening Closed Cases ). No new application is necessary.

EXAMPLE 4 : Mr. Blue and his family were placed on MHF in March. It is now August and Mr. Blue is reporting a job he started on April 2nd. The first day that Mr. Blue’s family could have received TMH coverage would be April 22 (Allowing 10-days from start of job to report change and 10-days for Adverse Action period). Since the family’s MHF coverage started in March and they would have moved to TMH in April, they do not meet the eligibility guideline of receiving MHF in three out of the last six months. The Blue family is not eligible for TMH. Complete an ex parte review of all household members.

NOTE : Each Prior Quarter month has its own independent evidence for the following: Prior Quarter Income, Prior Quarter Deductions, and Prior Quarter Medical Bills.

(magi)(1820-000-00)(1820-030-00)(1820-030-40)(block-1)1820.030.40 Untimely Report of Income Change Resulting in Ineligibility for MHF – DSS Manuals#

IM-19 February 7, 2018

The start date for TMH will always be calculated as the date the coverage should have begun (NOT the date of discovery).

When the change is reported/discovered before the 21st day of the fourth month of Transitional MO HealthNet eligibility , enter the income change as reported by the participant and MEDES will take the appropriate action.

EXAMPLE 1: Ms. Black and her family have been on MO HealthNet for Families since September. It is now the following June and Ms. Black just reported that she started a job on March 24th. We cannot affect her coverage for the month of March. Using March 24th as our starting point, allowing ten (10) days for Ms. Black to report the change, ten (10) days for FSD to process the information, and another ten (10) days for an adverse action, the first date that Ms. Black’s family could receive TMH coverage would be April 23rd. April counts as her first month of TMH.

When the change is reported/discovered after the 21st day of the fourth month but before the end of the sixth month of Transitional MO HealthNet eligibility , complete a closing transaction providing Transitional MO HealthNet for the first six months only. DO NOT give or send the parent/caretaker relative a quarterly report form. The due date passed and the caretaker cannot be eligible for the second six months. Explore eligibility for other MO HealthNet programs.

EXAMPLE 2: Ms. Orange and her family were placed on MHF 12 months ago (in February). It is now January and Ms. Orange is reporting a job she started on August 12th. Using August 12th as our starting point, allowing ten (10) days for Ms. Orange to report the change, ten (10) days for FSD to process the information, and another ten days for an adverse action, the first date that Ms. Orange’s family could receive TMH coverage would be September 11th. January would count as her fifth month of TMH. Since Ms. Orange did not report her income until after the first quarterly report would have been due (by the 21st day of the 4th month/December 21st), her household is only eligible for the first six months of coverage and no extended coverage.

p> When the change is reported/discovered after the end of the sixth month of Transitional MO HealthNet eligibility , follow appropriate closing procedures on the MHF case and do not transfer to Transitional MO HealthNet. Enter a complete comment in MEDES explaining why TMH was not entered into system. Explore eligibility for other MO HealthNet programs prior to closing the MHF case.

EXAMPLE: Ms. Crane and her family have received MHF for 9 months. Ms. Crane started a new job on January 20th; however, she did not report the new income to FSD until after August 3rd. Using January 20th as our starting point, allowing ten (10) days for Ms. Crane to report the change, ten (10) days for FSD to process the information, and another ten (10) days for an adverse action, the first month that Ms. Crane’s family could have received TMH coverage beginning February 19th. August would count as her seventh month of TMH. This income was reported after the sixth month (July) of possible TMH eligibility. Follow standard procedure and complete an ex parte review on all household members.

(magi)(1820-000-00)(1820-030-00)(1820-030-50)(block-1)1820.030.50 Untimely Agency Action on Change – DSS Manuals#

IM-26 February 22, 2019 ; IM-19 February 7, 2018

When a change is reported timely but agency does not enter the change timely, take the following actions:

Calculate when the TMH should have begun. The household is automatically eligible to receive a minimum of six (6) months TMH coverage.

Send the participant any quarterly reports they should have received by the current date and allow them twenty (20) days to return the completed document(s);

If document(s) is received, determine continued eligibility past the original six (6) months;

If document(s) is not received, send an IM-80 PRE which contains ex parte questions. If any household member is not eligible for any other MO HealthNet coverage, begin adverse action process by sending an Adverse Action Notice (IM-80). If there is no response from the participant within ten (10) days, close coverage on ineligible household member(s).

When the error is discovered before the 21st day of the fourth month of Transitional MO HealthNet eligibility , give or send the caretaker the first quarterly report form. Allow 20 days a reasonable amount of additional time for the parent/caretaker relative to complete the quarterly report form. Make sure the quarterly reports are entered into MEDES so that the participant is sent the next quarterly report timely.

EXAMPLE: Ms. Donner and her family are receiving MHF. Ms. Donner started a new job on June 21st and reported the new income to FSD on June 28th. Eligibility for MHF should have ended and TMH started sometime in July; however, FSD failed to act on the change until September 30th. This information was acted upon before the first quarterly report was due to be returned (21st day of the fourth month).

When the error is discovered after the 21st day of the fourth month but before the end of the sixth month of Transitional MO HealthNet eligibility , give or send the caretaker the quarterly report form to complete for the first three months. Allow 20 days for the parent/caretaker relative to complete the form, and reinstate coverage if necessary. Make sure the quarterly reports are entered into MEDES so that the participant is sent the next quarterly report timely.

EXAMPLE: Mr. Everly and his family are receiving MHF. Mr. Everly started a new job on March 21st and reported the new income to FSD on March 25th; however, FSD did not act on the income change until August 10th. Eligibility for MHF should have ended and TMH started sometime in April. This income was processed by FSD after the first quarterly report was due to be returned (21st day of the fourth month), but before the last day of the sixth month.

When the error is discovered after the end of the sixth month of Transitional MO HealthNet eligibility , give or send the parent/caretaker relative the necessary quarterly report forms and allow 20 days for the parent/caretaker relative to complete the forms. Make sure the quarterly reports are entered into MEDES so that the participant is sent the next quarterly report timely.

EXAMPLE: Ms. Farr and her family are receiving MHF. Ms. Farr started a new job on February 1st and reported the new income to FSD on February 9th; however, FSD did not act on the income change until September 2nd. Eligibility for MHF should have ended and TMH started sometime in February. This income was processed after the sixth month of possible TMH eligibility.

(magi)(1830-000-00)(1830-020-00)(block-1)1830.020.00 Prior Quarter (PQ) – DSS Manuals#

IM-108 July 19, 2022 ; IM-117 November 15, 2021

Eligibility determinations for PQ (also known as retroactive) coverage are separate from the eligibility determination for the month of application. Complete an eligibility determination for each PQ individually.

NOTE : The participant DOES NOT have to be eligible in the month of application to be eligible for PQ benefits.

The effective dates of PQ benefits can be no earlier than the first day of the third month prior to the month of application.

PQ Eligibility and Verification

To be eligible for PQ, a participant must meet the criteria listed below for each month of PQ.

Resident of Missouri (self-attestation)

Citizenship/Immigrant Status

Income eligible

Attest to having unpaid bills for a PQ month

Social Security Number

Tax Filing Status (self-attestation) and Tax relationship

Pregnant if requesting PQ for MPW

NOTE : Each PQ month has its own independent evidence for the following: PQ Income, PQ Deductions, and PQ Medical Bills.

The start date of the PQ specific evidence will be the first day of that individual month and the end date will be the last day of that individual month. All other evidence will be backdated by the system to the first day of the earliest PQ month.

Determine income for PQ months using the same methodology as the month of application. These guidelines are in manual section 1805.030.00 Modified Adjusted Gross Income (MAGI) Methodology .

When completing income budget(s) for PQ months, use reasonable compatibility (RC) to confirm the self-attestation of income in each month. Refer to manual section 1805.030.15 Reasonable Compatibility for more information on RC.

Use electronic data sources when available to verify attested information. If evidence cannot be verified electronically or by existing case information, attempt to contact the participant by phone prior to sending a Request for Information . Allow 10 days for the individual to provide the requested information.

If the participant returns the information, make an eligibility determination based on the information provided.

If the participant fails to provide the requested information within the 10-day Request for Information timeframe, reject all three months for Failure to Cooperate.

EXAMPLE: Sue applied for benefits for her son, Austin, in July. She requested PQ coverage for April, May and June. Because Sue’s income statement was not RC for May, and she could not be reached by phone, a Request for Information was sent. Sue failed to provide the requested information within the 10-day Request for Information timeframe. All PQ months, April, May and June, were rejected for Failure to Cooperate. Since she provided all other necessary information, a determination can be made for the application month and ongoing coverage.

Reapplication for PQ

The participant may apply or reapply for PQ for up to one year after the application date. They may apply for PQ in person, by telephone, or in writing. If it is a reapplication, only request the unverified information from the previous application for PQ.

EXAMPLE: Sue returns in December and requests that PQ for her son be explored again for April, May and June. Sue is provided with the Request for Information and given 10 days to provide the outstanding income information from May that was previously requested and not provided.

Reasonable Opportunity (RO)

Allow RO for PQ months. If the citizenship or qualified immigrant status is not verified at application, approve the PQ with RO when the ongoing benefit is approved.

MPW PQ

PQ for MO HealthNet for Pregnant Women (MPW) is treated differently. Review policy on PQ for MPW applications, 1850.030.00 Prior Quarter (PQ) and Month of Application Eligibility .

(magi)(1840-000-00)(1840-005-00)(block-1)1840.005.00 Legal Basis (CHIP) – DSS Manuals#

IM-22 March 7, 2017

SB 632 enacted changes effective September 1, 1998, providing Title XIX coverage to uninsured children with family income over the previous limits up to 300% of the federal poverty level (FPL). The bill required cost sharing for higher income families in the form of co-payments and premiums. Children’s Health Insurance Program funds (Title XXI of the Social Security Act) and premium collections provide funding for this expansion of health care benefits.

Senate Bill 539 (2005) enacted changes effective September 1, 2005, to the MC+ for Kids healthcare coverage program (CHIP). The bill lowered the income limit for no-cost coverage and eliminated all cost-sharing except premiums. Under SB 539, uninsured children are divided into two eligibility groups:

NON-PREMIUM GROUP: Gross income ABOVE 148% up to and including 150% FPL

PREMIUM GROUP: Reduced Premium: Gross income over 150% up to and including 185% FPL Reduced Premium: Gross income over 185%, up to and including 225% FPL Full Premium: Gross income over 225%, and up to 300% FPL

Missouri Revised Statutes, Section 208.640 limits premiums and other cost-sharing to no more than 5% of a family’s income. House Bill 11 (2005) limits premiums to:

No more than 1% for families whose income does not exceed 185% FPL; and

No more than 3% for families whose income is greater than 185% FPL but does not exceed 225% FPL

Senate Bill 577 (2007) enacted changes to the MO HealthNet CHIP program. The bill allowed for uninsured children in families with gross income up to 150% FPL to meet all Title XIX program guidelines as defined under Optional Targeted Low Income Children (Social Security Act 1902(a)(10)(A)(ii)). This allows:

Children in the non-premium CHIP group to have prior quarter healthcare coverage eligibility explored (no sooner than September 1, 2007)

removes any penalty for dropping insurance for children in either the premium or non-premium CHIP groups

eliminates assets as an eligibility factor, and

restores non-emergency transportation services. Uninsured children in families with gross income above 150% of FPL up to 300% of FPL are eligible for healthcare coverage under the State Children’s Health Insurance Program (SCHIP) under Section XXI of the Social Security Act.

Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA or more commonly called the ACA) of 2010 requires Family MO HealthNet programs to use Modified Adjusted Gross Income (MAGI) methodology. The ACA removed net worth as a requirement.

(magi)(1840-000-00)(1840-010-00)(1840-010-10)(block-1)1840.010.10 Uninsured – DSS Manuals#

IM-101 July 11, 2022 ; IM-22 March 7, 2017

Per Missouri State Statue RSMo 208.631.1 , health care must be made available to uninsured children whose household income falls within any of the CHIP groups (premium or non-premium), 150% to 300% of the FPL.

NOTE: Prior to July 1, 2014, children must have been uninsured for six (6) months. Senate Bill 754 (2014) removed the penalty for dropping insurance for both premium and non-premium CHIP groups.

Uninsured children are defined as any person up to nineteen (19) years of age and:

emancipated and do not have access to affordable employer-sponsored insurance

does not have other health care coverage

NOTE: Uninsured children must also meet Missouri residency requirements as well as all other financial and non-financial MO HealthNet eligibility criteria.

A child covered by health insurance at the time of CHIP eligibility is considered ineligible unless the insurance is one of the following:

Short Term Insurance

Accident Insurance

Fixed Indemnity Insurance

Limited Coverage Insurance

Credit Insurance

Healthcare Sharing Ministry Plans may be one of the following: a medical sharing plan, a private healthcare system (PHCS), or a faith-based 501(c)3 not-for-profit organization

Coverage issued as a supplement to liability insurance

Insurance arising out of a workers’ compensation insurance or similar law

Automobile Medical Payment Insurance

Insurance under which coverage is payable with or without regard to fault of an individual and which is required by statue to be contained in any liability insurance policy or equivalent self-insurance policy

The Caring Foundation for Children Program

The insurance enrollment is already paid for by the Health Insurance Premium Payment (HIPP) Program

An eligible child who has exceeded the annual or lifetime coverage maximums of his or her health plan for all healthcare services

NOTE : Persons who have exceeded an annual or lifetime maximum for all coverage under their plan are considered uninsured. The applicant/participant must provide verification from the health plan that the child has reached the annual/lifetime maximum for all plan coverage. The verification must provide a date if healthcare coverage will be reinstated for the child. The Eligibility Specialist must update the evidence in MEDES annually.

NOTE: A disabled child who is eligible for Non-Spend Down MO HealthNet for Disabled Children (MHDC) is considered insured and is ineligible to receive CHIP coverage. A disabled child who is eligible for Spend Down MHDC is considered uninsured and would be potentially eligible for CHIP coverage.

To determine insurance affordability refer to MAGI Policy Manual sections 1840.010.15 Access to Affordable Health Insurance and 1840.010.15.05 Affordable Insurance Definition .

(magi)(1840-000-00)(1840-010-00)(1840-010-15)(1840-010-15-05)(block-1)1840.010.15.05 Affordable Insurance Definition – DSS Manuals#

IM-26 March 30, 2020 ; IM-86 May 29, 2019 ; IM-28 March 30, 2018 ; IM-38 April 25, 2017 ; IM-25 May 5, 2016 ; IM-23 April 26, 2016 ; IM-20 March 19, 2015

The affordability standard, outlined in RSMo 208.640 , is based upon a percentage of income for a household of three at 150% (CHIP73), 185% (CHIP74), or 225% (CHIP75) of the FPL, depending upon the household’s gross income.

Households with income between 150% and 300% of the FPL with access to insurance must meet the following affordability guidelines:

For households with gross income above 150% up to and including 185% of FPL (CHIP73) the affordability standard is based upon a monthly premium amount of 3% of 150% of the FPL for a household of three (see Appendix I under CHIP program for current amount).

For households with gross income above 185% up to and including 225% of FPL (CHIP74) the affordability standard is based upon a monthly premium amount of 4% of 185% of the FPL for a household of three (see Appendix I under CHIP program for current amount).

For households with gross income above 225% up to and including 300% of FPL (CHIP75) the affordability standard is based upon a monthly premium amount of 5% of 225% of FPL for a household of three (see Appendix I under CHIP program for current amount).

NOTE: The affordability standard is updated each April if there are changes in the Federal Poverty Level.

NOTE: Consider all health insurance through employment with state agencies, where health insurance is available to their employees, as affordable regardless of the cost of the health insurance as compared to the affordability standards (see 1840.010.10.05 HIPP Effect on Uninsured Status ). If the state employee is receiving premium assistance through the HIPP program, they still have access to affordable insurance and are ineligible for all CHIP premium levels of coverage.

If insurance is available for the child(ren) at a cost below the affordability standards, the child(ren) is not eligible for the MO HealthNet for Kids CHIP Premium coverage due to access to affordable health insurance. Refer to 1840.010.10 Uninsured if the child(ren) has a pre-existing condition that the health insurance plan does not cover, or if the child(ren) has exceeded annual coverage for all healthcare services.

(magi)(1840-000-00)(1840-010-00)(1840-010-15)(1840-010-15-08)(block-1)1840.010.15.08 Affordability Test – DSS Manuals#

It is required that CHIP cases explore the potential for private affordable health care coverage prior to approval, outlined in 1840.010.15.05 Affordable Insurance Definition .

FSD will determine affordability using the CHIP Affordability Calculator. The calculator will compare CHIP premium amounts to insurance premium amounts on the FFM to determine affordability based on the size of the household and the region of the state they live in.

The individual can choose to provide an insurance quote if that is their preference but do not request them to provide insurance quotes since FSD can make the affordability determination using the calculator.

NOTE: Individuals will still be required to provide employer-sponsored insurance quotes when applicable.

Undocumented aliens are not insurable. Do not ask for private insurance quotes for undocumented aliens.

Individuals may research quotes during closed and open enrollment periods at www.healthcare.gov , but FFM coverage can only be purchased during the annual open enrollment period. Private insurance is considered available during open, closed, and special enrollment periods.

NOTE: The open-enrollment dates changes yearly. See www.CMS.gov to view the current enrollment period.

Closed enrollment period:

Apply employer-sponsored insurance affordability test.

Apply the CHIP private affordable health care coverage affordability test. Individuals who failed, or would fail, the affordability test during the open enrollment period may qualify during closed enrollment period.

Open enrollment period:

Apply the employer-sponsored insurance affordability test.

Apply the private affordable health care coverage affordability test. If they are ineligible for CHIP coverage they will be rejected and referred to the FFM. Exceptions will be made for children with special needs.

Special enrollment period:

An individual may qualify for a special open enrollment period with the FFM. During a special open enrollment individuals may qualify to purchase FFM insurance during the closed enrollment period.

FSD does not determine if an individual meets a special enrollment period.

CHIP Affordability Test

CHIP Affordability Test should be applied to CHIP 73, CHIP 74 and CHIP 75 cases.

FSD will complete the CHIP Affordability Calculator for purposes of determining the private affordable health care coverage affordability test.

NOTE: Compare the CHIP Premium to the FFM Highest Gold Premium. If it is more than the CHIP premium, no affordable insurance is available.

For the Instructions for Affordability Tests Using FFM Premiums, see Appendix F – CHIP Affordability Test Calculator Instructions .

(magi)(1840-000-00)(1840-010-00)(1840-010-15)(1840-010-15-10)(block-1)1840.010.15.10 Employer-Sponsored Insurance – DSS Manuals#

IM-129 October 10, 2017 ; IM-92 July 11, 2017

Employer-sponsored health insurance causes ineligibility if:

the premium meets the affordable definition in 1840.010.15.05 Affordable Insurance Definition

the coverage meets the definition of health insurance in 1840.010.10 Uninsured ; and

the insurance covers all of a child’s pre-existing conditions

EXAMPLE : Mrs. Maple applied for MO HealthNet for Kids for her daughter Ann. The Maple family income is over 150% of the federal poverty level (CHIP premium level). Ann does not have health insurance. Mr. Maple has employer-sponsored insurance that would cover Ann if he elected to cover her, but it will not cover her asthma, a pre-existing condition. Mrs. Maple provided a letter from Ann’s physician stating that Ann has asthma. She also furnished Mr. Maple’s health insurance member handbook that verifies that pre-existing conditions are not covered. Since Ann is uninsured and Mr. Maple’s employer-sponsored health insurance will not cover Ann’s asthma, Ann does not have access to affordable employer-sponsored health insurance. FSD staff processing the application must use the Affordability Calculator to determine if affordable insurance is available to this family. DO NOT require the family to provide insurance quotes unless they disagree with the Calculator determination. If that occurs, they may provide quotes verbally or in writing at an FSD office or through the FSD Information Center at 855-FSD-INFO (855-373-4636).

EXAMPLE : Mrs. Davis applied for MO HealthNet for Kids for her daughter Julie. Mr. Davis just purchased employer-sponsored health insurance for Julie, and then learned that her asthma will not be covered because it is a pre-existing condition. The Davis family income is over 150% of the federal poverty level (CHIP premium level). Julie has health insurance, but it does not cover her pre-existing conditions. Because Mr. Davis’ employee insurance will not cover Julie’s pre-existing condition she is eligible for MO HealthNet for Kids, CHIP premium level of care, even though she is an insured child. Third Party Liability (TPL) information must be submitted to MO HealthNet Division regarding Mr. Davis’ insurance.

If an individual does not meet the workplace criteria to be eligible for employer insurance at the time of application, such as hours worked or length of time with the company, then the insurance is not available to that person. It is the participant’s responsibility to report any changes that could affect his or her eligibility within ten days of the change.

(magi)(1840-000-00)(1840-010-00)(1840-010-15)(1840-010-15-12)(block-1)1840.010.15.12 State Employee Health Insurance – DSS Manuals#

IM-120 August 15, 2019 ; IM-77 June 27, 2017

Health insurance available to a state employee through a state agency is considered affordable regardless of cost. If the state employee is receiving premium assistance through the HIPP program, they still have access to affordable insurance and are ineligible for all CHIP premium levels of coverage.

Section 2110(b)(2)(B) of the Social Security Act (SSA) states children who have a family member eligible for health benefits coverage under a State health benefits plan on the basis of the family member’s employment with the State are not eligible for the Children’s Health Insurance Program (CHIP).

EXAMPLE: The Missouri Department of Transportation (MoDOT) is a state agency that does not participate in Missouri Consolidated Health Care Plan (MCHCP), however, provides health insurance to their employees.

Ms. Thompson applies for Family MO HealthNet for her two children and reports her employer as MoDOT. The expense of purchasing the MoDOT health insurance is $300.00 per month and therefore, the participant chose not to purchase the insurance. The participant’s household is uninsured. The participant is a state employee who can purchase health insurance through their state employer. The children are not eligible for CHIP level of care.

NOTE : Section 2110(b)(2)(B) of the SSA does NOT apply to non-CHIP Family MO HealthNet cases.

Not all individuals working for a state agency may be eligible to receive or purchase health benefits under a State health benefits plan. Some employment classifications may not be eligible to purchase health insurance through a State agency and should not be considered to have access to health benefits under a State health benefits plan. These positions include but are not limited to:

temporary employees,

part time employees,

interns and

contract employees

EXAMPLE: A participant reports income from the State and electronic sources shows a temporary employment agency (i.e. Manpower, C&S Business Solutions, Job Finders, etc.). The participant will need to clarify the source of income as they may have a job assignment with a state agency. Clarification can be a verbal attestation. The participant does not work directly for the State, therefore, does not have access to State Employee Health Insurance.

EXAMPLE: A participant reports income from another State Agency but lives in Missouri. If electronic sources are not in conflict with participant’s attestation of employment, then consider the participant to have access to affordable health insurance regardless of the cost.

EXAMPLE: A participant is a faculty member who works remotely from her home in Missouri at a university in Kansas. That university is considered a state agency and offers the same health insurance to its faculty members that is available to other State of Kansas employees. Because insurance for state employees is considered affordable regardless of the state, the participant is considered to have access to affordable insurance.

NOTE: If it is questionable if the employer is a state agency and if the household has access to State Employee Health Insurance, request a policy clearance (IM-14) through the appropriate supervisory channels.

(magi)(1840-000-00)(1840-010-00)(1840-010-15)(block-1)1840.010.15 Access to Affordable Health Insurance – DSS Manuals#

IM-129 October 10, 2017

In addition to being uninsured, Premium group children (income above 150% of FPL) (CHIP73, CHIP74, and CHIP75) cannot have access to affordable health insurance. Access to affordable insurance available through employment, a group membership, or from a private company causes ineligibility. Examples of group memberships that could offer health insurance are a union, professional organization, or trade association.

NOTE : If an individual does not meet the workplace or group membership criteria to be eligible for employer-sponsored or group membership insurance at the time of application, such as hours worked or length of membership, then the insurance is not available to that person. It is the participant’s responsibility to report any changes that could affect his or her eligibility within ten days of the change.

If the household fails to purchase the affordable health insurance, premium group children are ineligible as long as it is available. It is considered available even though there is a limited open enrollment period for which they need to wait.

EXAMPLE: In July, Ms. Marks applies for MO HealthNet for Kids (MHK) for her children. Her gross income places coverage within the Premium Group. Ms. Marks has been employed since February and chose not to enroll her children in employer-sponsored insurance that is considered affordable. Her employer offers open enrollment every October with coverage beginning in January. Ms. Marks has access to affordable health insurance and is not eligible for MHK coverage.

Senate Bill 577 (2007) modified RSMo 208.640 to provide that employer-sponsored health insurance and other health insurance that does not cover an eligible child’s pre-existing conditions is not considered affordable health insurance. The applicant/participant must provide verification from:

the health insurance plan that the eligible child’s pre-existing condition is not covered; and

the child’s physician that the child has the pre-existing condition the health plan will not cover

Additionally, Senate Bill 577 (2007) modified RSMo 208.640 to provide that an eligible child who has exceeded the annual coverage of his or her health plan for all healthcare services, is considered uninsured and does not have access to affordable health insurance.

(magi)(1840-000-00)(1840-025-00)(block-1)1840.025.00 Payment of Premium – DSS Manuals#

IM-22 April 11, 2024 ; IM-153 November 30, 2017 ; IM-123 September 11, 2017 ; IM-112 August 10, 2017

Families with income above 150% of poverty must pay a monthly premium for their children to be eligible for coverage. MO HealthNet Division (MHD) notifies the participant of the monthly premium amount and provides direction on how to make the payment. If payment is not received within 15 days, a second and final notice is sent by MHD requesting payment.

Note: Children who are members of a federally-recognized American Indian or Native Alaskan tribe may not have to pay a premium for CHIP level health care coverage. To stop owing a premium, qualifying households should contact the MHD Stakeholder Services Unit at 800-392-2161 for more information.

Failure to pay a premium is not a valid closing reason for children currently in their Continuous Eligibility for Children (CEC) period. Refer to section 1805.070.00 Continuous Eligibility for Children (CEC) .

Premiums may change on July 1 of each year. Refer to Appendix E – MO HealthNet for Kids – CHIP Premium Chart .

Premiums are calculated as follows:

Families with gross income above 150% up to and including 185% of the FPL are responsible for a monthly premium equal to: 4% of monthly income between 150% and 185% of the FPL for the family size.

Families with gross income above 185% up to and including 225% of the FPL are responsible for a monthly premium equal to: 4% of monthly income between 150% and 185% of the FPL for the family size plus 8% of monthly income between 185% and 225% of the FPL for the family size.

Families with gross income above 225% up to and including 300% of the FPL are responsible for a monthly premium equal to: 4% of monthly income between 150% and 185% of the FPL for the family size plus 8% of monthly income between 185% and 225% of the FPL for the family size plus 14% of monthly income between 225% and 300% of the FPL for the family size, but the total monthly premium is not to exceed 5% of the family’s gross income.

Approval in the CHIP premium group does not mean a child will receive coverage. It means the family is eligible to buy medical coverage for their child(ren) through the MO HealthNet for Kids CHIP Program. Premium payments are required for the below groups. Eligibility and coverage begin as follows:

Reduced Premium Group (above 150% to 225% FPL) – CHIP73 or CHIP74: There is no waiting period to begin eligibility. Once the child(ren) is determined eligible for CHIP73 or CHIP74, an invoice is mailed. Coverage begins the date the premium is received, not the eligibility start date.

Full Premium Group (above 225% and below 300% FPL) – CHIP75: RSMo Section 208.646 and State Regulation 13 CSR 70-4.080 requires an eligibility start date 30 days from the date of application for coverage to begin for children whose family’s gross income is over 225% of the FPL (CHIP 75). If the premium is paid within 30 days from the date of application, coverage is effective on the 30th day after application. The day following the day of application is considered day one. If the premium is not paid within the first 30-day period, coverage is effective the date of receipt of the premium. RSMo Section 208.647 makes an exception to the starting date for children determined to have special healthcare needs (Section 1820.020.05.20). For children determined to have special healthcare needs, the eligibility start date is the date of application and coverage starts on the date the premium is paid.

The Managed Care Enrollment Inquiry (MCII) screen displays coverage dates for individuals in the Premium groups. The enrollment date in a health plan on MCII is the first date of any coverage in the Premium group. The MCII screen is also used to show enrollment in a specific health plan. Premium group children are assigned to a pseudo plan until the effective date of their enrollment in a managed care health plan.

Example: Mrs. Jones applies October 1 for her child. She meets all eligibility requirements for Premium Group coverage, CHIP73 or CHIP74. Staff approve her case October 10. Eligibility for MO HealthNet for Kids begins October 1.

An invoice is mailed to Mrs. Jones October 11. Mrs. Jones’ payment is received by the MHD Stakeholder Services Unit on October 16. Her child’s coverage begins October 16.

The MO HealthNet Division Title XIX Cross Reference Eligibility (MXIX) screen in Legacy for her child displays October 1 as the Start Date. This is the Start Date for eligibility only. Check the child’s MCII screen to find the date of coverage. The Enrollment Start Date for the Pseudo Health Plan is the first date of coverage; for Mrs. Jones’ child, the Start Date displays October 16.

Example: Mr. Smith applies October 1 for his two children, Jane and Jack. He meets all eligibility requirements for Premium Group coverage, Level of Care 3 (CHIP75). Mr. Smith also provides verification that Jack has special healthcare needs. In the eligibility system, enter Jack’s special healthcare needs status in the application flow when the question is asked. Staff approve the case October 15. Jack’s eligibility for CHIP75 eligibility begins October 1; eligibility for Jane begins October 31.

An invoice is mailed to Mr. Smith on October 15, the date of approval. Mr. Smith’s payment is received by the MHD Stakeholder Services Unit on October 20. Jack’s coverage begins October 20, Jane’s on October 31.

The MXIX screen for Jack displays October 1 as the eligibility Start Date; for Jane, the screens display the eligibility start date of October 31. The MCII screen for Jack displays October 20 as the coverage Start Date; for Jane, MCII displays October 31 as the coverage Start Date.

Note: Continuous Eligibility for Children (CEC) begins at approval. Coverage, granted by MHD, begins once the first premium payment is paid. Refer to 1805.070.00 Continuous Eligibility for Children (CEC) .

(magi)(1850-000-00)(1850-010-00)(block-1)1850.010.00 Legal Basis – DSS Manuals#

IM-105 December 22, 2023 ; IM-135 August 28, 2019

Federal regulation 42 CFR 435.223 along with Senate Bill 588 from the Missouri 80th General Assembly allows Title XIX benefits to pregnant women who would be eligible for AFDC cash benefits as if in fact the child had already been born. This program became effective in Missouri August 13, 1980.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) P.L. No. 99-272 provides for Title XIX eligibility for pregnant women who would be eligible for AFDC based on the income and resource requirements and for 60-day postpartum Title XIX coverage for all pregnant women who received benefits under the MO HealthNet for Pregnant Women program (MPW). Deprived of Parental Support was removed as an eligibility factor for the MO HealthNet for Pregnant Women program. House Bill No. 518 enacted by the 84th General Assembly mandates these changes in RSMo 208.151 . An emergency clause made this part of the law effective upon passage and approval. House Bill No. 518 was signed into law July 7, 1987.

RSMo 208.151, beginning January 1, 1988, provides restricted MO HealthNet benefits, including 60-day postpartum benefits, for pregnant women who have family income less than 100% of the federal poverty level.

Senate Bill No. 765 enacted by the 85th General Assembly mandates changes in RSMo 208.151. Beginning July 1, 1990, Missouri provides MO HealthNet benefits, including 60-day postpartum benefits for pregnant women who have family income less than 133% of the federal poverty level, and provides continuous eligibility for pregnant women determined eligible under the MO HealthNet for Pregnant Women program when subsequent changes in income cause the claimant to become ineligible. The bill also eliminates resources as an eligibility factor.

HB 564 enacted changes effective January 1, 1994, providing Title XIX coverage to pregnant women with family income less than 185% of the federal poverty level.

Effective February 1, 1999 Missouri began providing two years of coverage for women’s health services to uninsured women losing MO HealthNet for Pregnant Women (MPW) eligibility 60 days after their pregnancy ends. To be eligible for the extended women’s health services (EWHS), MPW eligibility must have ended on or after January 31, 1999. A Medicaid waiver under Section 1115 of the Social Security Act authorizes this coverage.

Effective July 1, 2002 Missouri House Bill 1111 reduced the coverage for women’s health services to 12 months.

Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) of 2010 requires Family MO HealthNet programs to use Modified Adjusted Gross Income (MAGI) methodology. To reflect the PPACA requirement to remove income disregards from all Family MO HealthNet programs, the Federal Poverty Level (FPL) increased for MPW from 185% to 196%.

Federal regulation 42 CFR §435.116 replaced 42 CFR §435.223 effective July 15, 2013. The amendment implements sections 1902(a)(10)(A)(i)(III) and (IV); 1902(a)(10)(A)(ii)(I), (IV), and (IX); and 1931(b) and (d) of the Social Security Act.

Sections 9812 and 9822 of the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2) gave States the option to provide 12 months of extended postpartum coverage to pregnant individuals enrolled in Medicaid and CHIP. Senate Bills 45 and 106 were passed by the 102 nd General Assembly and signed by the Governor on July 6, 2023 implementing this change in Missouri. The EWHS program is being discontinued with the implementation of 12 month postpartum coverage.

(magi)(1855-000-00)(1855-030-00)(1855-030-05)(block-3)Children of Non-citizens or Ineligible Immigrants#

SMHB ME Codes Effective July 1, 2022

Children of SMHB recipients who were denied MPW due to citizenship will receive a level of care based on the income at the time of the SMHB approval.

ME 6S (formerly ME 62) is for children born to SMHB mothers who were at or below 196% of FPL (201% with the 5% disregard) at approval.

ME 9S (formerly ME 74 and 75) is for children born to SMHB mothers who were above 196% of FPL and below 300% of FPL (between 201% and 305% respectively, with the 5% disregard) at approval.

EXAMPLE : Jane applied for coverage for her pregnancy on January 10. Jane is not a US citizen or eligible immigrant. She was denied for MPW and approved for SMHB. Jane’s child was born February 19. Current records show that household income is 190% of FPL. The child is eligible for SMHB-Newborn (ME 6S). Before the child’s first birthday, the household will be re-evaluated and the child moved to the appropriate level of care.

SMHB ME Codes Effective January 1, 2016 through June 30, 2022

Children of SMHB recipients who were denied MPW due to citizenship will receive the appropriate level of care for their reported household income based on the income at the time of the SMHB approval. (ME code 62, 74, or 75) A Federal Grant Indicator (FGI) of 8 will show as a “C” on MXIX, and show $0 premium, if appropriate.

EXAMPLE : Jane applied for coverage for her pregnancy on January 10. Jane is not a US citizen or eligible immigrant. She was denied for MPW and approved for SMHB. Jane’s child was born February 19. Current records show that household income is 190% of FPL. The child is eligible for Child Under 1 (ME 62). The FGI of 8 (shown as a C in the TOC field on MXIX) indicates the child is SMHB until age one. Before the child’s first birthday, the household will be re-evaluated and the child moved to the appropriate level of care.

An ex parte review must be completed before the child turns age one (1).

(magi)(1865-000-00)(1865-020-00)(block-1)1865.020.00 Eligibility Requirements – DSS Manuals#

IM-95 September 21, 2021

All eligibility requirements in Chapters 1802.000.00 Applications and 1805.000.00 Eligibility and Verification must be met , in addition to the following:

Must be aged 19 to 64

Income at or below 133% of the Federal Poverty Level

Not pregnant

Not entitled to or enrolled in Medicare Part A or B Note : SSDI recipients may be eligible for Adult Expansion Group (AEG) if NOT entitled to or enrolled in Medicare Part A or B. Upon approval of SSDI, some recipients may have a two (2) year waiting period for Part A or B

Not receiving SSI

Ineligible for all MO HealthNet (MHN) mandatory category programs listed below: MO HealthNet for Pregnant Women (MPW) MO HealthNet for Families (MHF) MO HealthNet for the Aged, Blind, and Disabled (MHABD) Non-Spend Down , or MHN coverage for former foster youth who have aged out of Missouri foster care up until age 26. In January 2023, ALL MHN coverage for former foster youth becomes mandatory

See Appendix K – Identifying Mandatory and Non-mandatory Programs for a full list of mandatory MHN programs.

Note : Coverage listed on MAGI Appendix K as better level of care of the medical need should be treated as mandatory.

Participants who meet the eligibility criteria for AEG:

Are able to receive AEG coverage while they undergo a determination of eligibility by the Medical Review Team (MRT) for a non-MAGI program

Do not have to meet categorical requirements such as blindness, disability, or caring for a dependent child

If there is a child, under age 19 who does not have Minimum Essential Coverage (MEC) and is residing in the home of a parent or non-parent caretaker relative who assumes primary responsibility for the child , the adult applicant must apply for MHN coverage for the child and the child must be found eligible in order for the parent or non-parent caretaker to be eligible for the AEG. MEC is defined in 42 CFR 435.4. The parent or non-parent caretaker relative must attest that the child is enrolled in health care coverage that meets MEC requirements if the child is not eligible for MHN coverage.

Participants who are enrolled in AEG and report a pregnancy to the Family Support Division (FSD) must have eligibility explored under 1850.000.00 MO HealthNet for Pregnant Women (MPW) and 1855.000.00 Show-Me Healthy Babies (SMHB) . If eligible, FSD will take actions to change the program level to MPW or SMHB.

Examples of AEG Eligibility for Parent/Caretaker Relatives

John applies for MHN for himself. Included in John’s household are his wife and his two stepchildren. John refuses to apply for his stepchildren and his stepchildren are not enrolled in a health insurance plan that meets MEC requirements. John is found ineligible for AEG because he is the stepparent of children who reside in the home and the children are not enrolled in a health insurance plan that meets MEC requirements.

Note : If John’s stepchildren were enrolled in a health insurance plan that meets MEC requirements, John would be found eligible for AEG.

Mary (Mom), Bob (Dad), and Charlie (child in common) live in the same household. Mary and Bob are not married. Mary has income at 30% of FPL, but Bob has income that makes Charlie over income for all MHN programs. Charlie is not enrolled in a health insurance plan that meets MEC requirements. Mary is found ineligible for AEG because she is the parent of child who resides in the home who is not eligible for MHN and is not enrolled in a health insurance plan that meets MEC requirements.

Note : If Charlie was enrolled in a health insurance plan that meets MEC requirements, Mary would be found eligible for AEG.

Maggie (Mom) and Ben (child under one) apply for MHN coverage. Maggie meets most of the eligibility requirements for AEG except coverage for a dependent child. Ben still needs to provide proof of application for a Social Security Number (SSN) or the number. Maggie fails to provide verification of Ben’s SSN; therefore, Ben is denied MHN coverage. Ben does not have other health insurance that meets MEC requirements. Maggie is found ineligible for AEG because she is the parent of a child who resides in the home, who is not eligible for MHN and is not enrolled in other health insurance that meets MEC requirements.

Note : If Maggie had provided verification of Ben’s proof of application for SSN or the number within 10 days or within the cancel reject period, and Ben was found eligible for MHN then Maggie would be eligible for AEG.

Example of AEG Eligibility for Non-Citizens

Ahmed, 50 years old, is in need of healthcare coverage and applies for MHN. He reports on his application that he is a Lawful Permanent Resident of two years and is a refugee . He is claiming a disability, therefore, a concurrent eligibility determination is made for MAGI and Non-MAGI based methodology. He meets AEG eligibility but his class of admission needs to be confirmed. He provides verification of his immigration status and it is confirmed that he is a refugee , therefore, he does not have to meet the 5 year bar requirement (see 1805.020.10.10.05 Qualified Immigrants With No Waiting Period ). Ahmed meets all eligibility requirements for AEG and is approved while his Non-MAGI determination is pending.

Note : Citizenship and immigration requirements are outlined in policy subsections of 1805.020.00 Citizenship and Immigrant Status .

Examples of AEG Eligibility for Homeless Youth

Joe, 19 years old, is in need of healthcare coverage and applies for MHN. He reports that he is homeless. He is not reporting a disability, receipt of SSI or SSDI and he is not enrolled in/entitled to Medicare so coverage is only explored for AEG. Joe meets all eligibility factors for AEG, therefore, he is approved for the program.

Kenny, 21 years old, is in need of healthcare coverage and applies for MHN. He reports that he is homeless with monthly income of $1650.00, which is over the income threshold of 133% FPL, plus the 5% disregard, for a household of one (1). He is not reporting a disability, SSI, or SSDI and he is not enrolled in/entitled to Medicare so coverage is only explored for AEG. Kenny meets all other eligibility factors for AEG, with the exception of income, therefore he is found to be ineligible and his request is rejected for excessive income.

Note : If a homeless youth (19-20 years of age) is found ineligible for AEG, a policy clearance for interpretation (IM-14) must be submitted using appropriate supervisory channels, prior to rejecting the applicant’s request.

(magi)(1865-000-00)(1865-030-00)(block-1)1865.030.00 Begin and End Dates for Coverage – DSS Manuals#

IM-95 September 21, 2021

If eligible, the begin date for Adult Expansion Group (AEG) coverage is the first day of the month of application.

Note : AEG coverage, for any participant found eligible, will not begin prior to July 1, 2021 and will only be explored if the application is dated on or after July 1, 2021.

Example : John applies for MO HealthNet coverage on July 15th and is found eligible for AEG coverage. John’s AEG coverage will begin July 1st.

Example : Mary applies for MO HealthNet on June 30, 2021. A determination is made after July 1, 2021. Eligibility for AEG is not explored as the application is dated prior to July 1, 2021. Eligibility will be explored for all other MO HealthNet programs, except AEG, and she will be approved if eligibility exists under another program.

NOTE : AEG is not explored as Mary is not already receiving another MO HealthNet program. If someone is already receiving on or after July 1, 2021, then, Ex Parte rules (see 1890.000.00 Ex Parte Review Process and subsections) are used to explore eligibility for all other MO HealthNet programs including AEG.

Example : Jane made application at the end of May and her application was rejected June 15th because she failed to return income verification. Jane turns in the requested income verification on July 2nd. Cancel reject actions are taken on July 12th. Jane’s eligibility will be explored under All MO HealthNet programs, except AEG, as the application is dated prior to July 1, 2021. If Jane is found eligible under another MO HealthNet program, she will be approved.

The end date of AEG coverage is the day the Adverse Action (AA) period expires or the date of the action when Advance Notice requirements are exempt (see 0130.015.20 Exceptions to Advance Notice of Adverse Action ).

Example : Mary is receiving AEG coverage. She reports an increase in her income, making her ineligible for AEG. Mary is provided an adverse action period for her loss in eligibility, which expires on September 19th. The last day of AEG coverage for Mary is September 19th.

(magi)(1865-000-00)(1865-040-00)(1865-040-10)(block-1)1865.040.10 Choice of Adult Expansion Group (AEG) – DSS Manuals#

IM-95 September 21, 2021

Choice at Application

When an applicant submits a MO HealthNet (MHN) application, Family Support Division (FSD) will conduct a concurrent eligibility determination using MAGI and non-MAGI methodology if the following is reported:

Aged 19-64

Report a disability, blindness, breast/cervical cancer diagnosis, and/or SSDI

Not receiving SSI, and

Not enrolled in/entitled to Medicare Part A or B

Once FSD has determined eligibility under MAGI and non-MAGI methodology, the participant is given a choice of programs if found eligible for AEG and for a non-mandatory MO HealthNet for the Aged, Blind, and Disabled (MHABD) program (i.e. Spend Down, Blind Pension, etc.).

Notify the applicant of eligibility for both AEG and the non-mandatory MHABD program and they must choose between the two programs.

The applicant has 10 days to notify FSD staff of the program choice. If the applicant chooses to remain on AEG then the MAGI case will remain open. If the applicant chooses the non-mandatory MHABD program then FSD will take the action to transfer from AEG coverage to MHABD. FSD will need to send and observe an Adverse Action period if the choice is made verbally (not in writing). If the applicant does not notify FSD within 10 days, the applicant will remain enrolled in AEG. If the applicant notifies FSD, at a later date, of a request to transfer to the non-mandatory MHABD program, FSD staff will explore transitioning the individual to the other program.

NOTE : MAGI determinations are likely to be completed before non-MAGI determinations, therefore, the participant will be enrolled in AEG while the non-MAGI determination is pending. Refer to Appendix K – Identifying Mandatory and Non-mandatory Programs for a full listing of mandatory and non-mandatory programs.

Examples for Receipt of a New Application

Adam, 55 years old, is in need of healthcare coverage, is not claiming a disability and not currently receiving SSI or SSDI. Adam submits an MHN application. Only determine eligibility under MAGI based methodology.

John, 42 years old, is in need of healthcare coverage and is currently receiving SSI. John submits an MHN application. Only determine eligibility under non-MAGI based methodology. The receipt of SSI makes John ineligible for AEG.

Lisa, 28 years old, is in need of healthcare coverage. Lisa is claiming a disability, not currently receiving SSI or SSDI and submits an MHN application. Determine eligibility using MAGI and non-MAGI based methodologies.

Examples of Concurrent Eligibility Determinations at Application

Matt, 36 years old, applies for MHN and is determined eligible for AEG. Matt is claiming a disability, so eligibility is explored for MHABD at the same time as AEG. Matt does not receive SSI or SSDI so his information has been sent to the Medical Review Team (MRT). After the MRT review is complete, Matt is determined eligible for MHABD Spend Down. Matt must be given a choice of programs before granting MHABD Spend Down coverage. Matt chooses MHABD Spend Down by writing a letter, and action to transfer from AEG coverage to MHABD Spend Down is taken the same day.

Note : If the participant verbally chooses to transfer to a non-mandatory MHABD program from AEG, then send and observe a 10-day adverse action period before closing the AEG coverage and moving the participant to the non-mandatory MHABD program. If the participant is eligible for a mandatory MHABD program, the AEG participant would NOT be given a program choice and would be given an adverse action period of 10 days.

Bobby, 27 years old, applies for MHN and claims a disability. Bobby is determined eligible for AEG while his eligibility determination is pending with MRT. Bobby fails to return the information needed for MRT to make a determination; however, this does not affect his AEG eligibility. Since Bobby is already receiving AEG, he will remain on this program.

Choice at Annual Review/Renewal

When a participant submits an MHN Annual Review/Renewal form, FSD will conduct a concurrent eligibility determination using MAGI and non-MAGI methodology if the following applies to the participant:

Aged 19-64

Report a disability, blindness, breast/cervical cancer diagnosis, and/or SSDI

Not receiving SSI

Not enrolled in/entitled to Medicare Part A or Part B

Once FSD has determined eligibility under MAGI and non-MAGI methodology, the participant is given a choice if eligible for both AEG and a non-mandatory MHABD program.

Notify the participant of eligibility for both AEG and the non-MAGI, non-mandatory coverage and that they must choose between the two programs.

The participant has 10 days to notify FSD staff of the coverage choice. If the participant is receiving AEG coverage and chooses to remain on AEG then coverage will not be changed. If the participant is receiving MHABD coverage and chooses to remain on MHABD then the coverage will not be changed. If the participant is receiving AEG coverage and chooses the non-mandatory MHABD program then FSD will take action the same day if the choice is made in writing. If the participant is receiving AEG coverage and chooses the non-mandatory MHABD program then FSD will send and observe an adverse action period of 10 days for the AEG program before transferring to MHABD if the choice is not in writing. If the participant is receiving MHABD coverage and chooses to receive AEG coverage then FSD will take action the same day if the choice is made in writing. If the participant is receiving MHABD coverage and chooses to receive AEG coverage then FSD will send and observe an adverse action period of 10 days for the MHABD program before transferring to AEG if the choice is not in writing. If the participant does not notify FSD of the choice within 10 days, program coverage will not change from the current program level that he/she is receiving prior to the review and remains eligible for.

Examples for Receipt of an Annual Review/Renewal

John, 57 years old, is currently receiving MHABD and receives SSI. John submits an Annual Review for MHN. Only determine continued eligibility under non-MAGI based methodology. The receipt of SSI makes John ineligible for AEG.

Mark, 60 years old, currently receives MHABD Spend Down, does not receive SSI and is not entitled to or enrolled in Medicare. Mark submits an Annual Review for MHN. Explore eligibility under MAGI and non-MAGI based methodologies.

Example of Concurrent Eligibility Determinations at Annual Review/Renewal

Penny, 52 years old, currently receives AEG coverage and has returned an Annual Renewal. Penny is not receiving SSI or enrolled/entitled to Medicare, but is claiming a disability. Eligibility must be explored for MAGI and non-MAGI programs. Penny remains eligible for AEG and is determined eligible for MHABD Spend Down. Penny must be given a choice before granting MHABD Spend Down. Penny chooses MHABD Spend Down by calling, so an adverse action of 10 days is observed for the AEG coverage and then Penny is transferred to MHABD Spend Down.

Note : If Penny had not reported a disability, only continued coverage for AEG would be explored.

(magi)(1865-000-00)(1865-040-00)(block-1)1865.040.00 Interim Changes for Adult Expansion Group (AEG) – DSS Manuals#

IM-95 September 21, 2021

When a participant receiving coverage under AEG reports an Interim Change, Family Support Division (FSD) staff will explore all MO HealthNet (MHN) eligibility that is applicable to the information known to FSD.

If the AEG participant is NOT reporting a disability, blindness, breast/cervical cancer diagnosis, SSI, or SSDI, only explore continued eligibility using MAGI methodology.

If the AEG participant is reporting a disability, SSI, enrolled in/entitled to Medicare Part A or B, or SSDI, explore continued eligibility using MAGI and non-MAGI methodology (concurrent eligibility determination).

Note : For participants receiving non-mandatory, non-MAGI MHN coverage who report an interim change and are NOT receiving SSI are NOT enrolled in/entitled to Medicare Part A or B, and are aged 19-64, FSD will explore eligibility under AEG while reassessing MO HealthNet for Aged, Blind, and Disabled (MHABD) eligibility.

Participants who are currently receiving coverage under AEG and are determined eligible under a non-mandatory program ( 1865.020.00 Eligibility Requirements ) may choose to remain on AEG or choose to enroll in the non-mandatory program. Same-day actions are taken to process the participant’s request to transfer eligibility programs when the request is made in writing. If the request is made verbally then an adverse action period is observed before transferring from AEG to non-mandatory or non-mandatory to AEG.

Participants who are currently receiving coverage under a non-mandatory program (see Appendix K – Identifying Mandatory and Non-mandatory Programs ) and are determined eligible under AEG ( 1865.020.00 Eligibility Requirements ) may choose to remain on the non-mandatory program or choose to enroll in the AEG program. Same-day actions are taken to process the participant’s request to transfer eligibility programs when the request is made in writing. If the request is made verbally then an adverse action period is observed before transferring from AEG to non-mandatory or non-mandatory to AEG.

Participants who are currently receiving coverage under the AEG and are determined eligible under a mandatory program ( 1865.020.00 Eligibility Requirements ) will remain on AEG while an adverse action period is observed before transferring to the mandatory program.

Note : For additional information on mandatory and non-mandatory programs, refer to Appendix K – Identifying Mandatory and Non-mandatory Programs .

Examples of Receipt of an Interim Change

Mary, 50 years old, is currently receiving Women’s Health Services and submits a Change in Circumstance. Mary is not claiming a disability and not currently receiving SSI or SSDI. Only explore eligibility under MAGI based methodology.

Note : If Mary claimed a disability, blindness, breast/cervical cancer diagnosis, SSI, or SSDI, then explore under MAGI and Non-MAGI based methodologies.

John, 55 years old, is currently receiving MHABD and is receiving SSI. John submits a Change in Circumstance. Only explore eligibility under Non-MAGI based methodology. The receipt of SSI makes John ineligible for AEG.

Mark, 45 years old, is currently receiving MHABD Spend Down (a non-mandatory group). Mark is NOT entitled to or enrolled in Medicare Part A or B and is not receiving SSI. Mark submits a Change in Circumstance. Explore eligibility under MAGI and Non-MAGI based methodologies.

Luke, 58 years old, is currently receiving MHABD Spend Down and submits a Change in Circumstance. Luke is enrolled in Medicare Part A and B. Only explore continued eligibility under non-MAGI based methodologies. Because Luke is enrolled in Medicare Part A and B he is ineligible for AEG.

Examples of Concurrent Eligibility Determinations for Interim Changes

Maggie, 60 years old, is currently receiving MHABD Spend Down. She reports a change in income. Maggie is not receiving SSI or enrolled/entitled to Medicare, therefore, eligibility is explored for ongoing MHABD Spend Down as well as potential AEG eligibility. Maggie remains eligible for Spend Down at a lower rate but she is also found eligible for AEG. Maggie is given a choice between the non-mandatory MHABD and AEG programs. Maggie chooses to transfer to AEG. Same day actions are taken to transfer Maggie from MHABD Spend Down to AEG.

Note : If Maggie chooses to stay with the non-mandatory MHABD program, then she would receive a denial notice for AEG regarding her choice of non-mandatory MHN.

Examples of Follow-Up Eligibility Determinations for Interim Changes

Julie, 52 years old, is currently receiving MHABD Non-Spend Down (a mandatory program). Julie returns an Annual Review form reporting a change. During the review of continued eligibility for MHABD, it is determined that Julie is now eligible for MHABD Spend Down. Because Julie is now eligible for a non-mandatory MHN program, eligibility for AEG should be explored if she is not receiving SSI and not enrolled/entitled to Medicare Part A or B.

Note : If Julie reports SSI, or enrollment in/entitled to Medicare, then Julie is not eligible for AEG and she would only need a denial notice for AEG.

(magi)(1870-000-00)(1870-010-00)(1870-010-40)(block-1)1870.010.40 Ineligible for Any Other MO HealthNet Program (UWHS) – DSS Manuals#

IM-122 December 30, 2013

A woman is ineligible for UWHS if she qualifies for any other MO HealthNet program. Explore eligibility for any Family Healthcare program (MO HealthNet for Families, MO HealthNet for Kids, and MO HealthNet for Pregnant Women) prior to exploring eligibility for UWHS. If the participant has an active MO HealthNet for Families (MHF) or MO HealthNet for Kids (MHK) case, explore eligibility for MO HealthNet for Families prior to exploring eligibility for UWHS by completing an add-a-person application.

If ineligible for MO HealthNet for Families or any other full coverage program, explore eligibility for UWHS by registering a UWHS application and approve for UWHS if eligible on all UWHS eligibility factors. If the woman applies using the IM-1SSL application, she is ineligible for MO HealthNet for the Aged, Blind, and Disabled (MHABD) unless she either indicates that she is disabled or receives Social Security disability or SSI benefits.

EXAMPLE: Ms. Johnson meets all eligibility requirements for UWHS, but is receiving Extended Women’s Health Services (EWHS). Ms. Johnson is not eligible for UWHS as she is currently receiving MO HealthNet benefits under another program.

NOTE: Ms. Johnson should be reviewed for UWHS eligibility prior to closing EWHS.

EXAMPLE: Ms. Smith receives Social Security Disability of $650.00 per month, has resources under $1,000 and does not receive Medicare. She meets all other eligibility requirements for UWHS, but as she is disabled, she qualifies for MO HealthNet for the Aged, Blind and Disabled (MHABD) based on disability. Ms. Smith is not eligible for UWHS as she qualifies for MHABD.

EXAMPLE: Ms. Warren receives Social Security Disability of $1,000 per month, has resources under $1,000 and does not receive Medicare. She meets all other eligibility requirements for UWHS, but as she is disabled, she qualifies for MO HealthNet for the Aged, Blind and Disabled (MHABD) based on disability. Ms. Warren is not eligible for UWHS as she qualifies for MHABD on a spend down basis. If Ms. Warren fails to purchase the spend down coverage, she is ineligible as long as it is available. It is considered available even though she may not choose to pay her premium.

EXAMPLE: Ms. Harmony is included on her children’s MO HealthNet for Kids case. Ms. Harmony submits an IM-1SSL application. Ms. Harmony is not pregnant, disabled, or blind. The eligibility specialist registers an add-a-person application for Family MO HealthNet and an application for UWHS. If Ms. Harmony is determined ineligible for MO HealthNet for Families, explore eligibility for UWHS.

(magi)(1880-000-00)(1880-005-00)(block-1)1880.005.00 Pre-populated Annual Renewal Form – DSS Manuals#

IM-25 March 23, 2023 ; IM-50 March 25, 2019 ; IM-08 January 25, 2019 ; IM-137 November 20, 2017

As provided in 42 CFR 435.916(a)(3), a pre-populated annual renewal form must be sent when an ex parte renewal cannot be completed. The pre-populated annual renewal form includes:

The most current or reliable information known or available to the agency through: the household’s case record, or other information available to the agency, such as electronic data sources as listed in f the MAGI Family MO HealthNet (MHN) policy manual.

Request for required information from the participant to complete, sign, and return the annual renewal.

Filer consent information request.

Reporting requirements for changes that the participant is required to report throughout the duration of the certification period.

The household is given at least 30 days to complete, sign, and return the annual renewal form and to provide the requested information. Do not consider a pre-populated annual renewal form as received unless it is signed. If the annual renewal form and/or requested information is not received, the adverse action period begins 10 days prior to the last day of the certification period. If the household returns the annual renewal form, confirm/verify the information provided on the form.

Check FAMIS for missing, inconsistent, insufficient, or questionable information.

If pieces of information require further verification or clarification, send a request for information to the household. Allow 10 days for the household to respond to the request for information. If the household does not respond to the request for information, the case is closed. An ex parte is not required prior to closing to determine eligibility for other MHN categories. If the household provides the requested information, complete an eligibility determination on the case. If all participants are found eligible, send a notice informing the household that the case is renewed for 12 months. Complete an ex parte review to determine if eligibility exists in another MHN programs, if any participant is found ineligible.

NOTE : Refer to 1880.025.00 Annual Renewal Case Action Notifications , of the MAGI Family MO HealthNet (MHN) policy manual, for notice procedures.

Refer to 1880.020.00 Reconsideration Period when the pre-populated annual renewal form is received after the case has closed.

(magi)(1880-000-00)(1880-020-00)(block-1)1880.020.00 Reconsideration Period – DSS Manuals#

IM-30 May 17, 2024 ; IM-28 March 28, 2023 ; IM-25 March 23, 2023 ; IM-127 December 14, 2021 ; IM-137 November 20, 2017

Effective April 1, 2023 and until further notice, follow the guidance in IM-28 Reconsideration Period During the Transition Period for all MO HealthNet (MHN) Programs .

Per 42 CFR 435.916(C)(ii), allow submission of the annual renewal form up to 90 days after termination of eligibility. This 90 days is known as the reconsideration period.

For households that closed for failure to return the annual renewal form, the reconsideration period allows FSD to make a new eligibility determination without requiring a new application, if the participant returns the signed annual renewal form within 90 days.

Allow the reconsideration period if the participant fails to return the annual renewal form but provides all information required to complete the annual renewal by phone, online, in-person, or through the mail within the 90-day reconsideration period.

Note: The annual renewal form must be signed if the participant returns it.

When the annual renewal is received 30 days or less after the case closed:

Reopen the case.

Process the annual renewal.

Follow normal procedures to request clarification or verification.

If eligible, extend the certification period for 12 months.

If ineligible, authorize to close the case.

When the annual renewal is received 31 to 90 days after the case closed:

Use the annual renewal as a new application. Do not require the household to complete an application form.

The date the annual renewal is received is the application date.

Explore prior quarter coverage for all annual renewals received during the reconsideration period. Approve prior quarter for programs that provide prior quarter.

Complete the application following normal application processes.

Note: If additional information is required, only request information needed to renew eligibility. Review and use current information in the case record and electronic data sources before requiring the participant to provide information for the annual renewal.

When the annual renewal is received 91 days or more after the case closed:

Do not use the annual renewal form in place of an application.

Tell the participant how to reapply by sending the form Annual Renewal Received Outside Reconsideration Period (IM-1U90) .

(magi)(1880-000-00)(1880-025-00)(block-1)1880.025.00 Annual Renewal Case Action Notifications – DSS Manuals#

IM-25 March 23, 2023 ; IM-137 November 20, 2017

When an annual renewal is completed, send case action notices within 10 days of receiving the necessary information to determine continued eligibility.

If the annual renewal produces no change or a higher level of care – Send an action notice notifying the household of the action

If the annual renewal produces a lower level of care – Send an adverse action notice notifying the household 10 days prior to the change taking effect; Once the 10-day adverse action period expires, take action on the case; and Send an action notice notifying the household of the action

If the annual renewal produces an outcome of ineligibility – Send a pre-closing notice asking the household to notify FSD if they are pregnant, disabled, or have other changes. Once the pre-closing notice expires, send an adverse action notice notifying the participant/household that the agency will take action to close in 10 days. A participant cannot request a hearing until the adverse action notice is sent.

NOTE : A pre-closing notice is not required when the case is closing for failure to respond to a request for information.

Once the adverse action period expires, take action on the case, and

Send an action notice notifying the household of the action taken on the case as a result of the annual renewal.

When the annual renewal results in ineligibility for reasons other than failure to cooperate, evaluate eligibility for all other applicable categories of MO HealthNet (MHN) prior to taking action to close the case. If the participant/household is not eligible for any other MHN program, the case information is sent to the Federally Facilitated Marketplace (FFM) for an eligibility determination.

NOTE : An ex parte review is not required when the case is closed for failure to respond to the annual renewal or failure to provide requested information.

If a participant indicates a disability or blindness, complete a Non-MAGI determination. Do not close MAGI coverage until the Non-MAGI determination is complete.

(magi)(1885-000-00)(1885-005-00)(block-1)1885.005.00 Age Out – DSS Manuals#

IM-95 September 21, 2021 ; IM-55 August 10, 2018 ; IM-90 July 11, 2017

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.

MO HealthNet for Families (MHF) Child – 19 years old

MO HealthNet for Families (MHF) Adult – 65 years old

MO HealthNet for Adult Expansion Group (AEG) – 65 years old

MO HealthNet for Kids (MHK) – 19 years old

MO HealthNet for Kids under 1 (MHK under 1) – 1 year old

MO HealthNet for Newborns – 1 year old

Show Me Healthy Babies Newborns – 1 year old

Uninsured Women’s Health Services (UWHS) – 56 years old

RSMo 208.040 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 explored under AEG.

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.

EXAMPLE : John is currently receiving AEG and he is turning 65 years old in 60 days. Eligibility will be explored for non-MAGI coverage, MO HealthNet for the Aged, Blind, and Disabled, before closing AEG coverage.

EXAMPLE : Jill is currently receiving MHK and she is turning 19 years old in 20 days. Eligibility will be explored for AEG before closing MHK.

NOTE : If Jill is claiming a disability, receiving SSI, or receiving SSDI eligibility for non-MAGI coverage (MHABD) will be concurrently determined.

(magi)(1885-000-00)(1885-010-00)(block-1)1885.010.00 Adding a Person – DSS Manuals#

IM-22 April 11, 2024 ; IM-148 November 27, 2017 ; IM-90 July 11, 2017

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:

Online

By telephone

Mail

In person

Electronic data sources

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. If adding a child that is in their Continuous Eligibility (CEC) period, the child must continue at the same or better Level of Care (LOC). Refer to 1805.070.00 Continuous Eligibility for Children (CEC) .

Note: If a child moves to a new household where they are not eligible, but a portion of the CEC period remains, the child must remain at the current LOC and the CEC period continues. Eligibility is re-determined at annual renewal.

The individual being added can be included in multiple households; however, they cannot receive benefits in more than one household at a time.

Example : Sandy receives CHIP 75for her child, Patrick. On May 1, Sandy completed a change report and reported she is pregnant and married Bob on April 25. Bob and his daughter, Bailey, moved in with Sandy and Patrick. Prior to reporting the change, Bob and Bailey received MHF in another household with Bailey’s mother, Karen. Sandy and Bob intend to file taxes jointly and to claim Patrick as a tax dependent. Karen will claim Bailey as a dependent.

Outcome: Due to CiC, the MAGI households will change for all individuals and level of coverage will change for some household members. Bailey will be included in both households, but can only receive benefits in Sandy’s. After all changes are complete:

Sandy’s MAGI household includes 5 people: herself, her unborn child, Bob, Patrick and Bailey. She is now eligible for MPW effective May 1.

Bob’s MAGI household includes 4 people: himself, Sandy, Patrick, and Bailey. He is not eligible for MAGI benefits in Sandy’s household and is no longer eligible for benefits after his adverse action period. Sandy will receive a notice that Bob is not eligible. Karen will receive a notice that Bob has been removed from her household.

Patrick’s MAGI household includes 4 people: himself, Sandy, Bob and Bailey. He is no longer eligible for CHIP 75, but is now eligible for CHIP 74, effective May 1.

Bailey’s MAGI household includes 4 people: herself, Sandy, Bob, and Patrick. She is no longer eligible for MHF based on her current household and income, but as she is in the middle of her CEC period, she will remain MHF until her next annual renewal.

Karen’s MAGI household includes 2 people: herself and Bailey (her tax dependent). Even though Bailey is still included in her MAGI household as a tax dependent, she is not living in her home. As Karen no longer has an eligible child in the home, she can no longer receive MHF. After an adverse action period, she is now eligible for AEG.

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 .

When applicable, request information for medical support cooperation. Refer to MAGI Manual section, 1805.040.00 Cooperation in Pursuit of Medical Support .

(magi)(1885-000-00)(1885-015-00)(block-1)1885.015.00 Removing a Person – DSS Manuals#

IM-22 April 11, 2024 ; IM-11 February 20, 2020 ; IM-90 July 11, 2017

When it is reported that a household member is leaving action should be taken to remove the person from the home.

Note: Do not remove children during their Continuous Eligibility for Children (CEC) period unless you are moving them to another household or a valid closing reason applies. Refer to 1805.070.00 Continuous Eligibility for Children (CEC) for valid closing reasons.

Review the tax filing status and relationships. Determine the following:

Will the tax filing status and relationships remain the same?

Will coverage for anyone else in the household be affected?

Is person leaving the only one affected?

Is the person going on coverage somewhere else such as another household, Children’s Division, etc.?

When the head of the household is the individual being removed from the home, coverage ends for all household members age 19 and over. Individuals 18 and under will remain covered in this household through the end of their continuous eligibility period unless they meet a valid closing reason or they are approved in another household.

If the individual being removed is the only MO HealthNet for Families (MHF) eligible child in the home, MHF eligibility also ends for the parent/caretaker(s). If the child will continue to be their tax dependent they will be included in the MAGI Household size, but for a parent/caretaker to qualify for MHF there must be a MHF eligible child residing in the home. Refer to MAGI Manual section 1805.030.10.20 Exceptions to MAGI Household Composition .

Inform the household from which the individual is being removed prior to the action to remove the person takes effect. Send an Action Notice 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 period does not need to be given. Send the Action Notice to inform the household that the individual has been removed.

Example: Steven and Melissa are actively receiving MHF with their two children. Melissa calls in and says that Steven is no longer in the home and has moved out of state. 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 tax dependents of a non-custodial parent and therefore fall under tax non-filer rules.

Melissa’s household consists of herself and her two children. She continues to receive MHF with the children as she is the custodial parent (exercising more than 50% physical custody and care of the children).

The children now fall under non-filer rules, their household composition will consist of themselves, their sibling and Melissa. They continue to receive MHF.

Steven is ineligible because he is not a Missouri resident and is out of the home as the non-custodial parent.

Melissa will receive an adverse action notice that Steven is no longer eligible for MHN as he is no longer a Missouri resident. Steven’s benefits will end after the adverse action period.

(magi)(1885-000-00)(1885-020-00)(block-1)1885.020.00 Returned Mail – DSS Manuals#

IM-24 April 19, 2024 ; IM-22 April 11, 2024 ; IM-51 May 19, 2023 ; IM-40 April 24, 2023 ; IM-73 July 6, 2021 ; IM-151 November 29, 2017 ; IM-90 July 11, 2017

Effective April 1, 2023 and until further notice, follow the guidance in IM-40 Returned Mail Requirements During the Transition Period for all MO HealthNet (MHN) Programs .

The United States Post Office provides information which is found on the sticker attached to the envelope of mail that is undeliverable. This information shows a forwarding Missouri address, a forwarding out of state address, or no forwarding address (unable to locate.)

If there is a forwarding address: Missouri address – the address is updated in the system(s) and the document(s) are re-sent. Out of state address – the address is updated in the system(s) and the case is closed. 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. Missouri residency is a condition of Continuous Eligibility for Children (CEC). A child who has moved out of the state of Missouri can be closed. See 1805.070.00 Continuous Eligibility for Children (CEC) for valid closing reasons.

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.

If there is no forwarding address: No action is taken. The case will close or expire if the annual renewal or recertification documents are not returned.

Note: When returned mailed is received, review sources available to the Family Support Division (FSD). Current address or telephone number information may be located in the eligibility system(s). Attempt phone contact with the household to confirm their residency and mailing address prior to making any changes.

Once the correct action has been determined:

Information must be noted in the eligibility system: Type of mail that has been returned (example: Request for Information, Annual Renewal, or other form); Date the mail was sent to the participant; Date the mail was returned to FSD as undeliverable; and Forwarding address (if any)

Document if the mail was re-sent to the corrected address or if an action was taken to close the case

Undeliverable mail and its envelope should be scanned to the participant’s electronic case file in the Electronic Content Management (ECM) system

(magi)(1885-000-00)(1885-025-00)(block-1)1885.025.00 Moved Out of State – DSS Manuals#

IM-151 November 29, 2017

42 CFR 435.403 requires individuals to be residents of Missouri to receive MO HealthNet. When FSD discovers an individual or a household has moved out of state, action must be taken to close the MO HealthNet (MHN) eligibility.

If the individual reports in writing they moved out of state, action is taken immediately to close the case; an adverse action period is not required. If the agency discovers the individual moved out of state by any other means (examples: by a telephone call or report from another individual), an adverse action period must be granted.

NOTE : When only the head of household has moved out of state, the entire household eligibility closes. If there are household members who remain residents of Missouri, someone else will need to apply for the household.

EXAMPLE : Tim and Kristen have an active MO HealthNet for Families (MHF) case open with their child, Scott. Tim is the head of the household. Kristen notifies FSD that Tim moved to Oklahoma to live with his family and does not intend to return to Missouri. Tim was the only household member who moved. The case with Tim as head of the household is closed. Kristen must reapply as the head of the household for herself and Scott.

Refer to MAGI Manual section 1885.015.00 Removing a Person to remove individuals from the household.

Additionally, PARIS matches are an indicator that a MO HealthNet participant may be receiving Medicaid services in another state. When a PARIS match is received, review sources available to FSD, such as FAMIS, for the current address or telephone number. Attempt to contact the household to confirm their state of residency, as well as physical and mailing address.

NOTE : Do not send a Request for Information (IM-31A), when a review of the individual’s case record or a telephone call cannot verify the state of residency.

If benefits are opened in another state after benefits in Missouri were opened, assume the participant(s) has(ve) moved out of state. Provide a 10-day adverse action period by sending the Adverse Action Notice (IM-80). If benefits are opened in another state after benefits in Missouri were opened, assume the participant(s) has(ve) moved out of state. Provide a 10-day adverse action period by sending the Adverse Action Notice (IM-80).

EXAMPLE : Angie applied and was approved for MO HealthNet benefits on October 1, 2016. FSD received a PARIS match showing Angie is in the State of Iowa. It was confirmed with the State of Iowa that Angie applied and was approved for Medicaid benefits in Iowa on February 1, 2017. Action is taken to close the case.

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.

(magi)(1885-000-00)(1885-030-00)(block-1)1885.030.00 Reopening Closed Cases – DSS Manuals#

IM-78 June 11, 2020 ; IM-143 November 22, 2017

Family MO HealthNet cases may be reopened or cancel closed under the following circumstances:

When the case was closed in error, such as: incorrect data entry; or information was received in local office in a timely manner, but not entered into system in time to stop the case closing

When the participant provides ALL missing information that caused the case to close within 30 days of the date the closing action is complete. This information may include, but is not limited to: income information tax filing status current mailing address employer-sponsored insurance information

EXAMPLE : Mr. Patrick has a CHIP 73 case and reports that he has a new job that offers employer-sponsored insurance. FSD staff sent a request for information notice regarding income and employer-sponsored insurance information. Mr. Patrick fails to submit the information in ten days, and the case is closed.

Seven days after the closing is completed, Mr. Patrick submits the income verification, but not the employer-sponsored insurance information. Staff make a comment in the eligibility system regarding the income verification received but do NOT reopen the case or process the new evidence since the insurance information is still outstanding.

Twenty days after the closing is completed, Mr. Patrick submits the employer-sponsored insurance information. Staff make a comment in MEDES regarding the insurance information received and take action to reopen the case now that FSD has received all outstanding verification.

NOTE : When reopening a case due to the annual renewal or the 90-day reconsideration period, refer to MAGI manual section 1880.020.00 Reconsideration Period .

Restore coverage to the same level of care it was prior to closing. See Cancel Reject/Cancel Close in MEDES for additional information.

The MO HealthNet Division Stakeholder Services Unit (formerly the Premium Collections Unit) must be notified when a CHIP premium case is reopened for any reason. Staff should refer to the MEDES Resources for the current procedure for reopening CHIP premium cases.

(magi)(1885-000-00)(1885-035-00-away-from-home)(block-1)1885.035.00 Away From Home – DSS Manuals#

IM-22 April 11, 2024 ; IM-24 February 22, 2019

Circumstances may require temporary absence of either the child or the parent/caretaker relative from the home. Temporary absences do not affect eligibility as long as the individual intends to return to the home within 90 days.

Note: Do not remove children that are in their Continuous Eligibility for Children (CEC) period unless valid closing reasons apply. If a child is temporarily away from home, the CEC period continues. Refer to 1805.070.00 Continuous Eligibility for Children (CEC) .

A temporary absence versus a permanent absence can be defined by where the absent household member intends to reside.

Temporary Absence – the individual is absent from the home but intends to return to the household within 90 days or less. Household composition should not change. Support for or dependency of the individual continues.

Permanent Absence – the absent individual does not intend to return to the household. The absent individual is removed from the household. Support for or dependency of the individual is not expected to continue.

When an individual is permanently absent, the individual is no longer eligible for benefits in the household. See MAGI Family MO HealthNet (MHN) Policy sections, 1885.015.00 Removing a Person and 1805.030.10 MAGI Household Composition .

Children placed in Children’s Division (CD) or Division of Youth Services (DYS) Custody

If the child is removed from the household and placed in CD or DYS custody, the CEC period continues while the child is on CD or DYS coverage.

When a child has been released from CD or DYS custody, FSD eligibility must be reopened at the same level of care or better, with no lapse in eligibility.

If the CEC period expires before a child returns home from CD or DYS custody, complete an annual renewal upon return to the home to determine if MHN eligibility continues at the same level of care and begin a new CEC period.

(magi)(1885-000-00)(1885-040-00)(block-6)Suspending MO HealthNet#

When FSD is notified of a participant’s incarceration, MHN will be suspended for that individual. For the purposes of eligibility, the incarcerated participant and/or incarcerated individual will remain in the eligibility unit they were a part of prior to the suspension. This composition will also be applicable to all member of the eligibility unit for continued participation in a MHN benefit program. If the expected release date is thirty (30) days or less from the reported date, FSD will not take action to suspend MHN benefits.

Example: The correctional facility reports on 9/9/2019 that John was incarcerated effective 8/28/2019 and his expected release date is 9/30/2019. FSD reviews the task on 9/9/2019 and determines that the release date is in 21 days; therefore, FSD will NOT take action as the release date is less than 30 days from the reported date.

Example: The correctional facility reports on 9/9/2019 that Bob was incarcerated effective 8/28/2019 and his expected release date is 10/9/2019. FSD reviews the task on 9/9/2019 and determines that the release date is in 30 days; therefore, FSD will take action as the release date is 30 days from the reported date

If the incarcerated participant is the head of household and a single member household, he or she will receive all FSD notices while suspended. However, if the incarcerated participant is the head of household and is part of a multiple member household with a remaining adult in the home, all FSD notices will be sent to the last known home/mailing address.

If the incarcerated participant is the head of household and part of a multiple member household with NO remaining adult in the home, FSD will send a suspension notice to the incarcerated individual and establish where to send FSD notices regarding other active eligibility unit members.

Note: The last known address may be the address of the correctional facility.

Example: FSD receives a report that John is incarcerated and he is actively receiving MO HealthNet for Families (MHF) Adult. John is NOT the head of household; therefore, all FSD notices will be sent to the last known address and suspend John’s MHN benefits.

Example: FSD receives a report that Mary (age 17) is incarcerated and she is actively receiving MO HealthNet for Kids (MHK). Mary is the head of household and part of a single member household; therefore, Mary’s home address and mailing address will be updated to the institution’s address and FSD will suspend Mary’s MHN benefits.

Example: FSD receives a report that Bob is incarcerated and he is actively receiving MHF Adult. Bob is the head of household but his daughter’s mother, Kimberly, is still in the home. Therefore, Kimberly is a responsible adult for Bob’s daughter and can receive FSD notice regarding annual renewals and changes to eligibility.

Example: FSD receives a report that Steve is incarcerated and he is actively receiving MHF Adult. Steve is the head of household of a multiple member household with no other responsible adult in the home; therefore, FSD will require Steve to appoint an authorized representative or appoint a responsible contact for the remaining eligibility unit members, unless the remaining eligibility unit members are in care of the State.

Example: FSD receives a report that Eric is incarcerated and he is actively receiving MHF Adult. Eric is the head of household of a multiple member household with no other responsible adult in the home. FSD determines the remaining eligibility unit members are in care of the State. FSD will remove the eligibility unit members who are in State care and Eric is now a head of household for a single member household.

It is reasonable to assume that earned income for the incarcerated participant has ended. Income for the incarcerated participant will end the month in which the incarceration was reported to FSD. Supplemental Security Income (SSI) will be suspended after 30 days of incarceration. Social Security Disability and Social Security Retirement income will end after an incarcerated individual is convicted, but may continue during incarceration prior to conviction. If the source of unearned income is pension/retirement (income not based on eligibility factors), it is reasonable to assume that the incarcerated participant’s income will NOT end.

Example: DOC reports on 9/9/2019 that John was placed in custody on 7/23/2019. John works for McDonalds and it is reasonable to assume that he will no longer receive paychecks from his employer. Income for John will end in September 2019.

Example: Pettis County Jail reports on 9/9/2019 that Steven was placed in custody on 9/2/2019. Steven works for Wal-Mart and it is reasonable to assume that he will no longer receive paychecks from his employer. Income for Steven will end in September 2019.

Example: St. Louis City Jail reports on 9/9/2019 that Mary was placed in custody on 9/3/2019. Mary’s income source is her pension/retirement from General Motors. Mary’s income will still count in the MHN eligibility unit budget.

Example: Jefferson City Jail reports on 9/9/2019 that Sue was placed in custody on 9/3/2019. Sue’s income source is her pension/retirement from Unilever. Sue’s income was not ended in MEDES. Her husband, John, later reports that Sue’s pension/retirement from Unilever has ended and he provides a letter from Unilever advising that her pension/retirement will be terminated on a particular date. End the income source as of that date.

Example: Kansas City Jail reports on 9/9/2019 that Jane was placed in custody on 9/3/2019. Jane’s income source is her pension/retirement from Garmin. Jane’s income was not ended in MEDES. Her husband, Bob, later reports that Jane’s pension/retirement from Garmin has ended and he did NOT provide verification. FSD will send a request verification (IM-31A) and send the Authorization for Release of Information (IM-6) to the eligibility unit.

Example: Cole County Jail reports on 9/9/2019 that Bill was placed in custody on 9/2/2019. Bill is receiving SSA benefits (disability). It is reasonable to assume that his unearned income will end because the benefit is based on eligibility factors. Income for Bill will end in September 2019.

Note: If it is reported that the incarcerated participant’s pension/retirement (unearned income) has ended, request verification and send the Authorization for Release of Information (IM-6) form. If remaining adult or suspended participant is not able to obtain verification (i.e. no legal relationship or unauthorized) the remaining adult or suspended participant must provide a signed clarifying statement regarding the situation.

Note: The act of suspension is an Adverse Action and requires proper notification. MHN benefits are to remain suspended as long as the incarcerated person remains incarcerated.

Applications Pending for Incarcerated Individuals

If an application is pending and the participant becomes incarcerated, continue processing the application. All requests for verification must be sent according to policy.

If staff are able to approve the application, approve benefits for any period including any prior-quarter months they are eligible for prior to incarceration, but the participant must be suspended beginning the first day of incarceration.

Example: Anthony applied for MHN 10/5/2019. He was incarcerated on 10/16/2019. His application was processed on 10/27/2019 and all information required was provided with his application. Staff approved his application with MHF Adult benefits beginning 10/1/2019. His benefits were suspended 10/16/2019.

If staff are unable to complete the application with information received, and if information is not provided during the application timeframes, reject the application for the appropriate reason, such as “Failure to provide verification” or “Failure to cooperate.”

Example: Amelia applied for MHN on 11/16/2019. She was incarcerated on 11/26/2019. While processing the application, staff sent a Request for Information (IM-31A) and requested pay stubs on 11/19/2019, with information due 12/2/2019. The information was not received and a second request was sent 12/3/19, due 12/13/2019. The information was not received. The application was rejected on 12/16/19 for failure to provide verification.

See 0110.005.00 Residence/Household Composition .

Suspension of Time Limited Benefits

Transitional MO HealthNet (TMH)

If the incarcerated participant is receiving TMH, suspend the medical benefit. Suspended MHN benefits will NOT count towards the three of the last six months test for TMH eligibility. If the TMH period ends prior to release FSD will complete a pre-closing ex parte for all other MHN programs.

If eligibility exists after the TMH period, the new MHN program will be suspended and appropriate notices will be sent.

If no eligibility exists after the TMH period, the participant’s eligibility will close and appropriate notices will be sent.

Example: Tom’s TMH eligibility was suspended due to his incarceration of six months. The remaining eligibility unit members’ TMH ended three months prior to his release. When Tom is released the TMH period has been completed, therefore, Tom is no longer eligible for TMH. Complete an ex parte review to explore eligibility for other MHN programs.

Example: John is receiving MHF Adult for one month prior to his incarceration. During John’s incarceration the remaining adult, Susie, reports new earned income that puts the eligibility unit over the threshold of MHF (report is timely). Because John and Susie are married, Susie’s income is countable for John’s eligibility household. John is not eligible for TMH because he was not eligible for and did not receive MHF in three of the last six months. However, John is now eligible for AEG, therefore, he will move to AEG after appropriate advance notice periods are observed. His AEG is suspended.

Example: Matt is receiving MHF Adult for three months prior to incarceration. Upon Matt’s release, the remaining adult, Mary, reports new earned income that puts the eligibility household over the threshold of MHF (report is timely). Because Matt and Mary are married, Mary’s income is countable for Matt’s eligibility household. Upon release, a redetermination is made and Matt is found eligible for TMH because he meets the test of three of the last six months.

MO HealthNet for Pregnant Women (MPW) or Show-Me Healthy Babies (SMHB)

If the incarcerated participant is receiving MPW or SMHB, suspend the medical benefit for pregnancy coverage. The suspended participant, if eligible, will have their postpartum period benefits, when applicable.

If the delivery occurs prior to release or post-partum ends prior to release, the participant’s eligibility should be explored under other MHN programs.

If eligibility exists after the pregnancy coverage, suspend the new MHN program and send appropriate notices.

If no eligibility exists after pregnancy coverage, close the participant’s eligibility as no longer eligible for MHN and send appropriate notices.

Example: Mary was approved for MPW effective 11/1 with a due date of 6/15 and FSD receives a report of incarceration effective 2/5. FSD suspends Mary’s MPW eligibility during the incarceration period. On 5/26, FSD receives notice of inpatient services for labor and delivery; MPW is restored for eligible dates of service. In June, FSD is notified of Mary’s release and eligibility is redetermined as post-partum for 12 months.

Age Out

If the incarcerated participant is receiving MHN and will age out while incarcerated, FSD will complete an ex parte for all other MHN programs prior to when the participant reaches the specified age (see 1885.005.00 Age Out ).

If eligibility exists on the 19 th birthday the new MHN program will be suspended and appropriate notices will be sent.

If no eligibility exists on or after turning age 19, the participant’s eligibility will close due to being no longer eligible for MHN and appropriate notices will be sent as well as observation of adverse action period prior to closing eligibility.

Example: Alex is incarcerated while receiving MHK (non-premium) and his benefits are suspended. Alex will turn 19 years old and he is no longer eligible for MHK. FSD completes an ex parte, while he is incarcerated, for other MHN. He is eligible for MHN Adult Expansion Group (AEG). FSD will send appropriate notices.

Example: Beth is incarcerated while receiving MHN for the Adult Expansion Group (AEG) and her benefits are suspended. Beth will turn 65 years old and she is no longer eligible for AEG. FSD completes an ex parte, while she is incarcerated. FSD explores all other programs and she is ineligible for all other MHN programs. FSD will observe an adverse action period and send notices before closing Beth’s eligibility.

Renewals and Change in Circumstances While Suspended

The incarcerated participant’s eligibility will be included in the Annual Renewal process and any change in circumstances. It is the responsibility of the suspended individual, the remaining adult, and/or authorized representatives to complete annual renewals (when required) and report changes in a timely manner. FSD will take action on annual renewals and reported changes within a timely manner.

If there is a change to the suspended participant’s eligibility, FSD will allow the change or closure. Appropriate notices will be sent to the suspended participant, the household, and the authorized representative (if applicable). FSD will observe appropriate Adverse Action periods when a participant is found ineligible or eligible under a reduced benefit while suspended.

Note: Children under the age of 19 are subject to Continuous Eligibility for Children (CEC) if they or their parents are incarcerated. Refer to 1805.070.00 Continuous Eligibility for Children (CEC) .

Inpatient Services

If a suspended participant requires inpatient care at a medical facility for 24 hours or more while they are incarcerated, the suspended individual may be eligible for MHN to pay for medical expenses. The participant, household member, or an authorized representative may notify Family Support Division (FSD) of an inpatient event by using the form Inpatient Coverage for Incarcerated Participants (IM-151) . Additional information may be requested if a disability determination is required.

Note: The jail/prison or medical facility may also report the inpatient event to request payment for inpatient services. Any communication with entities outside of the household must be limited to information required to authorize payments.

FSD will review the inpatient coverage request and complete actions to determine if additional information is needed.

A new application is NOT required if the participant is suspended. However, if the incarcerated participant has previously been found ineligible for all MHN programs, a MO HealthNet Single Streamlined Addition form (IM-1ADP) or a full MHN application (see 1802.010.00 Requests for Benefits ) is needed depending on the status of the MHN case (see 1802.000.00 Applications and 1802.010.80.05 Adding a Person to an Existing Application ).

Note: If an incarcerated participant is receiving Women’s Health Services, but a change in circumstance exists, explore eligibility for other MHN programs at the time of the event.

FSD will notify MO HealthNet Division (MHD), the household, the participant, and their authorized representative (if applicable) of the eligibility decision. Department of Corrections (DOC) may also receive information regarding eligibility during an inpatient event as allowed by agreements between DOC, FSD, and MHD.

Redetermination and Restoring Benefits

Once FSD is notified of an incarcerated participant’s release, or pre-release, a redetermination must be completed and benefits restored upon release if the incarcerated participant remains eligible for the any level of care under MAGI.

If suspended participant is found ineligible, an ex parte review (refer to 1890.000.00 Ex Parte Review Process ) for all other MHN programs must be completed. If the suspended individual is found ineligible for all MHN programs the participant will receive a ten (10) day Adverse Action period before the suspension is terminated regarding the reason for ineligibility.

Note: Children under the age of 19 are subject to Continuous Eligibility for Children (CEC) upon release. Refer to 1805.070.00 Continuous Eligibility for Children (CEC) .

(magi)(1895-000-00)(block-1)1895.000.00 Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE) – DSS Manuals#

IM-106 July 19, 2022

The following memorandums were released due to the PHE:

2020

IM-19 COVID-19 VERIFICATIONS FOR FAMILY HEALTHCARE PROGRAMS (MAGI)

IM-34 COVID-19 FAMILY HEALTHCARE (MAGI) CHIP 75 THIRTY DAY WAITING PERIOD WAIVED

IM-35 COVID-19 ECONOMIC IMPACT PAYMENTS RESULTING FROM THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT FOR THE MO HEALTHNET, FOOD STAMP, TEMPORARY ASSISTANCE AND CHILD CARE SUBSIDY PROGRAMS

IM-37 COVID-19: NEW TYPES OF UNEMPLOYMENT COMPENSATION BENEFITS RESULTING FROM THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT FOR THE MO HEALTHNET, FOOD STAMP, CHILD CARE, AND TEMPORARY ASSISTANCE PROGRAMS

IM-42 COVID-19 VERIFICATION OF UNEMPLOYMENT COMPENSATION BENEFITS RESULTING FROM THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT FOR ALL PROGRAMS

IM-43 COVID-19 CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITIES (CARES) ACT IMPACT OF SMALL BUSINESS ADMINISTRATION (SBA) LOANS AND GRANTS TO ADULT AND FAMILY MO HEALTHNET PROGRAM PARTICIPANTS

IM-88 COVID-19 HAZARD PAY FOR ALL INCOME MAINTENANCE (IM) PROGRAMS

IM-127 CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) AGE OUTS WILL NOW CLOSE DURING COVID-19 EMERGENCY PERIOD IM-170 COVID-19 VERIFICATION FOR FAMILY HEALTHCARE PROGRAMS (MAGI) UPDATE AND CLARIFICATION

IM-174 GUIDANCE ON SIGNING MO HEALTHNET (MHN) APPLICATIONS DURING THE COVID-19 PUBLIC HEALTH EMERGENCY (PHE)

2021

IM-02 COVID-19: UNEMPLOYMENT COMPENSATION UPDATES RESULTING FROM THE CONSOLIDATED APPROPRIATIONS ACT, 2021

IM-04 COVID-19 ECONOMIC IMPACT PAYMENTS RESULTING FROM THE CONSOLIDATED APPROPRIATIONS ACT, 2021 FOR ALL INCOME MAINTENANCE (IM) PROGRAMS

IM-29 COVID-19: END OF EXTENSION FOR ALL SHOW ME HEALTHY BABIES (SMHB) PROGRAM COVERAGE

IM-38 COVID-19: UNEMPLOYMENT COMPENSATION UPDATES RESULTING FROM THE AMERICAN RESCUE PLAN ACT (ARPA) OF 2021 FOR ALL PROGRAMS

IM-47 COVID-19 ECONOMIC IMPACT PAYMENTS RESULTING FROM THE AMERICAN RESCUE PLAN ACT 2021 FOR ALL INCOME MAINTENANCE (IM) PROGRAMS

IM-57 FEDERAL PANDEMIC UNEMPLOYMENT COMPENSATION BENEFITS (UCB) ENDED

IM-76 TAX CREDIT CHANGES RESULTING FROM THE AMERICAN RESCUE PLAN ACT (ARPA) OF 2021

(magi)(appendix-a)(page-1)Page 1#

18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 1

MAGI Income max with 5% - CHIP 75, UWHS, MPW POV, MHK, & AEG – FPL Included and CHIP premium amounts 7/1/2026 – 3/31/2027 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty# SMHB & CHIP 75 4057 5501 6944 8388 9832 11275 12719 14163 15606 17050 18494 Premium 150 203 256 309 363 416 469 522 576 629 682 225% of Poverty CHIP 74 2993 4058 5123 6188 7253 8318 9383 10448 11513 12578 13643 Premium 62 83 105 127 148 170 191 214 236 257 279 201% of Poverty# UWHS 2740 3715 4690 5665 6641 7616 8591 9566 10541 11516 12491 196% of Poverty# MPW & MHK under 1 2674 3625 4577 5528 6479 7431 8382 9334 10285 11236 12188 185% of Poverty CHIP 73 2461 3337 4212 5088 5964 6839 7715 8591 9466 10342 11218 Premium 19 25 32 39 45 52 58 65 72 78 85 153% of Poverty* CHIP 4M 2035 2760 3484 4208 4932 5656 6381 7105 7829 8553 9277 150% of Poverty CHIP 71 & 72 1995 2705 3415 4125 4835 5545 6255 6965 7675 8385 9095 148% of Poverty# MHK 2035 2760 3484 4208 4932 5656 6381 7105 7829 8553 9277 141% of Poverty MPW HIF 1876 2543 3211 3878 4545 5213 5880 6548 7215 7882 8550 133% of Poverty# AEG 1836 2489 3142 3795 4449 5102 5755 6408 7061 7715 8368 110% of Poverty* 1463 1984 2504 3025 3546 4066 4587 5108 5628 6149 6670 MHF/MPW MHF

141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1330 1804 2277 2750 3224 3697 4170 4644 5117 5590 6064 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty# SMHB & CHIP 75 19937 21381 22825 24268 25712 27156 28599 30043 31487 32930 34374 Premium 735 789 842 895 948 1002 1055 1108 1161 1215 1268 225% of Poverty CHIP 74 14708 15773 16838 17903 18968 20033 21098 22163 23228 24293 25358 Premium 301 322 344 366 388 410 431 453 475 497 519 201% of Poverty# UWHS 13466 14441 15416 16391 17366 18341 19316 20291 21267 22242 23217 196% of Poverty# MPW & MHK under 1 13139 14091 15042 15993 16945 17896 18848 19799 20750 21702 22653 185% of Poverty CHIP 73 12093 12969 13845 14720 15596 16472 17347 18223 19099 19974 20850 Premium 92 98 105 111 118 125 131 138 145 151 158 153% of Poverty* CHIP 4M 10002 10726 11450 12174 12898 13623 14347 15071 15795 16519 17244 150% of Poverty CHIP 71 & 72 9805 10515 11225 11935 12645 13355 14065 14775 15485 16195 16905 148% of Poverty# MHK 10002 10726 11450 12174 12898 13623 14347 15071 15795 16519 17244 141% of Poverty MPW HIF 9217 9885 10552 11219 11887 12554 13222 13889 14556 15224 15891 133% of Poverty# AEG 9021 9674 10327 10981 11634 12287 12940 13593 14247 14900 15553 110% of Poverty* 7190 7711 8232 8752 9273 9794 10314 10835 11356 11876 12397 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 6537 7010 7484 7957 8430 8904 9377 9850 10324 10797 11270 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised (04/26)

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18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 2

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 4 /1/2026-6/30/2026 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 4057 5501 6944 8388 9832 11275 12719 14163 15606 17050 18494 Premium 147 198 250 301 353 405 456 508 559 611 662 225% of Poverty CHIP 74 2993 4058 5123 6188 7253 8318 9383 10448 11513 12578 13643 Premium 60 81 102 124 144 165 187 207 229 250 270 #201% of Poverty UWHS 2740 3715 4690 5665 6641 7616 8591 9566 10541 11516 12491 #196% of Poverty MPW & MHK under 1 2674 3625 4577 5528 6479 7431 8382 9334 10285 11236 12188 185% of Poverty CHIP 73 2461 3337 4212 5088 5964 6839 7715 8591 9466 10342 11218 Premium 18 25 31 38 44 50 57 63 70 76 82 153%* of Poverty CHIP 4M 2035 2760 3484 4208 4932 5656 6381 7105 7829 8553 9277 150% of Poverty CHIP 71 & 72 1995 2705 3415 4125 4835 5545 6255 6965 7675 8385 9095 #148% of Poverty MHK 2035 2760 3484 4208 4932 5656 6381 7105 7829 8553 9277 141% of Poverty MPW HIF 1876 2543 3211 3878 4545 5213 5880 6548 7215 7882 8550 #133% of Poverty AEG 1836 2489 3142 3795 4449 5102 5755 6408 7061 7715 8368 110%* of Poverty 1463 1984 2504 3025 3546 4066 4587 5108 5628 6149 6670 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1330 1804 2277 2750 3224 3697 4170 4644 5117 5590 6064 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 19937 21381 22825 24268 25712 27156 28599 30043 31487 32930 34374 Premium 714 766 817 869 920 972 1023 1075 1126 1178 1230 225% of Poverty CHIP 74 14708 15773 16838 17903 18968 20033 21098 22163 23228 24293 25358 Premium 292 313 334 355 377 397 418 440 460 482 503 #201% of Poverty UWHS 13466 14441 15416 16391 17366 18341 19316 20291 21267 22242 23217 #196% of Poverty MPW & MHK under 1 13139 14091 15042 15993 16945 17896 18848 19799 20750 21702 22653 185% of Poverty CHIP 73 12093 12969 13845 14720 15596 16472 17347 18223 19099 19974 20850 Premium 89 95 102 108 115 121 127 134 140 147 153 153%* of Poverty CHIP 4M 10002 10726 11450 12174 12898 13623 14347 15071 15795 16519 17244 150% of Poverty CHIP 71 & 72 9805 10515 11225 11935 12645 13355 14065 14775 15485 16195 16905 #148% of Poverty MHK 10002 10726 11450 12174 12898 13623 14347 15071 15795 16519 17244 141% of Poverty MPW HIF 9217 9885 10552 11219 11887 12554 13222 13889 14556 15224 15891 #133% of Poverty AEG 9021 9674 10327 10981 11634 12287 12940 13593 14247 14900 15553 110%* of Poverty 7190 7711 8232 8752 9273 9794 10314 10835 11356 11876 12397 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 6537 7010 7484 7957 8430 8904 9377 9850 10324 10797 11270 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised (04/26)

(magi)(appendix-a)(page-3)Page 3#

18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 3

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 7 /1/2025-3/31/2026 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3978 5376 6774 8172 9570 10968 12366 13764 15162 16559 17957 Premium 147 198 250 301 353 405 456 508 559 611 662 225% of Poverty CHIP 74 2935 3966 4997 6029 7060 8091 9122 10154 11185 12216 13247 Premium 60 81 102 124 144 165 187 207 229 250 270 #201% of Poverty UWHS 2687 3631 4575 5520 6464 7408 8352 9296 10240 11185 12129 #196% of Poverty MPW & MHK under 1 2622 3543 4464 5386 6307 7228 8149 9071 9992 10913 11834 185% of Poverty CHIP 73 2413 3261 4109 4957 5805 6653 7501 8349 9197 10044 10892 Premium 18 25 31 38 44 50 57 63 70 76 82 153%* of Poverty CHIP 4M 1996 2697 3398 4100 4801 5502 6203 6905 7606 8307 9008 150% of Poverty CHIP 71 & 72 1957 2644 3332 4019 4707 5394 6082 6769 7457 8144 8832 #148% of Poverty MHK 1996 2697 3398 4100 4801 5502 6203 6905 7606 8307 9008 141% of Poverty MPW HIF 1839 2486 3132 3778 4424 5071 5717 6363 7009 7656 8302 #133% of Poverty AEG 1800 2433 3065 3698 4330 4963 5595 6228 6860 7493 8125 110%* of Poverty 1435 1939 2443 2947 3451 3955 4460 4964 5468 5972 6476 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1305 1763 2221 2680 3138 3596 4055 4513 4971 5430 5888 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 19355 20753 22151 23549 24947 26345 27743 29141 30539 31937 33334 Premium 714 766 817 869 920 972 1023 1075 1126 1178 1230 225% of Poverty CHIP 74 14279 15310 16341 17372 18404 19435 20466 21497 22529 23560 24591 Premium 292 313 334 355 377 397 418 440 460 482 503 #201% of Poverty UWHS 13073 14017 14961 15905 16850 17794 18738 19682 20626 21570 22515 #196% of Poverty MPW & MHK under 1 12756 13677 14598 15519 16441 17362 18283 19204 20126 21047 21968 185% of Poverty CHIP 73 11740 12588 13436 14284 15132 15980 16828 17676 18524 19372 20219 Premium 89 95 102 108 115 121 127 134 140 147 153 153%* of Poverty CHIP 4M 9710 10411 11112 11813 12515 13216 13917 14618 15320 16021 16722 150% of Poverty CHIP 71 & 72 9519 10207 10894 11582 12269 12957 13644 14332 15019 15707 16394 #148% of Poverty MHK 9710 10411 11112 11813 12515 13216 13917 14618 15320 16021 16722 141% of Poverty MPW HIF 8948 9594 10241 10887 11533 12179 12826 13472 14118 14764 15411 #133% of Poverty AEG 8758 9390 10023 10655 11288 11920 12553 13185 13818 14450 15083 110%* of Poverty 6980 7485 7989 8493 8997 9501 10005 10510 11014 11518 12022 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 6346 6805 7263 7721 8180 8638 9096 9555 10013 10471 10930 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised (07/25)

(magi)(appendix-a)(page-4)Page 4#

18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 4

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 4/1/2025-6/30/2025 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3978 5376 6774 8172 9570 10968 12366 13764 15162 16559 17957 Premium 141 192 242 293 343 393 444 494 545 595 646 225% of Poverty CHIP 74 2935 3966 4997 6029 7060 8091 9122 10154 11185 12216 13247 Premium 58 78 99 119 141 161 181 203 223 243 264 #201% of Poverty UWHS 2687 3631 4575 5520 6464 7408 8352 9296 10240 11185 12129 #196% of Poverty MPW & MHK under 1 2622 3543 4464 5386 6307 7228 8149 9071 9992 10913 11834 185% of Poverty CHIP 73 2413 3261 4109 4957 5805 6653 7501 8349 9197 10044 10892 Premium 18 24 30 36 43 49 55 62 68 74 80 153%* of Poverty CHIP 4M 1996 2697 3398 4100 4801 5502 6203 6905 7606 8307 9008 150% of Poverty CHIP 71 & 72 1957 2644 3332 4019 4707 5394 6082 6769 7457 8144 8832 #148% of Poverty MHK 1996 2697 3398 4100 4801 5502 6203 6905 7606 8307 9008 141% of Poverty MPW HIF 1839 2486 3132 3778 4424 5071 5717 6363 7009 7656 8302 #133% of Poverty AEG 1800 2433 3065 3698 4330 4963 5595 6228 6860 7493 8125 110%* of Poverty 1435 1939 2443 2947 3451 3955 4460 4964 5468 5972 6476 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1305 1763 2221 2680 3138 3596 4055 4513 4971 5430 5888 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 19355 20753 22151 23549 24947 26345 27743 29141 30539 31937 33334 Premium 696 746 797 847 898 948 999 1049 1100 1150 1200 225% of Poverty CHIP 74 14279 15310 16341 17372 18404 19435 20466 21497 22529 23560 24591 Premium 285 305 326 346 367 388 408 429 450 470 490 #201% of Poverty UWHS 13073 14017 14961 15905 16850 17794 18738 19682 20626 21570 22515 #196% of Poverty MPW & MHK under 1 12756 13677 14598 15519 16441 17362 18283 19204 20126 21047 21968 185% of Poverty CHIP 73 11740 12588 13436 14284 15132 15980 16828 17676 18524 19372 20219 Premium 87 93 99 105 112 118 124 131 137 143 149 153%* of Poverty CHIP 4M 9710 10411 11112 11813 12515 13216 13917 14618 15320 16021 16722 150% of Poverty CHIP 71 & 72 9519 10207 10894 11582 12269 12957 13644 14332 15019 15707 16394 #148% of Poverty MHK 9710 10411 11112 11813 12515 13216 13917 14618 15320 16021 16722 141% of Poverty MPW HIF 8948 9594 10241 10887 11533 12179 12826 13472 14118 14764 15411 #133% of Poverty AEG 8758 9390 10023 10655 11288 11920 12553 13185 13818 14450 15083 110%* of Poverty 6980 7485 7989 8493 8997 9501 10005 10510 11014 11518 12022 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 6346 6805 7263 7721 8180 8638 9096 9555 10013 10471 10930 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised (04/25)

(magi)(appendix-a)(page-5)Page 5#

18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 5

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 7/1/2024-3/31/2025 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3828 5196 6563 7930 9298 10665 12033 13400 14768 16135 17502 Premium 141 192 242 293 343 393 444 494 545 595 646 225% of Poverty CHIP 74 2824 3833 4842 5850 6859 7868 8877 9885 10894 11903 12912 Premium 58 78 99 119 141 161 181 203 223 243 264 #201% of Poverty UWHS 2586 3509 4433 5356 6280 7204 8127 9051 9974 10898 11821 #196% of Poverty MPW & MHK under 1 2523 3424 4325 5226 6128 7029 7930 8831 9732 10633 11535 185% of Poverty CHIP 73 2322 3152 3981 4810 5640 6469 7299 8128 8958 9787 10616 Premium 18 24 30 36 43 49 55 62 68 74 80 153%* of Poverty CHIP 4M 1921 2607 3293 3978 4664 5350 6036 6722 7408 8094 8780 150% of Poverty CHIP 71 & 72 1883 2555 3228 3900 4573 5245 5918 6590 7263 7935 8608 #148% of Poverty MHK 1921 2607 3293 3978 4664 5350 6036 6722 7408 8094 8780 141% of Poverty MPW HIF 1770 2402 3034 3666 4299 4931 5563 6195 6827 7459 8092 #133% of Poverty AEG 1732 2351 2970 3588 4207 4826 5445 6063 6682 7301 7919 110%* of Poverty 1381 1874 2367 2860 3353 3846 4340 4833 5326 5819 6312 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1255 1704 2152 2600 3049 3497 3945 4394 4842 5290 5739 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 18870 20237 21605 22972 24339 25707 27074 28442 29809 31177 32544 Premium 696 746 797 847 898 948 999 1049 1100 1150 1200 225% of Poverty CHIP 74 13920 14929 15938 16947 17955 18964 19973 20982 21990 22999 24008 Premium 285 305 326 346 367 388 408 429 450 470 490 #201% of Poverty UWHS 12745 13669 14592 15516 16439 17363 18286 19210 20134 21057 21981 #196% of Poverty MPW & MHK under 1 12436 13337 14238 15139 16040 16941 17843 18744 19645 20546 21447 185% of Poverty CHIP 73 11446 12275 13105 13934 14763 15593 16422 17252 18081 18911 19740 Premium 87 93 99 105 112 118 124 131 137 143 149 153%* of Poverty CHIP 4M 9466 10152 10838 11524 12210 12896 13582 14268 14954 15640 16326 150% of Poverty CHIP 71 & 72 9280 9953 10625 11298 11970 12643 13315 13988 14660 15333 16005 #148% of Poverty MHK 9466 10152 10838 11524 12210 12896 13582 14268 14954 15640 16326 141% of Poverty MPW HIF 8724 9356 9988 10620 11252 11884 12517 13149 13781 14413 15045 #133% of Poverty AEG 8538 9157 9775 10394 11013 11632 12250 12869 13488 14106 14725 110%* of Poverty 6805 7299 7792 8285 8778 9271 9764 10258 10751 11244 11737 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 6187 6635 7084 7532 7980 8429 8877 9325 9774 10222 10670 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised (07/24)

(magi)(appendix-a)(page-6)Page 6#

18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 6

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 4/1/2024-6/30/2024 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3828 5196 6563 7930 9298 10665 12033 13400 14768 16135 17502 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2824 3833 4842 5850 6859 7868 8877 9885 10894 11903 12912 Premium 48 65 82 99 115 132 150 167 184 200 217 #201% of Poverty UWHS 2586 3509 4433 5356 6280 7204 8127 9051 9974 10898 11821 #196% of Poverty MPW & MHK under 1 2523 3424 4325 5226 6128 7029 7930 8831 9732 10633 11535 185% of Poverty CHIP 73 2322 3152 3981 4810 5640 6469 7299 8128 8958 9787 10616 Premium 15 20 25 30 35 40 46 51 56 61 66 153%* of Poverty CHIP 4M 1921 2607 3293 3978 4664 5350 6036 6722 7408 8094 8780 150% of Poverty CHIP 71 & 72 1883 2555 3228 3900 4573 5245 5918 6590 7263 7935 8608 #148% of Poverty MHK 1921 2607 3293 3978 4664 5350 6036 6722 7408 8094 8780 141% of Poverty MPW HIF 1770 2402 3034 3666 4299 4931 5563 6195 6827 7459 8092 #133% of Poverty AEG 1732 2351 2970 3588 4207 4826 5445 6063 6682 7301 7919 110%* of Poverty 1381 1874 2367 2860 3353 3846 4340 4833 5326 5819 6312 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1255 1704 2152 2600 3049 3497 3945 4394 4842 5290 5739 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 18870 20237 21605 22972 24339 25707 27074 28442 29809 31177 32544 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 13920 14929 15938 16947 17955 18964 19973 20982 21990 22999 24008 Premium 234 251 269 285 302 319 336 352 370 387 404 #201% of Poverty UWHS 12745 13669 14592 15516 16439 17363 18286 19210 20134 21057 21981 #196% of Poverty MPW & MHK under 1 12436 13337 14238 15139 16040 16941 17843 18744 19645 20546 21447 185% of Poverty CHIP 73 11446 12275 13105 13934 14763 15593 16422 17252 18081 18911 19740 Premium 71 76 82 87 92 97 102 107 113 118 123 153%* of Poverty CHIP 4M 9466 10152 10838 11524 12210 12896 13582 14268 14954 15640 16326 150% of Poverty CHIP 71 & 72 9280 9953 10625 11298 11970 12643 13315 13988 14660 15333 16005 #148% of Poverty MHK 9466 10152 10838 11524 12210 12896 13582 14268 14954 15640 16326 141% of Poverty MPW HIF 8724 9356 9988 10620 11252 11884 12517 13149 13781 14413 15045 #133% of Poverty AEG 8538 9157 9775 10394 11013 11632 12250 12869 13488 14106 14725 110%* of Poverty 6805 7299 7792 8285 8778 9271 9764 10258 10751 11244 11737 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 6187 6635 7084 7532 7980 8429 8877 9325 9774 10222 10670 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised (04/24)

(magi)(appendix-a)(page-7)Page 7#

18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 7

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 7/1/2023-3/31/2024 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3706 5013 6319 7625 8932 10238 11545 12851 14158 15464 16770 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2734 3698 4662 5625 6589 7553 8517 9480 10444 11408 12372 Premium 48 65 82 99 115 132 150 167 184 200 217 #201% of Poverty UWHS 2503 3386 4268 5150 6033 6915 7798 8680 9562 10445 11327 #196% of Poverty MPW & MHK under 1 2443 3304 4165 5025 5886 6747 7608 8469 9330 10191 11052 185% of Poverty CHIP 73 2248 3041 3833 4625 5418 6210 7003 7795 8588 9380 10172 Premium 15 20 25 30 35 40 46 51 56 61 66 153%* of Poverty CHIP 4M 1859 2515 3170 3825 4481 5136 5792 6447 7102 7758 8413 150% of Poverty CHIP 71 & 72 1823 2465 3108 3750 4393 5035 5678 6320 6963 7605 8248 #148% of Poverty MHK 1859 2515 3170 3825 4481 5136 5792 6447 7102 7758 8413 141% of Poverty MPW HIF 1714 2318 2922 3525 4129 4733 5337 5941 6545 7149 7753 #133% of Poverty AEG 1677 2268 2859 3450 4042 4633 5224 5815 6406 6997 7588 110%* of Poverty 1337 1808 2279 2750 3221 3692 4164 4635 5106 5577 6048 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1215 1644 2072 2500 2929 3357 3785 4214 4642 5070 5499 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 18077 19383 20690 21996 23302 24609 25915 27222 28528 29835 31141 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 13335 14299 15263 16227 17190 18154 19118 20082 21045 22009 22973 Premium 234 251 269 285 302 319 336 352 370 387 404 #201% of Poverty UWHS 12209 13092 13974 14857 15739 16621 17504 18386 19268 20151 21033 #196% of Poverty MPW & MHK under 1 11913 12774 13635 14496 15357 16218 17079 17940 18801 19662 20523 185% of Poverty CHIP 73 10965 11757 12550 13342 14134 14927 15719 16512 17304 18097 18889 Premium 71 76 82 87 92 97 102 107 113 118 123 153%* of Poverty CHIP 4M 9068 9724 10379 11034 11690 12345 13000 13656 14311 14966 15622 150% of Poverty CHIP 71 & 72 8890 9533 10175 10818 11460 12103 12745 13388 14030 14673 15315 #148% of Poverty MHK 9068 9724 10379 11034 11690 12345 13000 13656 14311 14966 15622 141% of Poverty MPW HIF 8357 8961 9565 10169 10773 11377 11981 12585 13189 13793 14397 #133% of Poverty AEG 8179 8770 9361 9953 10544 11135 11726 12317 12908 13499 14090 110%* of Poverty 6519 6991 7462 7933 8404 8875 9346 9818 10289 10760 11231 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5927 6355 6784 7212 7640 8069 8497 8925 9354 9782 10210 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised 04/2024

(magi)(appendix-a)(page-8)Page 8#

18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 8

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 4/1/2023-6/30/2023 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3706 5013 6319 7625 8932 10238 11545 12851 14158 15464 16770 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2734 3698 4662 5625 6589 7553 8517 9480 10444 11408 12372 Premium 48 65 82 99 115 132 150 167 184 200 217 #201% of Poverty UWHS 2503 3386 4268 5150 6033 6915 7798 8680 9562 10445 11327 #196% of Poverty MPW & MHK under 1 2443 3304 4165 5025 5886 6747 7608 8469 9330 10191 11052 185% of Poverty CHIP 73 2248 3041 3833 4625 5418 6210 7003 7795 8588 9380 10172 Premium 15 20 25 30 35 40 46 51 56 61 66 153%* of Poverty CHIP 4M 1859 2515 3170 3825 4481 5136 5792 6447 7102 7758 8413 150% of Poverty CHIP 71 & 72 1823 2465 3108 3750 4393 5035 5678 6320 6963 7605 8248 #148% of Poverty MHK 1859 2515 3170 3825 4481 5136 5792 6447 7102 7758 8413 141% of Poverty MPW HIF 1714 2318 2922 3525 4129 4733 5337 5941 6545 7149 7753 #133% of Poverty AEG 1677 2268 2859 3450 4042 4633 5224 5815 6406 6997 7588 110%* of Poverty 1337 1808 2279 2750 3221 3692 4164 4635 5106 5577 6048 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1215 1644 2072 2500 2929 3357 3785 4214 4642 5070 5499 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 18077 19383 20690 21996 23302 24609 25915 27222 28528 29835 31141 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 13335 14299 15263 16227 17190 18154 19118 20082 21045 22009 22973 Premium 234 251 269 285 302 319 336 352 370 387 404 #201% of Poverty UWHS 12209 13092 13974 14857 15739 16621 17504 18386 19268 20151 21033 #196% of Poverty MPW & MHK under 1 11913 12774 13635 14496 15357 16218 17079 17940 18801 19662 20523 185% of Poverty CHIP 73 10965 11757 12550 13342 14134 14927 15719 16512 17304 18097 18889 Premium 71 76 82 87 92 97 102 107 113 118 123 153%* of Poverty CHIP 4M 9068 9724 10379 11034 11690 12345 13000 13656 14311 14966 15622 150% of Poverty CHIP 71 & 72 8890 9533 10175 10818 11460 12103 12745 13388 14030 14673 15315 #148% of Poverty MHK 9068 9724 10379 11034 11690 12345 13000 13656 14311 14966 15622 141% of Poverty MPW HIF 8357 8961 9565 10169 10773 11377 11981 12585 13189 13793 14397 #133% of Poverty AEG 8179 8770 9361 9953 10544 11135 11726 12317 12908 13499 14090 110%* of Poverty 6519 6991 7462 7933 8404 8875 9346 9818 10289 10760 11231 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5927 6355 6784 7212 7640 8069 8497 8925 9354 9782 10210 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised 04/2023

(magi)(appendix-a)(page-9)Page 9#

18.2.1 MHN Income Standards – MAGI Income Limits (w/5%) and CHIP Premium Amounts Page 9

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 7/1/2022-3/31/2023 # of Persons 1 2 3 4 5 6 7 8 9 10 11 #300% of Poverty SMHB & CHIP 75 3455 4654 5854 7054 8253 9453 10653 11852 13052 14252 15451 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2549 3434 4319 5204 6089 6974 7859 8744 9629 10514 11399 Premium 48 65 82 99 115 132 150 167 184 200 217 #201% of Poverty UWHS 2333 3144 3954 4764 5575 6385 7195 8005 8816 9626 10436 #196% of Poverty MPW & MHK under 1 2277 3067 3858 4649 5439 6230 7020 7811 8602 9392 10183 185% of Poverty CHIP 73 2096 2823 3551 4279 5006 5734 6462 7189 7917 8645 9372 Premium 15 20 25 30 35 40 46 51 56 61 66 153%* of Poverty CHIP 4M 1733 2335 2936 3538 4140 4742 5344 5945 6547 7149 7751 150% of Poverty CHIP 71 & 72 1699 2289 2879 3469 4059 4649 5239 5829 6419 7009 7599 #148% of Poverty MHK 1733 2335 2937 3539 4140 4742 5344 5946 6548 7149 7751 141% of Poverty MPW HIF 1597 2152 2707 3261 3816 4370 4925 5480 6034 6589 7143 #133% of Poverty AEG 1563 2106 2649 3192 3735 4277 4820 5363 5906 6449 6991 110%* of Poverty 1246 1678 2111 2544 2976 3409 3842 4274 4707 5140 5572 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1133 1526 1920 2313 2706 3100 3493 3886 4280 4673 5066 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 #300% of Poverty SMHB & CHIP 75 16651 17851 19050 20250 21450 22649 23849 25049 26248 27448 28648 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 12284 13169 14054 14939 15824 16709 17594 18479 19364 20249 21134 Premium 234 251 269 285 302 319 336 352 370 387 404 #201% of Poverty UWHS 11246 12057 12867 13677 14487 15298 16108 16918 17729 18529 19349

#196% of Poverty MPW & MHK under 1 10523 11283 12044 12804 13565 14325 15086 15846 16606 17367 18127 185% of Poverty CHIP 73 10100 10828 11555 12283 13011 13738 14466 15194 15921 16649 17377 Premium 71 76 82 87 92 97 102 107 113 118 123 153%* of Poverty CHIP 4M 8353 8954 9556 10158 10760 11362 11963 12565 13167 13769 14371 150% of Poverty CHIP 71 & 72 8189 8779 9369 9959 10549 11139 11729 12319 12909 13499 14089 #148% of Poverty MHK 8353 8955 9557 10158 10760 11362 11964 12566 13167 13769 14371 141% of Poverty MPW HIF 7698 8253 8807 9362 9916 10471 11026 11580 12135 12689 13244 #133% of Poverty AEG 7534 8077 8620 9163 9705 10248 10791 11334 11877 12419 12962 110%* of Poverty 6005 6438 6870 7303 7736 8168 8601 9034 9466 9899 10332 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5460 5853 6246 6640 7033 7426 7820 8213 8606 9000 9393 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level.

Revised 07/2022

(magi)(appendix-a)(page-10)Page 10#

Section 1800.000.00 Appendix A, Page 10

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 4/1/2022 through 6/30/2022

# of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3455 4654 5854 7054 8253 9453 10653 11852 13052 14252 15451 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2549 3434 4319 5204 6089 6974 7859 8744 9629 10514 11399 Premium 48 65 82 99 115 132 150 167 184 200 217 201% of Poverty UWHS 2333 3144 3954 4764 5575 6385 7195 8005 8816 9626 10436 196% of Poverty MPW & 2277 3067 3858 4649 5439 6230 7020 7811 8602 9392 10183 MHK under 1 185% of Poverty CHIP 73 2096 2823 3551 4279 5006 5734 6462 7189 7917 8645 9372 Premium 15 20 25 30 35 40 46 51 56 61 66 150% of Poverty CHIP 71 & 72 1699 2289 2879 3469 4059 4649 5239 5829 6419 7009 7599 148% of Poverty MHK 1733 2335 2937 3539 4140 4742 5344 5946 6548 7149 7751 141% of Poverty MPW HIF 1597 2152 2707 3261 3816 4370 4925 5480 6034 6589 7143 133% of Poverty AEG 1563 2106 2649 3192 3735 4277 4820 5363 5906 6449 6991 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1133 1526 1920 2313 2706 3100 3493 3886 4280 4673 5066

# of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 16651 17851 19050 20250 21450 22649 23849 25049 26248 27448 28648 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 12284 13169 14054 14939 15824 16709 17594 18479 19364 20249 21134 Premium 234 251 269 285 302 319 336 352 370 387 404 201% of Poverty UWHS 11246 12057 12867 13677 14487 15298 16108 16918 17729 18529 19349 196% of Poverty MPW & MHK under 1 10523 11283 12044 12804 13565 14325 15086 15846 16606 17367 18127 185% of Poverty CHIP 73 10100 10828 11555 12283 13011 13738 14466 15194 15921 16649 17377 Premium 71 76 82 87 92 97 102 107 113 118 123 150% of Poverty CHIP 71 & 72 8189 8779 9369 9959 10549 11139 11729 12319 12909 13499 14089 148% of Poverty MHK 8353 8955 9557 10158 10760 11362 11964 12566 13167 13769 14371 141% of Poverty MPW HIF 7698 8253 8807 9362 9916 10471 11026 11580 12135 12689 13244 133% of Poverty AEG 7534 8077 8620 9163 9705 10248 10791 11334 11877 12419 12962 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5460 5853 6246 6640 7033 7426 7820 8213 8606 9000 9393 Revised 04/2022

(magi)(appendix-d)(page-1)Page 1#

1 | Page 18.2.1 MHN Income Standards – Federal Poverty Level (FPL) Chart POVERTY GUIDELINES April 1, 2026 Number of Persons 1 2 3 4 5 6 7 8 9 10 11 MHF Income Max monthly 141 241 301 353 400 445 490 532 574 616 658 300% of Poverty monthly 3990 5410 6830 8250 9670 11090 12510 13930 15350 16770 18190 225% of Poverty monthly 2993 4058 5123 6188 7253 8318 9383 10448 11513 12578 13643 201% of Poverty monthly 2674 3625 4577 5528 6479 7431 8382 9334 10285 11236 12188 196% of Poverty monthly 2607 3535 4463 5390 6318 7246 8174 9101 10029 10957 11885 185% of 185% Std monthly 4552 6172 7792 9412 11032 12652 14272 15892 17512 19132 20752 185% of Poverty monthly 2461 3337 4212 5088 5964 6839 7715 8591 9466 10342 11218 185% of 133% of Std monthly 3273 4438 5602 6767 7932 9096 10261 11425 12590 13755 14919 153% of Poverty monthly 2035 2760 3484 4208 4932 5656 6381 7105 7829 8553 9277 150% of Poverty monthly 1995 2705 3415 4125 4835 5545 6255 6965 7675 8385 9095 148% of Poverty monthly 1969 2669 3370 4070 4771 5472 6172 6873 7573 8274 8974 141% of Poverty monthly 1876 2543 3211 3878 4545 5213 5880 6548 7215 7882 8550 133% of Poverty monthly 1769 2399 3028 3658 4288 4917 5547 6176 6806 7435 8065 110% of Poverty monthly 1463 1984 2504 3025 3546 4066 4587 5108 5628 6149 6670 100% of Poverty monthly 1330 1804 2277 2750 3224 3697 4170 4644 5117 5590 6064 100% of Poverty Annual 15960 21640 27320 33000 38680 44360 50040 55720 61400 67080 72760 Number of Persons 12 13 14 15 16 17 18 19 20 21 22 MHF Income Max monthly 700 742 784 826 868 910 952 994 1036 1078 1120 300% of Poverty monthly 19610 21030 22450 23870 25290 26710 28130 29550 30970 32390 33810 225% of Poverty monthly 14708 15773 16838 17903 18968 20033 21098 22163 23228 24293 25358 201% of Poverty monthly 13139 14091 15042 15993 16945 17896 18848 19799 20750 21702 22653 196% of Poverty monthly 12812 13740 14668 15596 16523 17451 18379 19306 20234 21162 22090 185% of 185% Std monthly 22372 23992 25612 27232 28852 30472 32092 33712 35332 36952 38572 185% of Poverty monthly 12093 12969 13845 14720 15596 16472 17347 18223 19099 19974 20850 185% of 133% of Std monthly 16084 17249 18413 19578 20743 21907 23072 24236 25401 26566 27730 153% of Poverty monthly 10002 10726 11450 12174 12898 13623 14347 15071 15795 16519 17244 150% of Poverty monthly 9805 10515 11225 11935 12645 13355 14065 14775 15485 16195 16905 148% of Poverty monthly 9675 10375 11076 11776 12477 13177 13878 14578 15279 15980 16680 141% of Poverty monthly 9217 9885 10552 11219 11887 12554 13222 13889 14556 15224 15891 133% of Poverty monthly 8694 9324 9953 10583 11212 11842 12471 13101 13731 14360 14990 110% of Poverty monthly 7190 7711 8232 8752 9273 9794 10314 10835 11356 11876 12397 100% of Poverty monthly 6537 7010 7484 7957 8430 8904 9377 9850 10324 10797 11270 100% of Poverty Annual 78440 84120 89800 95480 101160 106840 112520 118200 123880 129560 135240

(magi)(appendix-d)(page-2)Page 2#

2 | Page 18.2.1 MHN Income Standards – Federal Poverty Level (FPL) Chart POVERTY GUIDELINES

April 1, 2025

Number of Persons 1 2 3 4 5 6 7 8 9 10 11 MHF Income Max monthly 141 241 301 353 400 445 490 532 574 616 658 300% of Poverty monthly 3913 5288 6663 8038 9413 10788 12163 13538 14913 16288 17663 225% of Poverty monthly 2935 3966 4997 6029 7060 8091 9122 10154 11185 12216 13247 201% of Poverty monthly 2622 3543 4464 5386 6307 7228 8149 9071 9992 10913 11834 196% of Poverty monthly 2557 3455 4353 5252 6150 7048 7947 8845 9743 10642 11540 185% of 185% Std monthly 4464 6033 7601 9170 10739 12307 13876 15445 17013 18582 20150 185% of Poverty monthly 2413 3261 4109 4957 5805 6653 7501 8349 9197 10044 10892 185% of 133% of Std monthly 3209 4337 5465 6593 7720 8848 9976 11104 12231 13359 14487 153% of Poverty monthly 1996 2697 3398 4100 4801 5502 6203 6905 7606 8307 9008 150% of Poverty monthly 1957 2644 3332 4019 4707 5394 6082 6769 7457 8144 8832 148% of Poverty monthly 1931 2609 3287 3966 4644 5322 6001 6679 7357 8036 8714 141% of Poverty monthly 1839 2486 3132 3778 4424 5071 5717 6363 7009 7656 8302 133% of Poverty monthly 1735 2345 2954 3564 4173 4783 5393 6002 6612 7221 7831 110% of Poverty monthly 1435 1939 2443 2947 3451 3955 4460 4964 5468 5972 6476 100% of Poverty monthly 1305 1763 2221 2680 3138 3596 4055 4513 4971 5430 5888 100% of Poverty Annual 15650 21150 26650 32150 37650 43150 48650 54150 59650 65150 70650 Number of Persons 12 13 14 15 16 17 18 19 20 21 22 MHF Income Max monthly 700 742 784 826 868 910 952 994 1036 1078 1120 300% of Poverty monthly 19038 20413 21788 23163 24538 25913 27288 28663 30038 31413 32788 225% of Poverty monthly 14279 15310 16341 17372 18404 19435 20466 21497 22529 23560 24591 201% of Poverty monthly 12756 13677 14598 15519 16441 17362 18283 19204 20126 21047 21968 196% of Poverty monthly 12438 13337 14235 15133 16032 16930 17828 18727 19625 20523 21422 185% of 185% Std monthly 21719 23288 24856 26425 27994 29562 31131 32700 34268 35837 37406 185% of Poverty monthly 11740 12588 13436 14284 15132 15980 16828 17676 18524 19372 20219 185% of 133% of Std monthly 15614 16742 17870 18998 20125 21253 22381 23509 24636 25764 26892 153% of Poverty monthly 9710 10411 11112 11813 12515 13216 13917 14618 15320 16021 16722 150% of Poverty monthly 9519 10207 10894 11582 12269 12957 13644 14332 15019 15707 16394 148% of Poverty monthly 9392 10071 10749 11427 12106 12784 13462 14141 14819 15497 16176 141% of Poverty monthly 8948 9594 10241 10887 11533 12179 12826 13472 14118 14764 15411 133% of Poverty monthly 8440 9050 9660 10269 10879 11488 12098 12708 13317 13927 14536 110% of Poverty monthly 6980 7485 7989 8493 8997 9501 10005 10510 11014 11518 12022 100% of Poverty monthly 6346 6805 7263 7721 8180 8638 9096 9555 10013 10471 10930 100% of Poverty Annual 76150 81650 87150 92650 98150 103650 109150 114650 120150 125650 131150

(magi)(appendix-d)(page-3)Page 3#

3 | Page 18.2.1 MHN Income Standards – Federal Poverty Level (FPL) Chart POVERTY GUIDELINES

April 1, 2024

Number of Persons 1 2 3 4 5 6 7 8 9 10 11 MHF Income Max monthly 141 241 301 353 400 445 490 532 574 616 658 300% of Poverty monthly 3765 5110 6455 7800 9145 10490 11835 13180 14525 15870 17215 225% of Poverty monthly 2824 3833 4842 5850 6859 7868 8877 9885 10894 11903 12912 201% of Poverty monthly 2523 3424 4325 5226 6128 7029 7930 8831 9732 10633 11535 196% of Poverty monthly 2460 3339 4218 5096 5975 6854 7733 8611 9490 10369 11248 185% of 185% Std monthly 4296 5830 7365 8899 10433 11968 13502 15037 16571 18106 19640 185% of Poverty monthly 2322 3152 3981 4810 5640 6469 7299 8128 8958 9787 10616 185% of 133% of Std monthly 3088 4192 5295 6398 7501 8604 9707 10810 11913 13017 14120 153% of Poverty monthly 1921 2607 3293 3978 4664 5350 6036 6722 7408 8094 8780 150% of Poverty monthly 1883 2555 3228 3900 4573 5245 5918 6590 7263 7935 8608 148% of Poverty monthly 1858 2521 3185 3848 4512 5176 5839 6503 7166 7830 8493 141% of Poverty monthly 1770 2402 3034 3666 4299 4931 5563 6195 6827 7459 8092 133% of Poverty monthly 1670 2266 2862 3458 4055 4651 5247 5844 6440 7036 7632 110% of Poverty monthly 1381 1874 2367 2860 3353 3846 4340 4833 5326 5819 6312 100% of Poverty monthly 1255 1704 2152 2600 3049 3497 3945 4394 4842 5290 5739 100% of Poverty Annual 15060 20440 25820 31200 36580 41960 47340 52720 58100 63480 68860 Number of Persons 12 13 14 15 16 17 18 19 20 21 22 MHF Income Max monthly 700 742 784 826 868 910 952 994 1036 1078 1120 300% of Poverty monthly 18560 19905 21250 22595 23940 25285 26630 27975 29320 30665 32010 225% of Poverty monthly 13920 14929 15938 16947 17955 18964 19973 20982 21990 22999 24008 201% of Poverty monthly 12436 13337 14238 15139 16040 16941 17843 18744 19645 20546 21447 196% of Poverty monthly 12126 13005 13884 14763 15641 16520 17399 18277 19156 20035 20914 185% of 185% Std monthly 21174 22709 24243 25778 27312 28846 30381 31915 33450 34984 36519 185% of Poverty monthly 11446 12275 13105 13934 14763 15593 16422 17252 18081 18911 19740 185% of 133% of Std monthly 15223 16326 17429 18532 19635 20738 21842 22945 24048 25151 26254 153% of Poverty monthly 9466 10152 10838 11524 12210 12896 13582 14268 14954 15640 16326 150% of Poverty monthly 9280 9953 10625 11298 11970 12643 13315 13988 14660 15333 16005 148% of Poverty monthly 9157 9820 10484 11147 11811 12474 13138 13801 14465 15129 15792 141% of Poverty monthly 8724 9356 9988 10620 11252 11884 12517 13149 13781 14413 15045 133% of Poverty monthly 8229 8825 9421 10018 10614 11210 11806 12403 12999 13595 14192 110% of Poverty monthly 6805 7299 7792 8285 8778 9271 9764 10258 10751 11244 11737 100% of Poverty monthly 6187 6635 7084 7532 7980 8429 8877 9325 9774 10222 10670 100% of Poverty Annual 74240 79620 85000 90380 95760 101140 106520 111900 117280 122660 128040

(magi)(appendix-d)(page-4)Page 4#

4 | Page 18.2.1 MHN Income Standards – Federal Poverty Level (FPL) Chart POVERTY GUIDELINES

April 1, 2023

Number of Persons 1 2 3 4 5 6 7 8 9 10 11 MHF Income Max monthly 141 241 301 353 400 445 490 532 574 616 658 300% of Poverty monthly 3645 4930 6215 7500 8785 10070 11355 12640 13925 15210 16495 225% of Poverty monthly 2734 3698 4662 5625 6589 7553 8517 9480 10444 11408 12372 201% of Poverty monthly 2443 3304 4165 5025 5886 6747 7608 8469 9330 10191 11052 196% of Poverty monthly 2382 3221 4061 4900 5740 6580 7419 8259 9098 9938 10777 185% of 185% Std monthly 4159 5625 7091 8557 10023 11489 12955 14421 15887 17353 18819 185% of Poverty monthly 2248 3041 3833 4625 5418 6210 7003 7795 8588 9380 10172 185% of 133% of Std monthly 2990 4044 5098 6152 7206 8260 9313 10367 11421 12475 13529 153% of Poverty monthly 1859 2515 3170 3825 4481 5136 5792 6447 7102 7758 8413 150% of Poverty monthly 1823 2465 3108 3750 4393 5035 5678 6320 6963 7605 8248 148% of Poverty monthly 1799 2433 3067 3700 4334 4968 5602 6236 6870 7504 8138 141% of Poverty monthly 1714 2318 2922 3525 4129 4733 5337 5941 6545 7149 7753 133% of Poverty monthly 1616 2186 2756 3325 3895 4465 5035 5604 6174 6744 7313 110% of Poverty monthly 1337 1808 2279 2750 3221 3692 4164 4635 5106 5577 6048 100% of Poverty monthly 1215 1644 2072 2500 2929 3357 3785 4214 4642 5070 5499 100% of Poverty Annual 14580 19720 24860 30000 35140 40280 45420 50560 55700 60840 65980 Number of Persons 12 13 14 15 16 17 18 19 20 21 22 MHF Income Max monthly 700 742 784 826 868 910 952 994 1036 1078 1120 300% of Poverty monthly 17780 19065 20350 21635 22920 24205 25490 26775 28060 29345 30630 225% of Poverty monthly 13335 14299 15263 16227 17190 18154 19118 20082 21045 22009 22973 201% of Poverty monthly 11913 12774 13635 14496 15357 16218 17079 17940 18801 19662 20523 196% of Poverty monthly 11617 12456 13296 14135 14975 15814 16654 17493 18333 19173 20012 185% of 185% Std monthly 20285 21750 23216 24682 26148 27614 29080 30546 32012 33478 34944 185% of Poverty monthly 10965 11757 12550 13342 14134 14927 15719 16512 17304 18097 18889 185% of 133% of Std monthly 14583 15637 16691 17745 18799 19853 20907 21960 23014 24068 25122 153% of Poverty monthly 9068 9724 10379 11034 11690 12345 13000 13656 14311 14966 15622 150% of Poverty monthly 8890 9533 10175 10818 11460 12103 12745 13388 14030 14673 15315 148% of Poverty monthly 8772 9406 10040 10674 11308 11942 12576 13209 13843 14477 15111 141% of Poverty monthly 8357 8961 9565 10169 10773 11377 11981 12585 13189 13793 14397 133% of Poverty monthly 7883 8453 9022 9592 10162 10731 11301 11871 12440 13010 13580 110% of Poverty monthly 6519 6991 7462 7933 8404 8875 9346 9818 10289 10760 11231 100% of Poverty monthly 5927 6355 6784 7212 7640 8069 8497 8925 9354 9782 10210 100% of Poverty Annual 71120 76260 81400 86540 91680 96820 101960 107100 112240 117380 122520

(magi)(appendix-d)(page-5)Page 5#

5 | Page 18.2.1 MHN Income Standards – Federal Poverty Level (FPL) Chart POVERTY GUIDELINES April 1, 2022 Number of Persons 1 2 3 4 5 6 7 8 9 10 11 MHF Income Max monthly 141 241 301 353 400 445 490 532 574 616 658 300% of Poverty monthly 3398 4578 5758 6938 8118 9298 10478 11658 12838 14018 15198 225% of Poverty monthly 2549 3434 4319 5204 6089 6974 7859 8744 9629 10514 11399 201% of Poverty monthly 2277 3067 3858 4649 5439 6230 7020 7811 8602 9392 10183 196% of Poverty monthly 2220 2991 3762 4533 5304 6075 6846 7617 8388 9159 9930 185% of 185% Std monthly 3876 5223 6569 7915 9261 10607 11954 13300 14646 15992 17338 185% of Poverty monthly 2096 2823 3551 4279 5006 5734 6462 7189 7917 8645 9372 185% of 133% of Std monthly 2787 3755 4723 5690 6658 7626 8594 9562 10529 11497 12465 153% of Poverty monthly 1733 2335 2936 3538 4140 4742 5344 5945 6547 7149 7751 150% of Poverty monthly 1699 2289 2879 3469 4059 4649 5239 5829 6419 7009 7599 148% of Poverty monthly 1677 2259 2841 3423 4005 4587 5169 5752 6334 6916 7498 141% of Poverty monthly 1597 2152 2707 3261 3816 4370 4925 5480 6034 6589 7143 133% of Poverty monthly 1507 2030 2553 3076 3599 4122 4646 5169 5692 6215 6738 110% of Poverty monthly 1246 1678 2111 2544 2976 3409 3842 4274 4707 5140 5172 100% of Poverty monthly 1133 1526 1920 2313 2706 3100 3493 3886 4280 4673 5066 100% of Poverty Annual 13590 18310 23030 27750 32470 37190 41910 46630 51350 56070 60790 Number of Persons 12 13 14 15 16 17 18 19 20 21 22 MHF Income Max monthly 700 742 784 826 868 910 952 994 1036 1078 1120 300% of Poverty monthly 16378 17558 18738 19918 21098 22278 23458 24638 25818 26998 28178 225% of Poverty monthly 12284 13169 14054 14939 15824 16709 17594 18479 19364 20249 21134 201% of Poverty monthly 10973 11764 12555 13345 14136 14926 15717 16508 17298 18089 18879 196% of Poverty monthly 10700 11471 12242 13013 13784 14555 15326 16097 16868 17639 18410 185% of 185% Std monthly 18684 20031 21377 22723 24069 25415 26762 28108 29454 30800 32146 185% of Poverty monthly 10100 10828 11555 12283 13011 13738 14466 15194 15921 16649 17377 185% of 133% of Std monthly 13433 14401 15368 16336 17304 18272 19240 20207 21175 22143 23111 153% of Poverty monthly 8353 8954 9556 10158 10760 11362 11963. 12565 13167 13769 14371 150% of Poverty monthly 8189 8779 9369 9959 10549 11139 11729 12319 12909 13499 14089 148% of Poverty monthly 8080 8662 9244 9826 10409 10991 11573 12155 12737 13319 13901 141% of Poverty monthly 7698 8253 8807 9362 9916 10471 11026 11580 12135 12689 13244 133% of Poverty monthly 7261 7784 8307 8831 9354 9877 10400 10923 11446 11969 12493 110% of Poverty monthly 6005 6438 6870 7303 7736 8168 8601 9034 9466 9899 10332 100% of Poverty monthly 5460 5853 6246 6640 7033 7426 7820 8213 8606 9000 9393 100% of Poverty Annual 65510 70230 74950 79670 84390 89110 93830 98550 103270 107990 112710

(magi)(magi-appendix-a)(block-1)MAGI Appendix A – DSS Manuals#

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 7/1/2022-4/30/2023 # of Persons 1 2 3 4 5 6 7 8 9 10 11 # 300% of Poverty SMHB & CHIP 75 3455 4654 5854 7054 8253 9453 10653 11852 13052 14252 15451 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2549 3434 4319 5204 6089 6974 7859 8744 9629 10514 11399 Premium 48 65 82 99 115 132 150 167 184 200 217 # 201% of Poverty UWHS 2333 3144 3954 4764 5575 6385 7195 8005 8816 9626 10436 # 196% of Poverty MPW & MHK under 1 2277 3067 3858 4649 5439 6230 7020 7811 8602 9392 10183 185% of Poverty CHIP 73 2096 2823 3551 4279 5006 5734 6462 7189 7917 8645 9372 Premium 15 20 25 30 35 40 46 51 56 61 66 153%* of Poverty CHIP 4M 1733 2335 2936 3538 4140 4742 5344 5945 6547 7149 7751 150% of Poverty CHIP 71 & 72 1699 2289 2879 3469 4059 4649 5239 5829 6419 7009 7599 # 148% of Poverty MHK 1733 2335 2937 3539 4140 4742 5344 5946 6548 7149 7751 141% of Poverty MPW HIF 1597 2152 2707 3261 3816 4370 4925 5480 6034 6589 7143 # 133% of Poverty AEG 1563 2106 2649 3192 3735 4277 4820 5363 5906 6449 6991 110%* of Poverty 1246 1678 2111 2544 2976 3409 3842 4274 4707 5140 5572 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1133 1526 1920 2313 2706 3100 3493 3886 4280 4673 5066 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. # of Persons 12 13 14 15 16 17 18 19 20 21 22 # 300% of Poverty SMHB & CHIP 75 16651 17851 19050 20250 21450 22649 23849 25049 26248 27448 28648 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 12284 13169 14054 14939 15824 16709 17594 18479 19364 20249 21134 Premium 234 251 269 285 302 319 336 352 370 387 404 # 201% of Poverty UWHS 11246 12057 12867 13677 14487 15298 16108 16918 17729 18529 19349 # 196% of Poverty MPW & MHK under 1 10523 11283 12044 12804 13565 14325 15086 15846 16606 17367 18127 185% of Poverty CHIP 73 10100 10828 11555 12283 13011 13738 14466 15194 15921 16649 17377 Premium 71 76 82 87 92 97 102 107 113 118 123 153%* of Poverty CHIP 4M 8353 5954 9556 10158 10760 11362 11963 12565 13167 13769 14371 150% of Poverty CHIP 71 & 72 8189 8779 9369 9959 10549 11139 11729 12319 12909 13499 14089 # 148% of Poverty MHK 8353 8955 9557 10158 10760 11362 11964 12566 13167 13769 14371 141% of Poverty MPW HIF 7698 8253 8807 9362 9916 10471 11026 11580 12135 12689 13244 # 133% of Poverty AEG 7534 8077 8620 9163 9705 10248 10791 11334 11877 12419 12962 110%* of Poverty 6005 6438 6870 7303 7736 8168 8601 9034 9466 9899 10332 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5460 5853 6246 6640 7033 7426 7820 8213 8606 9000 9393 *Income Ranges for CHIP 4M-Ages 1 through 5=148%-153% and ages 6 through 18=110%-153%; #=5% disregard applied at this level. Revised 07/2022

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 4/1/2022 through 6/30/2022 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3455 4654 5854 7054 8253 9453 10653 11852 13052 14252 15451 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2549 3434 4319 5204 6089 6974 7859 8744 9629 10514 11399 Premium 48 65 82 99 115 132 150 167 184 200 217 201% of Poverty UWHS 2333 3144 3954 4764 5575 6385 7195 8005 8816 9626 10436 196% of Poverty MPW & 2277 3067 3858 4649 5439 6230 7020 7811 8602 9392 10183 MHK under 1 185% of Poverty CHIP 73 2096 2823 3551 4279 5006 5734 6462 7189 7917 8645 9372 Premium 15 20 25 30 35 40 46 51 56 61 66 150% of Poverty CHIP 71 & 72 1699 2289 2879 3469 4059 4649 5239 5829 6419 7009 7599 148% of Poverty MHK 1733 2335 2937 3539 4140 4742 5344 5946 6548 7149 7751 141% of Poverty MPW HIF 1597 2152 2707 3261 3816 4370 4925 5480 6034 6589 7143 133% of Poverty AEG 1563 2106 2649 3192 3735 4277 4820 5363 5906 6449 6991 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1133 1526 1920 2313 2706 3100 3493 3886 4280 4673 5066 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 16651 17851 19050 20250 21450 22649 23849 25049 26248 27448 28648 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 12284 13169 14054 14939 15824 16709 17594 18479 19364 20249 21134 Premium 234 251 269 285 302 319 336 352 370 387 404 201% of Poverty UWHS 11246 12057 12867 13677 14487 15298 16108 16918 17729 18529 19349 196% of Poverty MPW & MHK under 1 10523 11283 12044 12804 13565 14325 15086 15846 16606 17367 18127 185% of Poverty CHIP 73 10100 10828 11555 12283 13011 13738 14466 15194 15921 16649 17377 Premium 71 76 82 87 92 97 102 107 113 118 123 150% of Poverty CHIP 71 & 72 8189 8779 9369 9959 10549 11139 11729 12319 12909 13499 14089 148% of Poverty MHK 8353 8955 9557 10158 10760 11362 11964 12566 13167 13769 14371 141% of Poverty MPW HIF 7698 8253 8807 9362 9916 10471 11026 11580 12135 12689 13244 133% of Poverty AEG 7534 8077 8620 9163 9705 10248 10791 11334 11877 12419 12962 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5460 5853 6246 6640 7033 7426 7820 8213 8606 9000 9393 Revised 04/2022

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & AEG- FPL included and CHIP premium amounts 7/1/2021 through 3/31/2022 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3274 4428 5582 6736 7890 9044 10198 11352 12505 13659 14813 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2415 3267 4118 4969 5820 6672 7523 8374 9225 10077 10928 Premium 48 65 82 99 115 132 150 167 184 200 217 201% of Poverty UWHS 2212 2991 3770 4550 5329 6108 6888 7667 8446 9226 10005 196% of Poverty MPW & 2158 2918 3679 4439 5200 5960 6721 7481 8241 9002 9762 MHK under 1 185% of Poverty CHIP 73 1986 2686 3386 4086 4786 5486 6186 6886 7585 8285 8985 Premium 15 20 25 30 35 40 46 51 56 61 66 150% of Poverty CHIP 71 & 72 1610 2178 2745 3313 3880 4448 5015 5583 6150 6718 7285 148% of Poverty MHK 1643 2222 2800 3379 3958 4537 5116 5695 6273 6852 7431 141% of Poverty MPW HIF 1514 2047 2581 3114 3648 4181 4715 5248 5781 6315 6848 133% of Poverty AEG 1482 2004 2526 3048 3570 4092 4614 5136 5658 6181 6703 MHF/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1074 1452 1830 2209 2587 2965 3344 3722 4100 4479 4857 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15967 17121 18275 19429 20583 21737 22891 24045 25199 26352 27506 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 11779 12630 13482 14333 15184 16035 16887 17738 18589 19440 20292 Premium 234 251 269 285 302 319 336 352 370 387 404 201% of Poverty UWHS 10785 11564 12343 13123 13902 14681 15461 16240 17020 17799 18578 196% of Poverty MPW & MHK under 1 10523 11283 12044 12804 13565 14325 15086 15846 16606 17367 18127 185% of Poverty CHIP 73 9685 10385 11085 11785 12485 13185 13885 14585 15285 15984 16684 Premium 71 76 82 87 92 97 102 107 113 118 123 150% of Poverty CHIP 71 & 72 7853 8420 8988 9555 10123 10690 11258 11825 12393 12960 13528 148% of Poverty MHK 8010 8589 9168 9747 10325 10904 11483 12062 12641 13220 13799 141% of Poverty MPW HIF 7382 7915 8449 8982 9516 10049 10583 11116 11649 12183 12716 133% of Poverty AEG 7225 7747 8269 8791 9313 9835 10357 10879 11402 11924 12446 MHF/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5235 5614 5992 6370 6749 7127 7505 7884 8262 8640 9019 Revised 09/2021

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & MHF Adult- FPL included and CHIP premium amounts 7/1/2021 through 3/31/2022 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3274 4428 5582 6736 7890 9044 10198 11352 12505 13659 14813 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2415 3267 4118 4969 5820 6672 7523 8374 9225 10077 10928 Premium 48 65 82 99 115 132 150 167 184 200 217 201% of Poverty UWHS 2212 2991 3770 4550 5329 6108 6888 7667 8446 9226 10005 196% of Poverty MPW & 2158 2918 3679 4439 5200 5960 6721 7481 8241 9002 9762 MHK under 1 185% of Poverty CHIP 73 1986 2686 3386 4086 4786 5486 6186 6886 7585 8285 8985 Premium 15 20 25 30 35 40 46 51 56 61 66 150% of Poverty CHIP 71 & 72 1610 2178 2745 3313 3880 4448 5015 5583 6150 6718 7285 148% of Poverty MHK 1643 2222 2800 3379 3958 4537 5116 5695 6273 6852 7431 141% of Poverty MPW HIF 1514 2047 2581 3114 3648 4181 4715 5248 5781 6315 6848 MHF Adult 195 314 393 464 530 594 658 719 779 840 901 MHF Child/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1074 1452 1830 2209 2587 2965 3344 3722 4100 4479 4857 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15967 17121 18275 19429 20583 21737 22891 24045 25199 26352 27506 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 11779 12630 13482 14333 15184 16035 16887 17738 18589 19440 20292 Premium 234 251 269 285 302 319 336 352 370 387 404 201% of Poverty UWHS 10785 11564 12343 13123 13902 14681 15461 16240 17020 17799 18578 196% of Poverty MPW & MHK under 1 10523 11283 12044 12804 13565 14325 15086 15846 16606 17367 18127 185% of Poverty CHIP 73 9685 10385 11085 11785 12485 13185 13885 14585 15285 15984 16684 Premium 71 76 82 87 92 97 102 107 113 118 123 150% of Poverty CHIP 71 & 72 7853 8420 8988 9555 10123 10690 11258 11825 12393 12960 13528 148% of Poverty MHK 8010 8589 9168 9747 10325 10904 11483 12062 12641 13220 13799 141% of Poverty MPW HIF 7382 7915 8449 8982 9516 10049 10583 11116 11649 12183 12716 MHF Adult 962 1023 1084 1145 1206 1267 1328 1389 1450 1510 1571 MHF Child/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5235 5614 5992 6370 6749 7127 7505 7884 8262 8640 9019 Revised 07/2021

MAGI income max with 5% -CHIP 75, UWHS, MPW POV, MHK, & MHF Adult- FPL included and CHIP premium amounts 4/01/2021 through 06/30/2021 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3274 4428 5582 6736 7890 9044 10198 11352 12505 13659 14813 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2415 3267 4118 4969 5820 6672 7523 8374 9225 10077 10928 Premium 48 65 82 99 115 132 150 167 184 200 217 201% of Poverty UWHS 2212 2991 3770 4550 5329 6108 6888 7667 8446 9226 10005 196% of Poverty MPW & 2158 2918 3679 4439 5200 5960 6721 7481 8241 9002 9762 MHK under 1 185% of Poverty CHIP 73 1986 2686 3386 4086 4786 5486 6186 6886 7585 8285 8985 Premium 15 20 25 30 35 40 46 51 56 61 66 150% of Poverty CHIP 71 & 72 1610 2178 2745 3313 3880 4448 5015 5583 6150 6718 7285 148% of Poverty MHK 1643 2222 2800 3379 3958 4537 5116 5695 6273 6852 7431 141% of Poverty MPW HIF 1514 2047 2581 3114 3648 4181 4715 5248 5781 6315 6848 MHF Adult 195 314 393 464 530 594 658 719 779 840 901 MHF Child/MPW MHF 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1074 1452 1830 2209 2587 2965 3344 3722 4100 4479 4857 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15967 17121 18275 19429 20583 21737 22891 24045 25199 26352 27506 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 11779 12630 13482 14333 15184 16035 16887 17738 18589 19440 20292 Premium 234 251 269 285 302 319 336 352 370 387 404 201% of Poverty UWHS 10785 11564 12343 13123 13902 14681 15461 16240 17020 17799 18578 196% of Poverty MPW & MHK under 1 10523 11283 12044 12804 13565 14325 15086 15846 16606 17367 18127 185% of Poverty CHIP 73 9685 10385 11085 11785 12485 13185 13885 14585 15285 15984 16684 Premium 71 76 82 87 92 97 102 107 113 118 123 150% of Poverty CHIP 71 & 72 7853 8420 8988 9555 10123 10690 11258 11825 12393 12960 13528 148% of Poverty MHK 8010 8589 9168 9747 10325 10904 11483 12062 12641 13220 13799 141% of Poverty MPW HIF 7382 7915 8449 8982 9516 10049 10583 11116 11649 12183 12716 MHF Adult 962 1023 1084 1145 1206 1267 1328 1389 1450 1510 1571 MHF Child/MPW MHF 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5235 5614 5992 6370 6749 7127 7505 7884 8262 8640 9019 Revised 04/2021

MAGI income max with 5% -CHIP 75, UWHS, MPW, MHK, & MHF Adult- FPL included and CHIP premium amounts 11/22/2020 through 3/31/2021 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3244 4382 5521 6660 7798 8937 10076 11214 12353 13492 14630 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2393 3233 4073 4913 5753 6593 7433 8273 9113 9953 10793 Premium 48 65 82 99 115 132 150 167 184 200 217 201% of Poverty UWHS 2191 2960 3729 4498 5267 6036 6805 7574 8343 9113 9882 196% of Poverty MPW & 2138 2888 3639 4389 5139 5890 6640 7391 8141 8891 9642 MHK under 1 185% of Poverty CHIP 73 1968 2658 3349 4040 4730 5421 6112 6802 7493 8184 8874 Premium 15 20 25 30 35 40 46 51 56 61 66 150% of Poverty CHIP 71 & 72 1595 2155 2715 3275 3835 4395 4955 5515 6075 6635 7195 148% of Poverty MHK 1627 2199 2770 3341 3912 4483 5055 5626 6197 6768 7339 141% of Poverty MPW HIF 1500 2026 2553 3079 3605 4132 4658 5185 5711 6237 6764 MHF Adult 195 313 392 463 528 592 656 716 777 838 898 MHF Child 141 241 301 353 400 445 490 532 574 616 658 100% of Poverty (without 5%) 1064 1437 1810 2184 2557 2930 3304 3677 4050 4424 4797 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15769 16908 18046 19185 20324 21462 22601 23740 24878 26017 27156 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 11633 12473 13313 14153 14993 15833 16673 17513 18353 19193 20033 Premium 234 251 269 285 302 319 336 352 370 387 404 201% of Poverty UWHS 10651 11420 12189 12958 13727 14496 15265 16034 16803 17572 18341 196% of Poverty MPW & MHK under 1 10392 11143 11893 12643 13394 14144 14895 15645 16395 17146 17896 185% of Poverty CHIP 73 9565 10256 10946 11637 12328 13018 13709 14400 15090 15781 16472 Premium 71 76 82 87 92 97 102 107 113 118 123 150% of Poverty CHIP 71 & 72 7755 8315 8875 9435 9995 10555 11115 11675 12235 12795 13355 148% of Poverty MHK 7911 8482 9053 9624 10195 10767 11338 11909 12480 13051 13623 141% of Poverty MPW HIF 7290 7817 8343 8869 9396 9922 10449 10975 11501 12028 12554 MHF Adult 959 1020 1080 1141 1202 1262 1323 1384 1444 1505 1566 MHF Child 700 742 784 826 868 910 952 994 1036 1078 1120 100% of Poverty (without 5%) 5170 5544 5917 6290 6664 7037 7410 7784 8157 8530 8904 Revised 11/2020

MAGI income maximums with 5% of FPL included and CHIP premium amounts 04/01/2020 through 11/21/2020 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3244 4382 5521 6660 7798 8937 10076 11214 12353 13492 14630 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2446 3305 4163 5022 5881 6739 7598 8457 9315 10174 11033 Premium 48 65 82 99 115 132 150 167 184 200 217 201% of Poverty UWHS 2191 2960 3729 4498 5267 6036 6805 7574 8343 9113 9882 196% of Poverty MPW & 2138 2888 3639 4389 5139 5890 6640 7391 8141 8891 9642 MHK under 1 185% of Poverty CHIP 73 2021 2730 3439 4149 4858 5567 6277 6986 7695 8405 9114 Premium 15 20 25 30 35 40 46 51 56 61 66 150% of Poverty CHIP 71 & 72 1649 2227 2806 3385 3963 4542 5121 5699 6278 6857 7435 148% of Poverty MHK 1627 2199 2770 3341 3912 4483 5055 5626 6197 6768 7339 141% of Poverty MPW HIF 1554 2099 2643 3189 3734 4278 4824 5369 5913 6460 7004 MHF 195 313 392 463 528 592 656 716 777 838 898 100% of Poverty (without 5%) 1064 1437 1810 2184 2557 2930 3304 3677 4050 4424 4797 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15769 16908 18046 19185 20324 21462 22601 23740 24878 26017 27156 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 11891 12750 13609 14467 15326 16185 17043 17902 18761 19619 20478 Premium 234 251 269 285 302 319 336 352 370 387 404 201% of Poverty UWHS 10651 11420 12189 12958 13727 14496 15265 16034 16803 17572 18341 196% of Poverty MPW & MHK under 1 10392 11143 11893 12643 13394 14144 14895 15645 16395 17146 17896 185% of Poverty CHIP 73 9823 10533 11242 11951 12661 13370 14079 14789 15498 16207 16917 Premium 71 76 82 87 92 97 102 107 113 118 123 150% of Poverty CHIP 71 & 72 8014 8593 9171 9750 10329 10907 11486 12065 12643 13222 13801 148% of Poverty MHK 7911 8482 9053 9624 10195 10767 11338 11909 12480 13051 13623 141% of Poverty MPW HIF 7549 8095 8639 9184 9730 10317 10819 11365 11910 12454 13000 MHF 959 1020 1080 1141 1202 1262 1323 1384 1444 1505 1566 100% of Poverty (without 5%) 5170 5544 5917 6290 6664 7037 7410 7784 8157 8530 8904 Revised 04/2020 MAGI income maximums with 5% of FPL included and CHIP premium amounts 07/01/2019 through 03/31/2020 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB &

CHIP 75 3175 4298 5422 6545 7669 8792 9916 11039 12162 13286 14409 Premium 117 159 200 241 283 324 366 407 449 490 532 225% of Poverty CHIP 74 2394 3242 4089 4936 5783 6630 7477 8325 9172 10019 10866 Premium 48 65 82 99 115 132 150 167 184 200 217 201% of Poverty UWHS 2145 2903 3662 4421 5180 5938 6697 7456 8215 8974 9732 196% of Poverty MPW & 2093 2833 3573 4314 5054 5794 6535 7275 8015 8756 9496 MHK under 1 185% of Poverty CHIP 73 1978 2678 3378 4078 4777 5477 6177 6877 7577 8277 8976 Premium 15 20 25 30 35 40 46 51 56 61 66 150% of Poverty CHIP 71 & 72 1614 2185 2756 3327 3897 4468 5039 5610 6181 6752 7323 148% of Poverty MHK 1593 2157 2720 3284 3847 4411 4974 5538 6101 6665 7228 141% of Poverty MPW HIF 1520 2058 2596 3133 3671 4209 4747 5284 5822 6360 6898 MHF 194 312 390 461 526 590 653 713 774 834 895 100% of Poverty (without 5%) 1041 1410 1778 2146 2515 2883 3251 3620 3988 4356 4725 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15533 16656 17779 18903 20026 21150 22273 23397 24520 25643 26767 Premium 573 614 656 697 739 780 822 863 904 946 987 225% of Poverty CHIP 74 11713 12560 13408 14255 15102 15949 16796 17643 18491 19338 20185 Premium 234 251 269 285 302 319 336 352 370 387 404 201% of Poverty UWHS 10491 11250 12009 12767 13526 14285 15044 15802 16561 17320 18079 196% of Poverty MPW & MHK under 1 10236 10977 11717 12457 13198 13938 14679 15419 16159 16900 17640 185% of Poverty CHIP 73 9676 10376 11076 11776 12476 13175 13875 14575 15275 15975 16675 Premium 71 76 82 87 92 97 102 107 113 118 123 150% of Poverty CHIP 71 & 72 7894 8465 9036 9607 10178 10748 11319 11890 12461 13032 13603 148% of Poverty MHK 7792 8356 8919 9483 10046 10610 11173 11737 12300 12864 13428 141% of Poverty MPW HIF 7436 7973 8511 9049 9587 10124 10622 11200 11738 12275 12813 MHF 955 1016 1076 1136 1197 1257 1318 1378 1438 1499 1559 100% of Poverty (without 5%) 5093 5461 5830 6198 6566 6935 7303 7671 8040 8408 8776 Revised 07/2019

MAGI income maximums with 5% of FPL included and CHIP premium amounts 04/01/2019 through 06/30/2019 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3175 4298 5422 6545 7669 8792 9916 11039 12162 13286 14409 Premium 114 154 195 235 276 316 357 397 438 478 519 225% of Poverty CHIP 74 2394 3242 4089 4936 5783 6630 7477 8325 9172 10019 10866 Premium 46 63 79 96 112 129 146 162 179 196 213 201% of Poverty UWHS 2145 2903 3662 4421 5180 5938 6697 7456 8215 8974 9732 196% of Poverty MPW & 2093 2833 3573 4314 5054 5794 6535 7275 8015 8756 9496 MHK under 1 185% of Poverty CHIP 73 1978 2678 3378 4078 4777 5477 6177 6877 7577 8277 8976 Premium 14 19 24 29 34 39 44 49 54 60 65 150% of Poverty CHIP 71 & 72 1614 2185 2756 3327 3897 4468 5039 5610 6181 6752 7323 148% of Poverty MHK 1593 2157 2720 3284 3847 4411 4974 5538 6101 6665 7228 141% of Poverty MPW HIF 1520 2058 2596 3133 3671 4209 4747 5284 5822 6360 6898 MHF 194 312 390 461 526 590 653 713 774 834 895 100% of Poverty (without 5%) 1041 1410 1778 2146 2515 2883 3251 3620 3988 4356 4725 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15533 16656 17779 18903 20026 21150 22273 23397 24520 25643 26767 Premium 559 600 640 681 721 762 802 843 883 924 964 225% of Poverty CHIP 74 11713 12560 13408 14255 15102 15949 16796 17643 18491 19338 20185 Premium 229 246 262 279 295 312 328 345 361 378 394 201% of Poverty UWHS 10491 11250 12009 12767 13526 14285 15044 15802 16561 17320 18079 196% of Poverty MPW & MHK under 1 10236 10977 11717 12457 13198 13938 14679 15419 16159 16900 17640 185% of Poverty CHIP 73 9676 10376 11076 11776 12476 13175 13875 14575 15275 15975 16675 Premium 70 75 80 85 90 95 100 105 110 115 120 150% of Poverty CHIP 71 & 72 7894 8465 9036 9607 10178 10748 11319 11890 12461 13032 13603 148% of Poverty MHK 7792 8356 8919 9483 10046 10610 11173 11737 12300 12864 13428 141% of Poverty MPW HIF 7436 7973 8511 9049 9587 10124 10622 11200 11738 12275 12813 MHF 955 1016 1076 1136 1197 1257 1318 1378 1438 1499 1559 100% of Poverty (without 5%) 5093 5461 5830 6198 6566 6935 7303 7671 8040 8408 8776 Revised 04/2019

MAGI income maximums with 5% of FPL included and CHIP premium amounts 07/01/2018 through 03/31/2019 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3086 4184 5282 6380 7478 8576 9674 10772 11870 12968 14066 Premium 114 154 195 235 276 316 357 397 438 478 519 225% of Poverty CHIP 74 2327 3155 3983 4811 5639 6467 7295 8123 8951 9779 10607 Premium 46 63 79 96 112 129 146 162 179 196 213 201% of Poverty UWHS 2085 2826 3568 4309 5051 5793 6534 7276 8017 8759 9501 196% of Poverty MPW & 2034 2758 3481 4205 4928 5652 6376 7099 7823 8546 9270 MHK under 1 185% of Poverty CHIP 73 1923 2607 3291 3975 4659 5343 6027 6711 7395 8079 8763 Premium 14 19 24 29 34 39 44 49 54 60 65 150% of Poverty CHIP 71 & 72 1569 2127 2685 3243 3801 4359 4917 5475 6033 6591 7149 148% of Poverty MHK 1548 2099 2650 3201 3752 4302 4853 5404 5955 6506 7056 141% of Poverty MPW HIF 1478 2004 2529 3055 3580 4106 4632 5157 5683 6208 6734 MHF 192 310 388 458 523 586 649 709 769 829 889 100% of Poverty (without 5%) 1012 1372 1732 2092 2452 2812 3172 3532 3892 4252 4612 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15164 16262 17360 18458 19556 20654 21752 22850 23948 25046 26144 Premium 559 600 640 681 721 762 802 843 883 924 964 225% of Poverty CHIP 74 11435 12263 13091 13919 14747 15575 16403 17231 18059 18887 19715 Premium 229 246 262 279 295 312 328 345 361 378 394 201% of Poverty UWHS 10242 10984 11725 12467 13209 13950 14692 15433 16175 16917 17658 196% of Poverty MPW & MHK under 1 9994 10717 11441 12164 12888 13612 14335 15059 15782 16506 17230 185% of Poverty CHIP 73 9447 10131 10815 11499 12183 12867 13551 14235 14919 15603 16287 Premium 70 75 80 85 90 95 100 105 110 115 120 150% of Poverty CHIP 71 & 72 7707 8265 8823 9381 9939 10497 11055 11613 12171 12729 13287 148% of Poverty MHK 7607 8158 8709 9260 9810 10361 10912 11463 12014 12564 13115 141% of Poverty MPW HIF 7260 7785 8311 8836 9362 9888 10413 10939 11464 11990 12516 MHF 949 1009 1069 1129 1189 1249 1309 1369 1429 1489 1549 100% of Poverty (without 5%) 4972 5332 5692 6052 6412 6772 7132 7492 7852 8212 8572 Revised 07/2018

MAGI income maximums with 5% of FPL included and CHIP premium amounts 04/01/2018 through 06/30/2018 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3086 4184 5282 6380 7478 8576 9674 10772 11870 12968 14066 Premium 113 152 191 231 270 309 348 387 427 466 505 225% of Poverty CHIP 74 2327 3155 3983 4811 5639 6467 7295 8123 8951 9779 10607 Premium 46 62 78 95 111 126 142 158 174 190 207 201% of Poverty UWHS 2085 2826 3568 4309 5051 5793 6534 7276 8017 8759 9501 196% of Poverty MPW & 2034 2758 3481 4205 4928 5652 6376 7099 7823 8546 9270 MHK under 1 185% of Poverty CHIP 73 1923 2607 3291 3975 4659 5343 6027 6711 7395 8079 8763 Premium 14 19 24 29 34 38 43 48 53 58 63 150% of Poverty CHIP 71 & 72 1569 2127 2685 3243 3801 4359 4917 5475 6033 6591 7149 148% of Poverty MHK 1548 2099 2650 3201 3752 4302 4853 5404 5955 6506 7056 141% of Poverty MPW HIF 1478 2004 2529 3055 3580 4106 4632 5157 5683 6208 6734 MHF 192 310 388 458 523 586 649 709 769 829 889 100% of Poverty (without 5%) 1012 1372 1732 2092 2452 2812 3172 3532 3892 4252 4612 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15164 16262 17360 18458 19556 20654 21752 22850 23948 25046 26144 Premium 544 583 623 662 701 740 779 818 858 897 936 225% of Poverty CHIP 74 11435 12263 13091 13919 14747 15575 16403 17231 18059 18887 19715 Premium 223 239 254 270 286 303 319 335 351 367 382 201% of Poverty UWHS 10242 10984 11725 12467 13209 13950 14692 15433 16175 16917 17658 196% of Poverty MPW & MHK under 1 9994 10717 11441 12164 12888 13612 14335 15059 15782 16506 17230 185% of Poverty CHIP 73 9447 10131 10815 11499 12183 12867 13551 14235 14919 15603 16287 Premium 68 73 77 82 87 92 97 102 107 112 116 150% of Poverty CHIP 71 & 72 7707 8265 8823 9381 9939 10497 11055 11613 12171 12729 13287 148% of Poverty MHK 7607 8158 8709 9260 9810 10361 10912 11463 12014 12564 13115 141% of Poverty MPW HIF 7260 7785 8311 8836 9362 9888 10413 10939 11464 11990 12516 MHF 949 1009 1069 1129 1189 1249 1309 1369 1429 1489 1549 100% of Poverty (without 5%) 4972 5332 5692 6052 6412 6772 7132 7492 7852 8212 8572 Revised 04/2018

MAGI income maximums with 5% of FPL included and CHIP premium amounts 07/01/2017 through 03/31/2018 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3066 4128 5191 6253 7315 8378 9440 10503 11565 12627 13690 Premium 113 152 191 231 270 309 348 387 427 466 505 225% of Poverty CHIP 74 2312 3113 3914 4715 5517 6318 7119 7920 8721 9522 10324 Premium 46 62 78 95 111 126 142 158 174 190 207 201% of Poverty UWHS 2071 2788 3506 4223 4941 5659 6376 7094 7811 8529 9246 196% of Poverty MPW & 2021 2721 3421 4121 4821 5521 6221 6922 7622 8322 9022 MHK under 1 185% of Poverty CHIP 73 1910 2572 3234 3895 4557 5219 5881 6543 7205 7866 8528 Premium 14 19 24 29 34 38 43 48 53 58 63 150% of Poverty CHIP 71 & 72 1558 2098 2638 3178 3718 4258 4798 5338 5878 6417 6957 148% of Poverty MHK 1538 2071 2604 3137 3670 4203 4736 5269 5802 6335 6868 141% of Poverty MPW HIF 1468 1977 2485 2993 3503 4011 4519 5029 5537 6045 6554 100% of Poverty 1005 1354 1702 2050 2399 2747 3095 3444 3792 4140 4489 MHF 192 308 386 456 520 582 645 704 764 823 882 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 14752 15815 16877 17940 19002 20064 21127 22189 23252 24314 25376 Premium 544 583 623 662 701 740 779 818 858 897 936 225% of Poverty CHIP 74 11125 11667 12727 13528 14329 15131 15932 16733 17534 18335 19136 Premium 223 239 254 270 286 303 319 335 351 367 382 201% of Poverty UWHS 9964 10682 11399 12117 12834 13552 14269 14987 15705 16422 17140 196% of Poverty MPW & MHK under 1 9722 10422 11122 11823 12523 13223 13923 14623 15323 16024 16724 185% of Poverty CHIP 73 9190 9852 10514 11176 11837 12499 13161 13823 14485 15147 15808 Premium 68 73 77 82 87 92 97 102 107 112 116 150% of Poverty CHIP 71 & 72 7497 8037 8577 9117 9657 10197 10737 11277 11817 12357 12896 148% of Poverty MHK 7401 7934 8466 8999 9532 10065 10598 11131 11664 12197 12730 141% of Poverty MPW HIF 7063 7571 8080 8588 9096 9606 10114 10622 11132 11640 12148 100% of Poverty 4837 5185 5534 5882 6230 6579 6927 7275 7624 7972 8320 MHF 942 1002 1060 1120 1180 1239 1298 1358 1417 1477 1536

Revised 06/2017

MAGI income maximums with 5% of FPL included and CHIP premium amounts 04/01/2017 through 06/30/2017 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3066 4128 5191 6253 7315 8378 9440 10503 11565 12627 13690 Premium 111 150 189 228 267 305 344 383 422 461 500 225% of Poverty CHIP 74 2312 3113 3914 4715 5517 6318 7119 7920 8721 9522 10324 Premium 46 62 78 93 109 125 141 157 173 188 204 201% of Poverty UWHS 2071 2788 3506 4223 4941 5659 6376 7094 7811 8529 9246 196% of Poverty MPW & 2021 2721 3421 4121 4821 5521 6221 6922 7622 8322 9022 MHK under 1 185% of Poverty CHIP 73 1910 2572 3234 3895 4557 5219 5881 6543 7205 7866 8528 Premium 14 19 24 28 33 38 43 48 53 57 62 150% of Poverty CHIP 71 & 72 1558 2098 2638 3178 3718 4258 4798 5338 5878 6417 6957 148% of Poverty MHK 1538 2071 2604 3137 3670 4203 4736 5269 5802 6335 6868 141% of Poverty MPW HIF 1468 1977 2485 2993 3503 4011 4519 5029 5537 6045 6554 100% of Poverty 1005 1354 1702 2050 2399 2747 3095 3444 3792 4140 4489 MHF 192 309 386 456 520 582 645 704 764 823 882 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 14752 15815 16877 17940 19002 20064 21127 22189 23252 24314 25376 Premium 539 578 617 656 695 734 773 812 851 890 929 225% of Poverty CHIP 74 11125 11667 12727 13528 14329 15131 15932 16733 17534 18335 19136 Premium 220 236 253 269 285 300 316 332 348 364 380 201% of Poverty UWHS 9964 10682 11399 12117 12834 13552 14269 14987 15705 16422 17140 196% of Poverty MPW & MHK under 1 9722 10422 11122 11823 12523 13223 13923 14623 15323 16024 16724 185% of Poverty CHIP 73 9190 9852 10514 11176 11837 12499 13161 13823 14485 15147 15808 Premium 67 72 77 82 87 91 96 101 106 111 116 150% of Poverty CHIP 71 & 72 7497 8037 8577 9117 9657 10197 10737 11277 11817 12357 12896 148% of Poverty MHK 7401 7934 8466 8999 9532 10065 10598 11131 11664 12197 12730 141% of Poverty MPW HIF 7063 7571 8080 8588 9096 9606 10114 10622 11132 11640 12148 100% of Poverty 4837 5185 5534 5882 6230 6579 6927 7275 7624 7972 8320 MHF 942 1002 1060 1120 1180 1239 1298 1358 1417 1477 1536

Revised 04/01/2017

MAGI income maximums with 5% of FPL included and CHIP premium amounts 07/01/2016 through 03/31/2017 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3020 4072 5124 6177 7229 8281 9336 10393 11451 12508 13565 Premium 111 150 189 228 267 305 344 383 422 461 500 225% of Poverty CHIP 74 2277 3071 3864 4658 5451 6245 7040 7838 8635 9432 10230 Premium 46 62 78 93 109 125 141 157 173 188 204 201% of Poverty UWHS 2040 2751 3461 4172 4883 5458 6306 7020 7734 8448 9162 196% of Poverty MPW & 1990 2684 3377 4071 4764 5458 6153 6850 7546 8243 8940 MHK under 1 185% of Poverty CHIP 73 1881 2537 3192 3848 4503 5159 5816 6475 7133 7792 8451 Premium 14 19 24 28 33 38 43 48 53 57 62 150% of Poverty CHIP 71 & 72 1535 2070 2604 3139 3674 4209 4745 5282 5819 6357 6894 148% of Poverty MHK 1515 2043 2571 3099 3627 4154 4684 5214 5744 6275 6805 141% of Poverty MPW HIF 1446 1950 2453 2957 3461 3964 4469 4975 5482 5988 6494 100% of Poverty 990 1335 1680 2025 2370 2715 3061 3408 3755 4101 4448 MHF 191 308 385 455 519 581 644 703 762 822 881 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 14623 15680 16737 17795 18852 19909 20967 22024 23081 24139 21596 Premium 539 578 617 656 695 734 773 812 851 890 929 225% of Poverty CHIP 74 11027 11824 12622 13419 14216 15014 15811 16608 17406 18203 19000 Premium 220 236 253 269 285 300 316 332 348 364 380 201% of Poverty UWHS 9876 10591 11305 12019 12733 13447 14161 14875 15590 16304 17018 196% of Poverty MPW & MHK under 1 9637 10334 11030 11727 12424 13121 13818 14514 15211 15908 16605 185% of Poverty CHIP 73 9109 9768 10427 11085 11744 12403 13061 13720 14379 15037 15696 Premium 67 72 77 82 87 91 96 101 106 111 116 150% of Poverty CHIP 71 & 72 7431 7969 8506 9043 9581 10118 10655 11193 11730 12267 12805 148% of Poverty MHK 7336 7866 8396 8927 9457 9988 10518 11048 11579 12109 12640 141% of Poverty MPW HIF 7000 7506 8012 8518 9025 9531 10037 10543 11049 11555 12061 100% of Poverty 4795 5141 5488 5835 6181 6528 6875 7221 7568 7915 8261 MHF 940 1000 1059 1118 1178 1237 1296 1356 1415 1474 1534 Revised 06/01/2016

MAGI income with 5% of FPL included and CHIP premium amounts 04/01/2016 through 06/30/2016 # of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty SMHB & CHIP 75 3086 4184 5282 6380 7478 8576 9674 10772 11870 12968 14066 Premium 113 152 191 231 270 309 348 387 427 466 505 225% of Poverty CHIP 74 2327 3155 3983 4811 5639 6467 7295 8123 8951 9779 10607 Premium 46 62 78 95 111 126 142 158 174 190 207 201% of Poverty UWHS 2085 2826 3568 4309 5051 5793 6534 7276 8017 8759 9501 196% of Poverty MPW & 2034 2758 3481 4205 4928 5652 6376 7099 7823 8546 9270 MHK under 1 185% of Poverty CHIP 73 1923 2607 3291 3975 4659 5343 6027 6711 7395 8079 8763 Premium 14 19 24 29 34 38 43 48 53 58 63 150% of Poverty CHIP 71 & 72 1569 2127 2685 3243 3801 4359 4917 5475 6033 6591 7149 148% of Poverty MHK 1548 2099 2650 3201 3752 4302 4853 5404 5955 6506 7056 141% of Poverty MPW HIF 1478 2004 2529 3055 3580 4106 4632 5157 5683 6208 6734 MHF 192 310 388 458 523 586 649 709 769 829 889 100% of Poverty (without 5%) 1012 1372 1732 2092 2452 2812 3172 3532 3892 4252 4612 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty SMHB & CHIP 75 15164 16262 17360 18458 19556 20654 21752 22850 23948 25046 26144 Premium 544 583 623 662 701 740 779 818 858 897 936 225% of Poverty CHIP 74 11435 12263 13091 13919 14747 15575 16403 17231 18059 18887 19715 Premium 223 239 254 270 286 303 319 335 351 367 382 201% of Poverty UWHS 10242 10984 11725 12467 13209 13950 14692 15433 16175 16917 17658 196% of Poverty MPW & MHK under 1 9994 10717 11441 12164 12888 13612 14335 15059 15782 16506 17230 185% of Poverty CHIP 73 9447 10131 10815 11499 12183 12867 13551 14235 14919 15603 16287 Premium 68 73 77 82 87 92 97 102 107 112 116 150% of Poverty CHIP 71 & 72 7707 8265 8823 9381 9939 10497 11055 11613 12171 12729 13287 148% of Poverty MHK 7607 8158 8709 9260 9810 10361 10912 11463 12014 12564 13115 141% of Poverty MPW HIF 7260 7785 8311 8836 9362 9888 10413 10939 11464 11990 12516 MHF 949 1009 1069 1129 1189 1249 1309 1369 1429 1489 1549 100% of Poverty (without 5%) 4972 5332 5692 6052 6412 6772 7132 7492 7852 8212 8572 Revised 03/03/2016

MAGI income with 5% of FPL included and CHIP premium amounts effective 07/01/2015 – 3/31/2016

300% of Poverty CHIP 75 3020 4072 5124 6176 7229 8281 9336 10393 11451 12508 13343 Premium 110 149 188 227 266 305 344 383 422 461 500 225% of Poverty CHIP 74 2278 3071 3864 4658 5452 6245 7040 7837 8635 9432 10007 Premium 45 61 77 93 109 125 141 157 173 188 204 201% of Poverty UWHS 2040 2751 3461 4172 4883 5594 6306 7020 7734 8448 8940 196% of Poverty MPW & MHK under 1 1991 2684 3377 4070 4765 5458 6153 6849 7547 8243 8718 185% of Poverty CHIP 73 1882 2537 3192 3848 4504 5159 5816 6474 7134 7792 8228 Premium 14 19 23 28 33 38 43 48 53 57 62 150% of Poverty CHIP 71 & 72 1535 2070 2604 3139 3674 4209 4745 5282 5820 6357 6672 148% of Poverty MHK 1516 2043 2571 3098 3627 4155 4684 5214 5745 6275 6583 141% of Poverty MWP HIF 1446 1950 2453 2957 3461 3965 4469 4975 5482 5988 6271 100% of Poverty 990 1335 1680 2025 2370 2715 3061 3408 3755 4101 4448 MHF 191 308 385 455 519 581 644 703 762 822 881 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty CHIP 75 3149 4206 5263 6321 7378 8435 9493 10550 11607 12665 13722 Premium 539 578 617 656 695 734 773 812 851 890 929 225% of Poverty CHIP 74 2375 3172 3969 4767 5564 6361 7159 7956 8753 9551 10348 Premium 220 236 253 269 285 300 316 332 348 364 380 201% of Poverty UWHS 2127 2841 3555 4270 4984 5697 6412 7126 7840 8555 9268 196% of Poverty MPW & MHK under 1 2076 2772 3469 4166 4863 5559 6257 6953 7650 8347 9044 185% of Poverty CHIP 73 1962 2621 3279 3938 4597 5255 5914 6573 7231 7890 8549 Premium 67 72 77 82 87 91 96 101 106 111 116 150% of Poverty CHIP 71 & 72 1601 2138 2675 3213 3750 4287 4825 5362 5899 6437 6974 148% of Poverty MHK 1580 2110 2640 3172 3702 4232 4763 5293 5823 6354 6884 141% of Poverty MWP HIF 1508 2014 2520 3026 3532 4038 4545 5051 5556 6063 6569 100% of Poverty 1033 1379 1726 2073 2419 2766 3113 3459 3806 4153 4499 MHF 940 1000 1059 1118 1178 1237 1296 1356 1415 1474 1534

Revised 03/03/2016

# of Persons 1 2 3 4 5 6 7 8 9 10 11 300% of Poverty CHIP 75 2992 4049 5107 6164 7221 8279 9336 10393 11451 12508 13565 Premium 109 148 186 224 262 300 338 376 414 452 490 225% of Poverty CHIP 74 2256 3054 3851 4648 5446 6243 7040 7838 8635 9432 10230 Premium 45 60 76 92 107 122 138 154 170 185 200 201% of Poverty UWHS 2021 2735 3449 4163 4878 5592 6306 7020 7734 8448 9162 196% of Poverty MPW & MHK under 1 1972 2669 3366 4062 4759 5456 6153 6850 7546 8243 8940 185% of Poverty CHIP 73 1864 2523 3181 3840 4499 5157 5816 6475 7133 7792 8451 Premium 14 18 23 28 33 37 42 47 52 56 61 150% of Poverty CHIP 71 & 72 1521 2058 2595 3133 3670 4207 4745 5282 5819 6357 6894 148% of Poverty MHK 1501 2032 2562 3092 3623 4153 4684 5214 5744 6275 6805 141% of Poverty MWP HIF 1433 1939 2445 2951 3457 3963 4469 4975 5482 5988 6494 100% of Poverty 981 1328 1675 2021 2368 2715 3061 3408 3755 4101 4448 MHF 191 308 385 455 519 581 644 703 762 822 881 # of Persons 12 13 14 15 16 17 18 19 20 21 22 300% of Poverty CHIP 75 14623 15680 16737 17795 18852 19909 20967 22024 23081 24139 25196 Premium 528 566 604 642 680 718 757 795 833 871 909 225% of Poverty CHIP 74 11027 11824 12622 13419 14216 15014 15811 16608 17406 18203 19000 Premium 216 231 247 263 279 293 309 325 341 356 371 201% of Poverty UWHS 9876 10591 11305 12019 12733 13447 14161 14875 15590 16304 17018 196% of Poverty MPW & MHK under 1 9637 10334 11030 11727 12424 13121 13818 14514 15211 15908 16605 185% of Poverty CHIP 73 9109 9768 10427 11085 11744 12403 13061 13720 14379 15037 15696 Premium 66 70 75 80 85 89 94 99 104 108 113 150% of Poverty CHIP 71 & 72 7431 7969 8506 9043 9581 10118 10655 11193 11730 12267 12805 148% of Poverty MHK 7336 7866 8396 8927 9457 9988 10518 11048 11579 12109 12640 141% of Poverty MWP HIF 7000 7506 8012 8518 9025 9531 10037 10543 11049 11555 12061 100% of Poverty 4795 5141 5488 5835 6181 6528 6875 7221 7568 7915 8261 MHF 940 1000 1059 1118 1178 1237 1296 1356 1415 1474 1534

Revised 5/20/2015

Section 1800.000.00 Appendix A, Page 18

(mhabd)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual#

(mhabd)(0803-000-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0803-000-00#

(mhabd)(0803-000-00)(block-1)0803.000.00 Authorized Representative(s) for MO HealthNet – DSS Manuals#

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(mhabd)(0804-000-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0804-000-00#

(mhabd)(0804-000-00)(0804-005-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0804-005-00#

(mhabd)(0804-000-00)(0804-005-00)(block-1)0804.005.00 MHABD Application Timeframes – DSS Manuals#

IM-125 September 13, 2022

MO HealthNet (MHN) applications must be processed without delay. Complete the eligibility determination to ensure the participant is mailed their approval or denial notice in a timely manner within the specific application timeframes for MO HealthNet for the Aged, Blind, and Disabled (MHABD) programs shown below.

Program Name: Application timeframe: MHABD – using Old Age Assistance (OAA) eligibility 45 days MHABD – using Permanently and Totally Disabled (PTD) or Aid to the Blind (AB) eligibility 90 days Supplemental Aid to the Blind (SAB) 90 days Blind Pension (BP) 90 days Supplemental Nursing Care (SNC) – using OAA eligibility 45 days SNC – using PTD eligibility 90 days Medicare Savings Plan programs including Qualified Medicare Beneficiary (QMB) and Specified Low Income Medicare Beneficiary (SLMB) 45 days Qualified Disabled Working Individuals (QDWI) 45 days

(mhabd)(0804-000-00)(0804-010-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0804-010-00#

(mhabd)(0804-000-00)(0804-010-00)(block-1)0804.010.00 Voluntary Withdrawal – DSS Manuals#

IM-125 September 13, 2022

An applicant has the right to withdraw their application at any time. If the applicant chooses to withdraw, accept the applicant’s verbal or written statement that they are withdrawing the application.

When an application is voluntarily withdrawn, document any relevant information including the reason for the action and clearly indicate that withdrawal was made at the request of the applicant. Provide the applicant with appropriate notice that the application was denied.

(mhabd)(0804-000-00)(0804-015-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0804-015-00#

(mhabd)(0804-000-00)(0804-015-00)(block-1)0804.015.00 Rejection Before the End of the Timeframe – DSS Manuals#

IM-125 September 13, 2022

MO HealthNet (MHN) applications can be rejected for failure to cooperate or failure to provide verification prior to the application due date if the participant has been provided with a Request for Information and has failed to provide the requested information. If all of the information is provided by or on the final day of the application timeframe as outlined in 0804.005.00 MHABD Application Timeframes , the application should be cancel rejected and processed using the original application date. See 0804.020.00 Canceling a Rejection .

(mhabd)(0804-000-00)(0804-020-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0804-020-00#

(mhabd)(0804-000-00)(0804-020-00)(block-1)0804.020.00 Canceling a Rejection – DSS Manuals#

IM-125 September 13, 2022

MO HealthNet for the Aged, Blind, and Disabled (MHABD) applications rejected due to verification not provided or participant’s failure to cooperate may be cancel rejected when:

the application was rejected in error

a hearing decision requires this action, or

ALL requested information is provided by the application due date

Agency errors occur when staff fail to act promptly on information provided by the participant and/or verification provided, causing the application to reject. Applications rejected due to an agency error must be cancel rejected. See IM Resources for guides.

MHABD applications rejected for failure to provide information or failure to cooperate may be cancel rejected if ALL requested information is received by the application due date.

Application due dates are referenced in MHABD manual section 0804.005.00 MHABD Application Timeframes .

If all necessary information is not provided by the original due date of the application, no further action is necessary and the participant would need to reapply.

EXAMPLE: Bob applied for MHABD on April 25 and his application is due 45 days from the application date, on June 9. On April 25, a Request for Information notification was generated requesting verification of his income. The notification expired on May 5. The requested information was not received, and Bob did not request more time, so staff rejected the application.

On May 25, Bob provided the information. Staff cancel rejected the application and processed using the original application date of April 25. If the requested information had been provided after June 9, the rejection could not be canceled and he would have had to reapply.

Add a Person Requests

An add a person application will have different processing guidelines depending on if the person is requesting coverage or being added as an included household member.

If the person being added is requesting coverage: Follow the same timeframes as an initial application. If the case closed due to failure to provide requested verification and ALL requested verification is provided within the cancel rejection timeframe , cancel close the case. After authorizing the cancel close, register a new add a person application using the original application date.

If the person being added is not requesting coverage: Consider this a change in circumstance, not an application. If the case closes, only the cancel close policy would apply, not the cancel rejection policy. Refer to 0840.015.10 Reopening Closed Cases .

EXAMPLE: On July 16, Mary requested to add coverage to her active MHABD case for her spouse, Louis, as he is permanently and totally disabled (PTD). FSD sent a Request for Information Notice and it expired on July 30 with no response from the participants. The case closed and the add a person application rejected on August 10.

An application based on PTD is due within 90 days, or October 14th. Mary and Louis provide ALL of the requested information on October 12. Mary’s case must be cancel closed because the verification was provided before the cancel rejection timeframe, even though it was provided after the cancel closing timeframe.

After cancel closing, staff must register an add a person application requesting benefits for Louis using July 16 (the original add a person request date) as the application date.

Cancel Rejections for Add a Category Requests

When a participant requests an additional benefit be added to their existing MO HealthNet (MHN) coverage, it is considered an add a category request. Follow application timeframes when applying the cancel rejection policy. Refer to 0840.015.10 Reopening Closed Cases .

Additions to existing MHN coverage include, but are not limited to:

Adding QMB or SLMB

Adding a grant such as Blind Pension (BP), Supplemental Aid to the Blind (SAB), or Supplemental Nursing Care (SNC)

NOTE: A new application is not required to move from one MO HealthNet program to another MO HealthNet only program. However, a signed application is required to move from a MHN only program to an MHABD Cash assistance program, such as BP, SAB, or SNC. A signed application may be required to move from QMB only, SLMB1 only, or SLMB2 only to other MHABD benefits.

Changing a category from one type of medical coverage to another is a change in circumstance. If the case closes, apply the cancel closing policy; do NOT apply the cancel rejection policy.

Changes in MHN category include, but are not limited to:

A change from MHABD (Spend Down or Non-Spend Down) coverage to Ticket to Work Health Assurance (TWHA) coverage

A change from MHABD (Spend Down or Non-Spend Down) coverage to Vendor or Home and Community Based Services (HCB) coverage

A change from MO HealthNet for Disabled Children (MHDC) to Missouri’s Children with Developmental Disabilities (MOCDD)

A change from Vendor coverage to MHABD (Spend Down or Non-Spend Down) coverage

A change from MHABD (Spend Down or Non-Spend Down) coverage to 1619b coverage

NOTE: The MO HealthNet Division (MHD) Stakeholder Services Unit (formerly the Premium Collections Unit) must be notified when a MHABD Spend Down or Ticket to Work (TWHA) case is reopened for any reason.

The MHD Medicare Buy-In Unit must be notified when a QMB/SLMB case is reopened for any reason. Refer to IM Resources for the current procedure for reopening Spend Down, TWHA, and QMB/SLMB cases.

(mhabd)(0804-000-00)(0804-025-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0804-025-00#

(mhabd)(0804-000-00)(0804-025-00)(block-1)0804.025.00 MO HealthNet Application Concurrent With MHABD Cash Programs – DSS Manuals#

IM-125 September 13, 2022

If a participant requests MHN coverage and any type of MHABD cash program at the same time, process the applications together. If all information is received to approve the MHN case before all necessary information needed to determine eligibility for the cash program is received, approve the MHN case. When the information is received to complete the cash determination and eligibility is determined, authorize approval or rejection, and send a notice advising the participant of the change.

An active MHABD program participant may use the MO HealthNet Application Addendum: Request to Add Cash Benefits (IM-1MAC) to apply for the following programs:

Supplemental Nursing Care (SNC)

Supplemental Aid to the Blind (SAB)

Blind Pension (BP)

The IM-1MAC is NOT a stand-alone application and can only be used for participants who:

have active MHABD coverage; OR

have a pending MHABD application

(mhabd)(0804-000-00)(block-1)0804.000.00 Application Processing – DSS Manuals#

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(mhabd)(0805-000-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-000-00#

(mhabd)(0805-000-00)(0805-005-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-005-00#

(mhabd)(0805-000-00)(0805-005-00)(block-1)0805.005.00 December 1973 Eligibility Requirements – DSS Manuals#

IM-93 June 10, 2019

RSMo 208.151 establishes that to be eligible for MO HealthNet for the Aged, Blind and Disabled (MHABD), the participant must meet the December 1973 eligibility requirements for Old Age Assistance (OAA), Permanent and Total Disability (PTD), or Aid to the Blind (AB). MHABD OAA, PTD, or AB eligibility is always based on eligibility factors in effect in December 1973. The participant is approved for the most appropriate coverage type.

These eligibility factors are explained in 1000.000.00 December 1973 Eligibility Requirements . If the participant is ineligible on any one of these factors, explore eligibility for Related Special Eligibility Groups .

(mhabd)(0805-000-00)(0805-015-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-00#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-05)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-05#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-05)(0805-015-05-05)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-05-05#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-05)(0805-015-05-05)(block-1)0805.015.05.05 Couple Cases in the IMU5 System – DSS Manuals#

IM-112 September 16, 2002

To prevent spenddown couples from each paying the full amount of spenddown, the IMU5 system requires married couples to be combined on one Medical Assistance case. If one spouse is eligible and the other is not, the system requires the non-eligible spouse to be entered as an included person (level of care “Z” in field 13G) in IMU5.

The casehead or payee must be an active MA recipient. If the payee loses eligibility for any reason the case must be closed and a new case opened in the name of the eligible spouse. A new application will not be required.

This section only applies to MA cases using a two-person expense. It does not apply to cases that always use a one-person expense such as BP, SAB, Vendor, MA-HCB, MA-WD, etc.

(mhabd)(0805-000-00)(0805-015-00)(0805-015-05)(block-1)0805.015.05 Persons Whose Income and Needs Are Considered – DSS Manuals#

IM-79 June 30, 2017 ; IM-97 November 7, 2013

A claimant’s need is determined as single individual or a married couple.

For a single individual Age 18 and over, consider only the claimant’s gross income in determining the adjusted income Under age 18, refer to the MA disabled child budgeting procedures in 0805.020.00 Medical Assistance for Disabled Children (MADC) EXCEPTION : When a child under age 18 is approved for Missouri’s Children with Developmental Disabilities (MOCDD) waiver services, refer to MOCDD budgeting procedures in 0825.030.35 Income and Budgeting .

For a married couple who are living together: Consider the gross income of the couple in determining the adjusted income Do not consider the income and expenses of minor children Consider the medical expenses of the couple in determining whether or not the spenddown is met, when applicable

When a married couple is living together and one spouse is receiving MO HealthNet under Supplemental Nursing Care (SNC), Supplemental Aid to the Blind (SAB), or Supplemental Payments (SP), treat the MO HealthNet for the Aged, Blind, and Disabled (MHABD) participant as a single individual; do not consider the income and medical expenses of their spouse in the MHABD eligibility determination. The income maximum is that for a single person.

When the spouse of a MHABD claimant is receiving MO HealthNet under Blind Pension (BP), MO HealthNet for Families (MHF) (with or without a Temporary Assistance (TA) cash grant), MO HealthNet for Kids (MHK), MO HealthNet for Pregnant Women (MPW), or Transitional Medical Assistance (TMA), treat the MHABD participant as a couple and include their spouse’s needs and income (excluding the BP cash grant) in the MHABD eligibility determination.

When a spouse of a MHABD participant is receiving MHF with a TA cash grant, do not include the TA cash grant in the MHABD eligibility determination.

Medical expenses, of the spouse that has coverage under another MO HealthNet program, that are not paid by MO HealthNet, may be allowed to meet the MHABD participant’s spend down. In addition, continue to use the income and expenses of the MHABD participant in determining MHF, MHK, MPW, or TA eligibility if the person meets criteria for inclusion in that assistance group.

(mhabd)(0805-000-00)(0805-015-00)(0805-015-10)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-10#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-10)(0805-015-10-05)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-10-05#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-10)(0805-015-10-05)(block-1)0805.015.10.05 Social Security Cost of Living Adjustment (COLA) Disregard – DSS Manuals#

IM-76 December 23, 2014 ; IM-114 December 13, 2013 ; IM-100 December 7, 2012 ; IM-04 January 7, 2008

Senate Bill 577 (2007) amended RSMo 208.153 to specify that programs in which income eligibility is determined by Federal Poverty Level (FPL) will not be adjusted for annual Cost of Living Adjustment (COLA) changes in OASDI or SSI benefits until the next FPL adjustment.

FAMIS disregards the COLA amount entered for January’s income for the MO HealthNet for Aged, Blind and Disabled (MHABD) Spend down and Non-Spenddown Programs until the next FPL adjustment for April. SSA and SSI incomes for individuals in any FAMIS EU entered after the adjustment must include the pre-COLA adjusted amount for December and the COLA-adjusted amount for January with a verification code of CO (COLA).

Example 1 : Applications Made After COLA Mass Adjustment (December)

On February 8, Ms. Foster applies for Food Stamps and MO HealthNet for Aged Blind and Disabled benefits. Ms. Foster has been receiving Social Security Disability Income (SSDI/SSA) for five years. Enter Ms. Foster’s pre-COLA adjusted SSA income for the month of December with the appropriate verification code of HC or TC. Enter her COLA-adjusted SSA income for the budget month of January and ongoing with verification code of CO. The Food Stamp EU eligibility determination budgets the current (COLA-adjusted) SSA amounts; the MHABD eligibility determination budgets the pre-COLA adjusted SSA amount.

Example 2 : Active EUs with Participants that Begin Receiving SSA/SSI Between COLA and FPL Mass Adjustments

The Jackson family is active in FAMIS, receiving MHABD and Food Stamp benefits. Mrs. Jackson reports that daughter, Jessie, begins receiving SSI February 1. Enter Jessie’s new SSI income for the month of February with a verification code of HC or TC. Continue to budget Mrs. Jackson’s pre-COLA SSA income that she was receiving based on disability using a verification code of CO; do not change the verification code from CO to HC or TC.

Example 3 : Exploring Prior Quarter for MHABD Applications Taken After the FPL Adjustments

On March 15, Ms. Ola applies for MO HealthNet for Aged, Blind, and Disabled (MHABD). She requests prior quarter coverage for her emergency room visit. Ms. Ola has been receiving SSDI for several years. Enter her pre-COLA SSDI received for December with the appropriate verification code of HC or TC and the COLA-adjusted income for the months of January-March with a verification code of CO.

NOTE: FAMIS does not disregard the COLA amount entered for January’s income for Blind Pension (BP), Vendor (VEND), Missouri Children with Developmental Disabilities (MOCDD), Home and Community Based (HCB) Waiver Services, Supplemental Aid to the Blind(SAB), and Supplemental Nursing Care (SNC) programs.

(mhabd)(0805-000-00)(0805-015-00)(0805-015-10)(block-1)0805.015.10 Income Exclusions – DSS Manuals#

IM-127 September 22, 2022 ; IM-47 April 27, 2021 ; IM-04 January 26, 2021 ; IM-133 August 27, 2020 ; IM-35 April 29, 2020 ; IM-33 April 17, 2020 ; IM-162 October 10, 2019 ; IM-81 May 17, 2019 ; IM-11 January 28, 2019 ; IM-02 January 17, 2019 ; IM-79 June 30, 2017 ; IM-96 October 26, 2015 ; IM-30 April 9, 2010 ; IM-15 March 9, 2010 ; IM-55 July 21, 2009 ; IM-69 July 26, 2007 ; IM-137 October 24, 2003 ; IM-122 December 31, 1992 ; IM-54 March 15, 2001 ; IM-81 April 26, 2001

Exclude, as income, any of the following:

Department of Mental Health Funds

Compensation received under the Federal Older Americans Volunteer Program – Section 611 of Title VI of Public Law 93-29 dated May 3, 1973, (also called the “Foster Grandparent” and Older Americans Community Service Program) excludes any income received under this program by the individual volunteers, age 60 or over, from being considered on the budget.

Any payments for supportive services or reimbursement of out-of-pocket expenses made to individual volunteers, grandparents, senior health aides, or senior companions, and to persons serving in the Service Corps of Retired Executives (SCORE) and Active Corps of Executives (ACE) and any other programs under Title II and III of the Domestic Volunteer Services Act of 1973 (Public Law 93-113).

Vocational Rehabilitation Payments – Payments made for maintenance, transportation, tuition, fees, etc., in connection with a claimant participating in training or school attendance subsidized by the Division of Vocational Rehabilitation.

Loans or grants to an undergraduate student for educational purposes made or insured under any program administered by the Commissioner of Education. This includes the Basic Educational Opportunity Grants Program (BEOG), Supplemental Educational Opportunity Grants (SEOG), National Direct Student Loans (NDSL) and Guaranteed Student Loans and PELL grants.

Veterans Education Assistance – Exclude as income that portion of a Veterans Educational Assistance payment that is for the “student” and that is actually used for items such as tuition, books, fees, equipment, transportation for school purposes, child care services necessary for school attendance, etc.

Low-Income Home Energy Assistance payments made under the Low Income Home Energy Assistance Act of 1981 are not considered as income.

Certain Home Energy Assistance payments made on or after October 1, 1983, by energy suppliers or private nonprofit organizations are excluded. “Home energy assistance” is defined as any assistance that is related to home energy, except food or clothing.

Exclude the payment as income if it is made in cash or in-kind by:

a supplier of home heating gas or oil a municipal utility providing home energy

If the payment is made in-kind by a private nonprofit organization, exclude the payment as income. Consider cash payments made by private nonprofit organizations as income.

Agent Orange – payments made as a result of the class action lawsuit In Re: Agent Orange product liability litigation, M.D.L. No. 381 (E.D.N.Y). This settlement fund was closed in 1997.

Disability payments received from the Veterans Administration (VA) due to service-related disabilities resulting from exposure to Agent Orange should be treated in the same manner as other VA payments.

Missouri Family Trust Fund – Exclude payments from the Missouri Family Trust Fund made on behalf of a beneficiary who is an applicant/recipient of MO HealthNet.

Temporary Assistance cash grant

Blind Pension cash grant

Bona Fide Loans – Refer to 1025.015.14 Proceeds From a Bona Fide Loan of the December 1973 Eligibility Requirements manual.

Ricky Ray Hemophilia Fund – Refer to 1025.015.08 Ricky Ray Hemophilia Fund and Susan Walker v. Bayer Corporation Class Action Settlement Payments of the December 1973 Eligibility Requirements manual.

PASS Account – Money SSI recipients set aside under an approved Plan for Achieving Self-Support (PASS). SSA must approve the written plan.

The allowance provided to children of Vietnam veterans (including adult children) who were born with the congenital defect, spina bifida

Any income earned by individuals eligible for certified extended employment at a sheltered workshop. This includes income earned from employment at a sheltered workshop and from other employers.

Supportive service payments, stipends (a payment received while participating in a training program), and needs related payments from Workforce Investment Act (WIA) program(s)

WIA work experience payments

Any portion of a veteran’s pension designated for Aid and Attendance. Aid and Attendance provides income for veterans and surviving spouses who require the assistance of another person to perform daily living activities such as bathing and dressing. Use verification from the Veterans Administration to determine what portion of the payment is designated as Aid and Attendance.

Any benefits designated for a veteran’s dependent. Dependents of veterans are considered when determining a veteran’s or a surviving spouse’s eligibility for pension and can result in an increased pension. Use verification from the Veterans Administration to determine what portion of the payment is designated as dependent income.

Any portion of a veteran’s pension paid for Unusual Medical Expenses, also known as unreimbursed medical expenses. The Veterans Administration uses a formula to compare medical expenses to the monthly income in the veteran’s household which can result in a higher pension payment. Use verification from the Veterans Administration to determine what portion of the payment is designated as Unusual Medical Expenses

VA Housebound Allowances, also known as Home Bound, may increase a monthly pension when the veteran is confined to their home due to a permanent disability. Use verification from the Veterans Administration to determine what portion of the payment is designated as VA Housebound Allowances.

Achieving a Better Life Experience (ABLE) account. Third-party contributions to and interest, dividends, or other distributed earnings in an ABLE account. Also exclude from income payments made from an ABLE account for qualified disability expenses. Refer to manual section 1025.015.17 for more information regarding ABLE accounts.

Any payment received from a State or Federal government emergency disaster relief assistance program. Examples include: National Flood Insurance Act of 1968 (NFIP), Federal Emergency Management Agency (FEMA), the Disaster Relief and Emergency Assistance Act (P.L. 100-707), because of a presidentially declared major disaster, comparable assistance received from a State or local government or from a disaster assistance organization. Refer to 1025.015.01.01 Cash Remaining From Any State or Federal Assistance Check of the December 1973 Eligibility Requirements manual for more information regarding State or Federal government emergency assistance payments. NOTE: Interest earned on any unspent State or Federal government emergency disaster or relief assistance payments is excluded from income. However, any interest earned on such payments that is retained into the month following the month of receipt, is a countable resource.

Any payment received from Economic Impact Payments, also known as COVID-19 Stimulus, approved as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act signed into law on March 27, 2020, Consolidated Appropriations Act, December 27, 2020, and the American Rescue Plan Act, March 11, 2021. These payments were made automatically to qualifying individuals. Payment is excluded as a resource for the first 12 months of receipt.

Certain Native American (Indian) incomes including: Any funds distributed per capita to or held in trust for members of any tribe under Public Law 92-254, Section 7 of Public Law 93-134, Public Law 94-540, Section 4 of Public Law 97-458, or Section 2 of Public Law 98-64. Pursuant to Section 15 of Public Law 100-241, any of the following distributions from a Native Corporation established pursuant to the Alaska Native Claims Settlement Act (Public Law 92-203). Cash (including cash dividends on stock received from a Native Corporation) not exceeding $2000 per individual per year. Stock (including stock issued or distributed by a Native Corporation as a dividend or distribution on stock). A partnership interest in land, land, or an interest in land received from a Native Corporation as a dividend or distribution on stock. An interest in a settlement trust. Payments received by any member of the Passamaquoddy Tribe, the Penobscot Nation, or the Houlton Band of Maliseet Native Americans pursuant to the Maine Indian Claims Act of 1980 (Public Law 96-420). Payments received by any member of the Aroostook Band of Micmacs pursuant to the Aroostook Band of Micmacs Settlement Act (Public Law 102-171).

NOTE: Payments issued outside of a trust to individual members of a tribe on a per capita basis, such as casino profits, are countable income in the month received. These payments become a resource if retained into the following month.

(mhabd)(0805-000-00)(0805-015-00)(0805-015-15)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-15#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-15)(block-1)0805.015.15 Overhead Expense of Producing Income – DSS Manuals#

IM-129 August 20, 2020

Deduct the following “overhead expenses” for income producing property or self-employment enterprises, when applicable, to arrive at the gross earned or non-earned income:

Verifiable cost of ownership: mortgage or contract payments interest payments made on a loan for business purposes (payments made on a loan principal will not be considered a business expense) taxes insurance

Any verifiable expenses relating to the cost of renting property. EXAMPLE: Ms. Jones became disabled and moved in with her daughter. She receives $200.00 a month OASDI, and rents her home for $60.00 a month. Since Ms. Jones’ son-in-law actually manages the property, this income is considered non-earned income. She does pay taxes of $240.00 a year and insurance of $96.00 on the property she rents. Her expense of producing this income is $28.00 ($240.00 + $96.00 = $336.00 divided by 12 = $28.00). Her gross unearned income entered on Line 4 of the IM-30A is $232.00 [$200.00 + $32.00 ($60.00 – $28.00)].

Any verifiable expenses relating to the cost of producing income from farm property: cost of feed, seed, fertilizers, tools, equipment repair and replacement, labor, cost of operation of farm machinery, shipping costs, custom work, and land rental. NOTE: To determine the gross cash income received from farming, refer to the procedures outlined in 1025.015.01 Cash Remaining From an Assistance Check or Other Budgeted Monthly Income of the December 1973 Eligibility Requirements manual.

Any verifiable expenses relating to the cost of producing business income: cost of tools; equipment repair and replacement; labor; operating equipment; purchase of materials, supplies, or stock of goods; rental or ownership costs and utilities on separate business establishment; subcontracting (as paid).

(mhabd)(0805-000-00)(0805-015-00)(0805-015-20)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-20#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-20)(block-1)0805.015.20 Determination of Gross Earned Income – DSS Manuals#

Gross earned income is the total amount of all non-excluded earned income, minus any allowable overhead expenses for income producing property.

(mhabd)(0805-000-00)(0805-015-00)(0805-015-25)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-25#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-25)(block-1)0805.015.25 Standard Deductions From Gross Earned Income – DSS Manuals#

Determine the total adjusted earned income by deducting the following amounts, as applicable, from the claimant’s (and spouse’s, if married and living together) gross earned income:

Earned Income Exemption: The first $65.00 of the claimant’s (and spouse’s, if married and living together) earned income, plus 1/2 of the remainder.

AB and/or Student Exemption: AB work expenses — If the claimant is approved for MA under AB eligibility requirements, subtract work expenses from the earned income on an “as paid” basis. Disregard only ordinary and necessary expenses reasonably related to the earning of income. These expenses fall into three broad categories: Getting to and from work; Performing on the job; and/or Qualifying for promotion to a better paying or next higher job. EXAMPLE: Bus or taxi fare, seeing eye dog and his upkeep. These expenses must be paid by the claimant and must be job related in order to be allowed. Student exemptions — If the claimant is: under age 22, a student; approved for MA under AB or PTD eligibility requirements, subtract educational expenses from the claimant’s earned income on an “as paid” basis. Educational expenses include: Tuition and fees; Books; Room and Board; and Other expenses as determined by the educational institution to be related to student needs. The gross earned income figure minus the allowable deductions shown above, equals the adjusted earned income.

(mhabd)(0805-000-00)(0805-015-00)(0805-015-30)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-30#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-30)(block-1)0805.015.30 Unearned Income – DSS Manuals#

IM-181 December 16, 2019 ; IM-162 October 10, 2019 ; IM-146 September 27, 2019 ; IM-33 March 29, 2012 ; IM-88 December 23, 2009 ; IM-76 January 4, 1996 (1995 memo)

Gross unearned income is the total amount of all non-excluded, unearned income, including gross unearned income from income producing property minus any overhead expenses such as taxes and insurance. Evaluate the unearned income of the participant and spouse. Enter all types of income into the electronic record, including excluded income types.

Possible sources of unearned income include but are not limited to:

Child Support payments received for a child not in the home – the portion not given to or used on behalf of the child is to be considered as unearned income to the applicant/participant Child support Child support arrearages

NOTE: If a child in the home is receiving child support, budget the income to the child.

Alimony payments including the following: alimony alimony arrearages

Interest income

Property rental

Income from stocks, bonds, investments, trusts

Royalties, residual income

Benefits received under Social Security Programs, such as Social Security Disability or Social Security Retirement or SSI NOTE: Payments from Social Security, SSI, Veterans Administration (VA), or Railroad Retirement Benefits (RRB) are sometimes reduced in order to recoup an overpayment. If funds are withheld from one of these sources to repay an overpayment of funds from the same source or from any current benefits received from Social Security, SSI, VA, or RRB, budget the amount of income that remains after the ongoing recoupment is deducted. Fully record details in the electronic record to explain the reduced amount of gross income.

EXAMPLE: Mr. Ross received an over payment of $300 on his SSI benefits. Mr. Ross is now eligible for SS of $830 per month. His current Social Security benefit is being reduced by $30 per month to repay the SSI overpayment. $800 is his countable Social Security amount.

Do not deduct from gross income funds withheld for federal intercepts such as Treasury Offset Program for unpaid taxes, or past due student loans, or other state or federal unpaid debts.

Social Security and/or SSI recipients with drug addiction or alcoholism (DA&A) as a factor contributing to their disability must have payments made through a representative payee. The representative payee is allowed to charge the individual a service fee when disability is based on DA&A. This fee is not an allowable expense for MHABD.

Fees charged by Public Administrators are not an allowable expense for MHABD.

Veteran’s benefits compensation, and allowances; see 0815.030.05 Determining Adjusted Gross Income participants in vendor placements receiving a reduced VA pension.

Worker’s Compensation awards

Retirement pensions (see number 39 “Domestic Relations Orders”)

Unemployment Compensation payments

Annuities

Railroad retirement benefits

Contributions from relatives, friends, churches, clubs, etc., paid directly to the EU

NOTE: Contributions paid on behalf of the participant or spouse to a third party are not considered unearned income.

Real or personal property when sold on a time payment plan, if the unpaid balance does not cause ineligibility on resources. Consider the down payment (if any) as income in the month received. Include ongoing time payments as notes receivable.

Aliens with sponsors. Income received from sponsors is to be counted in its entirety;

Grants and scholarships for graduate students available for living expenses (grants and scholarships minus school expenses). This does not apply to undergraduate students.

Allotments including: Allowances and allotments from members of the armed forces Military allotments Community spouse allotments

Blind Pension

Supplemental Aid to the Blind

Refugee Cash Assistance

PTD State Supplemental Payment

Welfare payments from another state

Agent Orange Veterans benefits

Black Lung benefits

Payments held in trust by Secretary of Interior for Indian Tribes

Military retirement

Disability benefit

Strike benefits

Severance payments received from an employer when an employee’s job is terminated

Subsidized employment

Cash gifts, gift cards that are not store specific, received on a regular basis and can be anticipated

Lottery/gambling income

Incentive payments to encourage activity

Representative payee payments not given to the beneficiary

Notes receivable

Non–bona fide loans

Nursing home insurance income – Consider payments from long term care insurance policies as income.

Domestic Relations Orders – 26 USC 414(p): A domestic relations order (DRO) is not a type of income ; it is a court ordered division of property granting a spouse or dependent (alternate payee) ownership of certain property or portions of property owned by married individuals in the event of a divorce. Property becomes a resource to whomever is awarded the property or portion of property as a result of a DRO. Any income generated by the property belongs to the individual who owns the property after the divorce. DROs can require pensions and other retirement plans to be treated as property during divorce proceedings; the right to receive all or part of the benefits of a plan participant’s retirement plan can be awarded to an alternate payee. Generally, DROs specify the amount or percentage of the plan participant’s retirement benefits to be paid to the alternate payee. Note: A qualified domestic relations order (QDRO) is a common type of DRO utilized by non-government employers. DROs may be subject to certain state laws and specific provisions that govern how they are administered. In addition, the terms of the retirement plan may affect the administration of the DRO. Below are some examples of details that may differ among DROs. Plans may state that payments to the alternate payee will cease upon the death of the plan participant unless certain conditions are met. Cost of living increases may not be included for an alternate payee. The percentage of benefits to which the alternate payee is entitled may be limited. Example: Plans for Missouri State employees limit an alternate payee to 50% of the plan retirement benefit. Note : Missouri State employees are subject to a DRO known as a Division of Benefits Order. RSMo 104.312. Plans may or may not allow an alternate payee to receive a benefit prior to when the plan participant begins to receive a benefit from the plan. Income Budgeting Funds divided as a result of a DRO are paid by the retirement plan directly to the plan participant and alternate payee as if both were plan participants. For the retired plan participant, count the gross amount of the retirement benefit that remains after the portion payable to the alternate payee is deducted. For the alternate payee, count the gross amount of his/her portion received from the retirement plan. Example: Jack and Diane divorced in 2008. Jack is a State of Missouri employee and a Division of Benefits Order awarded Diane 50% of Jack’s future pension as part of the divorce. Jack retired from the State in December of 2018. His full pension amount is $2000 per month; he begins to receive $1000 countable monthly pension in January 2019. Although Diane retired 2 years ago, she becomes eligible for $1000 in countable monthly pension in January 2019. Example : Miranda’s years of service entitle her to a $2400 monthly pension from the Sunflower Farms Retirement Plan. As a result of a divorce, her pension is subject to a QDRO that stipulates her ex-spouse (alternate payee), Jeff, is entitled to 25% of her pension, or $600 per month. Miranda’s countable monthly pension income is $1800. Jeff’s countable monthly pension income is $600. Benefits paid to a child or other dependent (not an ex-spouse) as a result of a DRO are budgeted to the child or other dependent, although those benefits are taxed to the plan participant. Note: Do not consider DROs in the same manner as alimony, also known as maintenance or spousal support. An alternate payee receiving income as a result of a DRO receives the income as if s/he was the retirement plan participant. Under a DRO, there is no obligation on the part of one spouse to pay another spouse on a regular basis, as is normally the case with a maintenance order. Example: Howard receives a $2400 monthly pension Sunflower Farms Retirement plan. He is divorced and in the terms of his divorce, he is ordered to pay his ex-spouse, Jamie, $600 per month in alimony. Howard’s countable monthly pension is $2400. Jamie’s countable monthly alimony is $600.

Foster Care income – countable only to the participant for whom it is received.

(mhabd)(0805-000-00)(0805-015-00)(0805-015-35)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-35#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-35)(block-1)0805.015.35 Income Exemptions/Deductions – DSS Manuals#

IM-81 May 17, 2019

Personal Income Exemption : Deduct a $20.00 personal income exemption. Only one $20.00 exemption is allowed even if the income of a couple is being considered.

SSI Payment : Deduct any SSI payment received by the claimant (and spouse, if married and living together).

Hospital and Medical Insurance : Deduct medical insurance premiums as paid by the claimant (and spouse, if married and living together). The Supplemental Medical Insurance (SMI) premium will not be allowed on a non-spend down case, if the claimant is participating in Medicare – Part B, paying the premium, and receiving SSI, QMB or SLMB. The SMI premium will be allowed on a spend down case, if the claimant is participating in Medicare – Part B and not receiving QMB or SLMB. (If allowing the SMI premium on a spend down case causes the case to become non-spend down, the SMI premium will still be allowed).

If it is verified that an insurance policy is intended to provide health insurance, the premium must be considered an incurred medical expense and deducted from countable income. If an insurance policy specifies that it is designated to assist with nursing care costs while a person is a patient in a medical institution, it will be considered a health insurance policy. The following examples are types of insurance are reported through the TPL-1 system and allowable as a medical deduction: Blue Cross Blue Shield Medicare Supplement policies Cancer Insurance Nursing Care Veterans Administration Other health insurance policies The following types of insurance are not reported through the TPL-1 system and are not allowable as a medical deduction: Wage or Income Replacement policies Accident policies Life Insurance policies Combination Life and Accident Disability policies Burial Insurance policies

Health and Accident policies are not allowable as a medical deduction; however, if the policy allows for direct payment to the hospital, the policy is reported through the TPL system.

(mhabd)(0805-000-00)(0805-015-00)(0805-015-40)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-40#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-40)(block-1)0805.015.40 Types of Need Determination – DSS Manuals#

IM-08 January 24, 2012

After the participant’s gross income has been determined, and all exclusions, exemptions, and deductions allowed, round the remaining income down to the nearest whole dollar amount to arrive at the adjusted gross income.

To determine eligibility based on need, compare the adjusted gross income to the current income maximum. There are two types of need determinations: non-spend down and spend down.

If the adjusted gross income is equal to or less than the income maximum the case is eligible for MO HealthNet as non-spend down.

Spend down is an eligibility category of MO HealthNet for individuals whose income exceeds the current income maximum for MO HealthNet. If the adjusted gross income is greater than the non-spend down income maximum, the participants must reduce their income to the non-spend down income limit— “spend down” their excess income—to have MO HealthNet coverage. Federal law allows the participants to deduct from their income the amount of incurred medical expenses that are not subject to payment by a third party, or to pay-in to the state the amount of their adjusted gross income that exceeds the non-spend down income limit. This amount is the participants’ monthly spend down obligation.

(mhabd)(0805-000-00)(0805-015-00)(0805-015-45-income-maximum)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-015-45-income-maximum#

(mhabd)(0805-000-00)(0805-015-00)(0805-015-45-income-maximum)(block-1)0805.015.45 Income Maximum – DSS Manuals#

IM-49 March 21, 2019 ; IM-30 April 19, 2018 ; IM-30 March 29, 2017 ; IM-26 May 9, 2016 ; IM-22 March 20, 2015 ; IM-17 March 21, 2014 ; IM-26 March 11, 2013 ; IM-20 March 13, 2012 ; IM-08 January 24, 2012 ; IM-16 March 14, 2011 ; IM-13 March 5, 2009 ; IM-22 March 7, 2008 ; IM-26 March 23, 2007 ; IM-28 March 17, 2006 ; IM-69 June 27, 2005 ; IM-22 March 17, 2005 ; IM-70 July 29, 2004 ; IM-28 March 19, 2004 ; IM-114 August 22, 2003 ; IM-43 March 20, 2003 ; IM-119 September 20, 2002

Effective July 1, 2005, the non-spend down income maximum is 85% of the Federal Poverty Level (FPL) for both single individuals and married couples with eligibility based on OAA and PTD criteria.

Effective July 1, 2004, the non-spend down income maximum is 100% of the Federal Poverty Level (FPL) for both single individuals and married couples with eligibility based on AB criteria. The change in state law that lowered the income limit for determinations based on OAA or PTD did not affect determinations based on AB.

Before October 1, 2002, the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Income Limits were the current SSI Maximums for both single individuals and married couples. From October 1, 2002, through September 30, 2003, the non-spend down income maximum for an individual was 80% of the federal poverty level (FPL). During this period the couple limit was the SSI maximum as it exceeded 80% FPL. From October 1, 2003 through June 30, 2004, the non-spend down income maximum was 90% of the Federal Poverty Limit (FPL) for both single individuals and married couples. From July 1, 2004 through June 30, 2005, the non-spend down income maximum was 100% of the Federal Poverty Limit (FPL) for both single individuals and married couples based with eligibility based on OAA, PTD, or AB criteria.

Refer to table below for the income maximums from January 1, 2002 through June 30, 2005.

MHABD NON-SPEND DOWN OAA/PTD/AB INCOME LIMITS

EFFECTIVE DATE SINGLE COUPLE 01/01/02 $545.00 (SSI MAX) $817.00 (SSI MAX) 10/01/02 $591.00 (80%FPL) $817.00 (SSI MAX) 01/01/03 $591.00 (80%FPL) $829.00 (SSI MAX) 04/01/03 $599.00 (80% FPL) $829.00 (SSI MAX) 10/01/03 $674.00 (90% FPL $909.00 (90% FPL) 04/01/04 $699.00 (90% FPL) $937.00 (90% FPL) 7/01/04 $776.00 (100% FPL) $1041.00 (100% FPL) 4/01/05 $798.00 (100% FPL) $1070.00 (100% FPL) 04/01/19 and ongoing Refer to MHABD Appendix J

Refer to tables below for the income maximums beginning September 1, 2005 through March 31, 2019. Refer to MHABD Appendix J for current income maximums effective 04/01/2019 and ongoing.

MHABD NON-SPEND DOWN OAA/PTD INCOME LIMITS

EFFECTIVE DATE SINGLE COUPLE 9/01/05 $678.00 (85% FPL) $909.00 (85% FPL) 4/01/06 $695.00 $935.00 4/01/07 $724.00 $970.00 4/01/08 $737.00 $992.00 4/01/09 $768.00 $1033.00 4/01/11 $772.00 $1042.00 4/01/12 $792.00 $1072.00 4/01/13 $814.00 $1099.00 4/1/14 $827.00 $1115.00 4/1/15 $834.00 $1129.00 04/01/16 $842.00 $1,135.00 04/01/17 $855.00 $1,151.00 04/01/18 $860.00 $1,166.00 04/01/19 and ongoing Refer to MHABD Appendix J

MHABD NON-SPEND DOWN AB INCOME LIMITS

EFFECTIVE DATE SINGLE COUPLE 9/01/05 $776.00 (100% FPL) $1,041.00 (100% FPL) 4/01/06 $817.00 $1,100.00 4/01/07 $851.00 $1,141.00 4/01/08 $867.00 $1,167.00 4/01/09 $903.00 $1,215.00 4/01/11 $908.00 $1,226.00 4/01/12 $931.00 $1,261.00 4/01/13 $958.00 $1,293.00 4/01/14 $973.00 $1,311.00 4/01/15 $981.00 $1,328.00 4/01/16 $990.00 $1,335.00 4/01/17 $1,005.00 $1,354.00 4/01/18 $1,012.00 $1,372.00 04/01/19 and ongoing Refer to MHABD Appendix J

(mhabd)(0805-000-00)(0805-015-00)(block-1)0805.015.00 Financial Need – DSS Manuals#

IM-112 September 16, 2002 ; IM-81 April 26, 2001

If the claimant meets the December 1973 OAA, PTD, or AB eligibility requirements, determine need based on adjusted gross income. Determine the adjusted gross income as follows:

Determine whose needs and income must be considered

Determine the gross earned and non-earned income

Determine the adjusted earned income by subtracting the standard earned income deductions from the gross earned income

Add the non-earned income to the adjusted earned income

Subtract the applicable income exemptions/deductions

Round down to the nearest whole dollar amount

NOTE: Complete a separate computation for each month, if there have been changes in income.

(mhabd)(0805-000-00)(0805-020-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-020-00#

(mhabd)(0805-000-00)(0805-020-00)(0805-020-05-definition-of-living-with-a-parent)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-020-05-definition-of-living-with-a-parent#

(mhabd)(0805-000-00)(0805-020-00)(0805-020-05-definition-of-living-with-a-parent)(block-1)0805.020.05 Definition of Living With a Parent – DSS Manuals#

IM-120 November 18, 2021

Deeming of parental income and resources is based on the living arrangement and marital status of the disabled child.

A disabled child is considered to be living with a parent when the child resides in the same home with a natural or adoptive parent (unless the disabled child’s spouse is in the home). A child is also considered as living with a parent:

when the child is out of the home to attend school;

when the child is hospitalized for 30 days or less;

when the child is in a psychiatric treatment facility Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) for 30 days or less; or

during a period of temporary absence.

A disabled child is NOT considered to be living with a parent if:

a natural or adoptive parent is not in the home;

the child is married and living with their spouse, even though a parent may be in the same home;

the child resides in a Nursing Facility or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID);

the child is the custody of a state agency and placed in Foster Care or a Group Home;

the child is in a hospital or psychiatric treatment facility (JCAHO), and the stay is expected to be for more than 30 days; or

the child and parent are not residing in the same household for a period of time longer than that which is considered a temporary absence.

A temporary absence exists when an individual (child or parent) leaves the household but intends to, and does, return in the same month or following month. When a child is out of the home to attend school, the absence is always considered temporary when the parents retain custody, care and control of the child.

Parental income and resources are only deemed if the child meets the above definition of living with a parent. If a child is not considered to be living with a parent, do not deem parental income and resources. However, include any income that the parent actually contributes to the child as the child’s unearned income.

When a disabled child reaches age 18 or moves from the parent’s home, stop deeming effective with the following month.

Example: If a child turns age 18 on February 10, the parent’s income and resources are deemed to determine February eligibility. Determine March eligibility without deeming the parent’s income and resources.

(mhabd)(0805-000-00)(0805-020-00)(0805-020-10)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-020-10#

(mhabd)(0805-000-00)(0805-020-00)(0805-020-10)(block-1)0805.020.10 Deeming Parental Resources – DSS Manuals#

IM-94 June 11, 2019 ; IM-48 August 7, 2018

If the disabled child meets the definition of living in the home with a natural or adoptive parent, deem the entire amount of the parent’s available resources to the child. If there is a stepparent in the home, consider the full value of available resources owned jointly by the parent and stepparent. Do not consider the value of resources owned solely by the stepparent.

EXCEPTION: DO NOT deem the available resources of the parent if the parent or spouse of the parent is receiving MA (non-spenddown).

To determine the parents’ available resources follow the instructions in Section 1030.000.00 Available Resources (OAA and PTD) on what is included as an available resource. All resources that would be considered available if the parent were the applicant are deemed, with the exception of retirement accounts. For the purpose of deeming resources to disabled children, exclude retirement accounts (individual retirement accounts (IRA), 401(k) plans, 403(b) plans, Keogh plans, pension plans, etc.) that belong to their parents.

Add the deemed resources to the child’s available resources. If the total is less than the individual resource limit, the child is eligible on the factor of available resources. If the total exceeds the individual resource limit, the child is ineligible.

Refer to MHABD Appendix J for the current resource maximums.

(mhabd)(0805-000-00)(0805-020-00)(0805-020-15)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0805-020-15#

(mhabd)(0805-000-00)(0805-020-00)(0805-020-15)(block-1)0805.020.15 Deeming Parental Income – DSS Manuals#

IM-143 December 5, 2022 ; IM-129 December 21, 2021 ; IM-166 December 11, 2020 ; IM-172 December 2, 2019 ; IM-35 March 21, 2013 ; IM-73 November 30, 1993

If the disabled child meets the definition of living in the home with a natural or adoptive parent, deem income from the parent(s). Do not deem the income of any other persons in the home, including a stepparent.

EXCEPTIONS: Do not deem parental income if the parent or spouse of the parent is receiving Title XIX under a MA non-spenddown case. Do not deem income of a parent receiving cash public assistance: Temporary Assistance cash, SSI, SAB, SP, Refugee Assistance, Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian Affairs, and Veteran’ Administration pensions.

For MO HealthNet for Disabled Child (MHDC) spend down, incurred medical expenses, not subject to payment by a third party, of the following may be used to determine if the disabled child meets spend down:

the disabled child, and

the disabled child’s natural or adoptive parent/s whose income is used in determining eligibility.

NOTE: This does not include a stepparent because under Missouri law stepparents are not legally liable for the support of step children.

Use the following method for deeming income from parents to disabled children:

Determine an allocation for each minor child (under age 18) who is living in the home and who is not applying for MA. Do not include an allocation for any child who receives cash public assistance: Temporary Assistance cash, SSI, Refugee Assistance, Disaster Relief Act of 1974, general assistance programs of the Bureau of Indian Affairs, and Veteran’ Administration pensions. Determine the allocation by subtracting the SSI maximum for one person from the SSI maximum for two persons. For each child who is receiving an allocation, deduct that child’s own income to determine the final amount of the allocation.

Determine the parental income, earned and unearned. Income exclusions in Section 0805.015.10 deduction of overhead expenses in Section 0805.015.15 apply to the parents’ income. Do not consider payments from the Missouri Family Trust Fund made to the parent for the disabled child as income of the parent or child.

Subtract the allocation determined in Step 1 from the parental unearned income. If the allocation is greater than the unearned income, or if there is no unearned income, subtract the excess allocation from the parental earned income.

Subtract the $20 personal income exclusion from any remaining parental unearned income. If the remaining unearned income is less than $20, subtract the remainder of the $20 from the parental earned income.

Subtract $65 from the remaining earned income.

Subtract one-half of the remaining earned income from the result of Step 5.

Add any unearned income remaining from Step 4 to the result of Step 6.

Subtract the parental living allowance from the result of Step 7. The parental living allowance is the SSI maximum for the number of parents in the home whose income was used in deeming.

The amount in Step 8 must be deemed to the disabled children in the home who are applying for MHDC. If there is more than one disabled child, divide the deemed income equally among them.

NOTE: Data used in the examples below is for illustrative purposes only. Examples do not show current annual numbers.

Example #1 : Mrs. Boulanger has two children, Marie and Jane. She is applying for MHDC benefits for Marie. Jane has no income; Marie receives $140.00 OASDI from her father’s account. Mrs. Boulanger receives $441.00 OASDI benefits from her deceased husband’s account. She also earns $2,297.00 per month.

SSI maximum for two persons $ 1261 SSI maximum for one person – $ 841 Maximum allocation per non-MHDC child $ 420 Total allocation for Jane $ 420 Parent’s unearned income $ 441 Total allocation for Jane – $ 420 $ 21.00 Personal income exclusion – $ 20.00 Remainder of unearned income $ 1.00 Parent’s earned income $2297.00 Standard earned income exemption – $ 65.00 $2232.00 Subtract half – $1116.00 $1116.00 Add remainder of unearned income $ 1.00 Total net income $1117.00 SSI maximum for one (The number of parents in the home) – $ 841 Amount to deem to Marie $ 276

Example #2: Mr. and Mrs. Johnson apply for their disabled child, Kay. They have two other children, Cindy and Denise. Cindy receives OASDI benefits of $258.00. Denise has no income. Mr. and Mrs. Johnson have gross unearned income of $452.00 and gross earned income of $2382.00

SSI maximum for two persons $ 1261 SSI maximum for one person – $ 841 Maximum allocation per non-MHDC child $ 420 Cindy’s allocation ($420-258) $ 162.00 Denise’s allocation $ 420 Total allocation for non-MHDC children $ 582 Parent’s unearned income $ 452.00 Total allocation for non-MHDC children – $ 582 Remainder of unearned income $ 0 Leftover allocation not taken out of parent’s unearned income $ 130 Parent’s earned income $2382.00 Leftover allocation – $ 130.00 $2252 Personal income exclusion – $ 20.00 $2232.00 Standard earned income exemption – $ 65.00 $2167.00 Subtract half – $ 1083.50 $ 1083.50 SSI maximum for two (The number of parents in the home) – $ 1261.00 Amount to deem to Kay $ 0.00

(mhabd)(0805-000-00)(0805-020-00)(block-1)0805.020.00 MO HealthNet for Disabled Children (MHDC) – DSS Manuals#

IM-22 April 11, 2024

If otherwise eligible, disabled children (under age 18) may receive MO HealthNet as spend down, non-spend down or vendor. Eligibility requirements for disabled children are the same as those for disabled individuals age 18 and over, except that income and resources of the disabled child’s parents are deemed in certain circumstances. Parental income and resources are deemed if the child meets the definition of living with a parent.

Note: Always consider the disabled child’s (and spouse’s as appropriate) income and resources. DO NOT deem the income or available resources of any other persons (including a stepparent or sibling) living with the disabled child.

Note: Continuous Eligibility for Children (CEC) must be applied to eligible participants under the age of 19. Refer to section 1805.070.00 Continuous Eligibility for Children (CEC) in the MAGI Manual.

(mhabd)(0805-000-00)(block-1)0805.000.00 Eligibility – DSS Manuals#

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(mhabd)(0810-000-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0810-000-00#

(mhabd)(0810-000-00)(0810-005-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0810-005-00#

(mhabd)(0810-000-00)(0810-005-00)(block-1)0810.005.00 MO HealthNet Non-Spend Down Coverage – DSS Manuals#

IM-08 January 24, 2012

For non-spend down cases the participant’s eligibility for MO HealthNet coverage begins with the first day of the month of application, provided the participant is subsequently found eligible, and was not obviously ineligible for the entire month of application and any subsequent month prior to approval. If the participant was obviously ineligible for the entire month of application and any subsequent months prior to approval, the MO HealthNet eligibility date begins with the first day of the month in which eligibility was met.

EXAMPLE : The participant submits the application on June 18. The participant is ineligible because of excess resources until the resources have been reduced on July 3. MO HealthNet eligibility begins July 1.

(mhabd)(0810-000-00)(0810-010-00)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0810-010-00#

(mhabd)(0810-000-00)(0810-010-00)(0810-010-05)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0810-010-05#

(mhabd)(0810-000-00)(0810-010-00)(0810-010-05)(block-1)0810.010.05 Processing Spend Down MO HealthNet Cases – DSS Manuals#

IM-22 April 11, 2024 ; IM-08 January 24, 2012 ; IM-126 October 3, 2002 ; IM-106 September 10, 2002

Once a participant is determined eligible for MO HealthNet on all factors, the case must be approved and will remain active until a change in the participant’s situation causes ineligibility on a factor other than meeting spend down. Any proposed closing, increase in spend down, or change from Non-Spend Down to Spend Down requires normal adverse action procedures to be followed.

(mhabd)(0810-000-00)(0810-010-00)(0810-010-10)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0810-010-10#

(mhabd)(0810-000-00)(0810-010-00)(0810-010-10)(0810-010-10-05)Missouri MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual: 0810-010-10-05#

(mhabd)(0810-000-00)(0810-010-00)(0810-010-10)(0810-010-10-05)(block-1)0810.010.10.05 Notification of Spend Down on New Approvals – DSS Manuals#

IM-08 January 24, 2012 ; IM-159 November 26, 2002 ; IM-106 September 10, 2002

On new approvals, FAMIS sends the approval letter (FA-460 MO HealthNet Action Notice) notifying the participant they have been approved for spend down, but MO HealthNet coverage will not begin until the spend down is met. The letter will inform the participant of the spend down amount and the months for which they can receive coverage by meeting spend down.

If the eligibility specialist has already received bills to meet spend down for the month of approval or prior quarter months, the eligibility specialist must send a Spend Down Notification form IM-29(SPDN) to notify the participant of coverage dates. If the eligibility specialist has received proof of incurred expenses but the participant has not met spend down, the eligibility specialist must send the Spend Down Notification form IM-29 (SPDN) to notify the participant of countable medical expenses that have not met their spend down and the amount they have left to meet their spend down.

When a new approval is entered in the FAMIS system, MHD will send separate invoices for the month of approval and the month following approval. These invoices are sent on the day after the approval is entered. The participant will not receive invoices from MHD for the three months prior to the month of application. The participant has to provide documentation of incurred medical expenses that are not subject to payment by a third party for the prior quarter months to meet spend down.

(magi)Missouri Family MO HealthNet (MAGI) Manual#

(magi)(1800-000-00)Missouri Family MO HealthNet (MAGI) Manual: 1800-000-00#

(magi)Missouri Family MO HealthNet (MAGI) Manual#

(magi)(1800-000-00)Missouri Family MO HealthNet (MAGI) Manual: 1800-000-00#

(magi)(1800-000-00)(1800-005-00)Missouri Family MO HealthNet (MAGI) Manual: 1800-005-00#

(magi)(1800-000-00)(1800-005-00)(block-1)1800.005.00 Legal Basis – DSS Manuals#

(magi)(1800-000-00)(block-1)1800.000.00 Family MO HealthNet Programs – DSS Manuals#

(magi)(1801-000-00)Missouri Family MO HealthNet (MAGI) Manual: 1801-000-00#

(magi)(1801-000-00)(1801-005-00)Missouri Family MO HealthNet (MAGI) Manual: 1801-005-00#

(magi)(1801-000-00)(1801-005-00)(block-1)1801.005.00 Legal Basis – DSS Manuals#

(magi)(1801-000-00)(1801-010-00)Missouri Family MO HealthNet (MAGI) Manual: 1801-010-00#

(magi)(1801-000-00)(1801-010-00)(1801-010-10)Missouri Family MO HealthNet (MAGI) Manual: 1801-010-10#

(magi)(1801-000-00)(1801-010-00)(1801-010-10)(block-1)1801.010.10 Appointing an Authorized Representative in a Household With Multiple Adults – DSS Manuals#

(magi)(1801-000-00)(1801-010-00)(1801-010-20)Missouri Family MO HealthNet (MAGI) Manual: 1801-010-20#

(magi)(1801-000-00)(1801-010-00)(1801-010-20)(block-1)1801.010.20 Appointing Another Adult Member of the Household as an Authorized Representative – DSS Manuals#

(magi)(1801-000-00)(1801-010-00)(block-1)1801.010.00 Appointing an Authorized Representative – DSS Manuals#

(magi)(1801-000-00)(1801-020-00)Missouri Family MO HealthNet (MAGI) Manual: 1801-020-00#

(magi)(1801-000-00)(1801-020-00)(block-1)1801.020.00 Duration of Appointment of Representative – DSS Manuals#

(magi)(1801-000-00)(1801-030-00)Missouri Family MO HealthNet (MAGI) Manual: 1801-030-00#

(magi)(1801-000-00)(1801-030-00)(block-1)1801.030.00 Revoking an Authorized Representative Appointment – DSS Manuals#

(magi)(1801-000-00)(block-1)1801.000.00 Authorized Representative(s) for MO HealthNet – DSS Manuals#

(magi)(1802-000-00)Missouri Family MO HealthNet (MAGI) Manual: 1802-000-00#

(magi)(1802-000-00)(1802-005-00)Missouri Family MO HealthNet (MAGI) Manual: 1802-005-00#

(magi)(1802-000-00)(1802-005-00)(block-1)1802.005.00 Legal Basis – DSS Manuals#

(magi)(1802-000-00)(1802-010-00)Missouri Family MO HealthNet (MAGI) Manual: 1802-010-00#

(magi)(1802-000-00)(1802-010-00)(1802-010-80)Missouri Family MO HealthNet (MAGI) Manual: 1802-010-80#

(magi)(1802-000-00)(1802-010-00)(1802-010-80)(1802-010-80-05)Missouri Family MO HealthNet (MAGI) Manual: 1802-010-80-05#

(magi)(1802-000-00)(1802-010-00)(1802-010-80)(1802-010-80-05)(block-1)1802.010.80.05 Adding a Person to an Existing Application – DSS Manuals#

(magi)(1802-000-00)(1802-010-00)(1802-010-80)(1802-010-80-10)Missouri Family MO HealthNet (MAGI) Manual: 1802-010-80-10#

(magi)(1802-000-00)(1802-010-00)(1802-010-80)(1802-010-80-10)(block-1)1802.010.80.10 Applications on a Closed Case – DSS Manuals#

(magi)(1802-000-00)(1802-010-00)(1802-010-80)(1802-010-80-15)Missouri Family MO HealthNet (MAGI) Manual: 1802-010-80-15#

(magi)(1802-000-00)(1802-010-00)(1802-010-80)(1802-010-80-15)(block-1)1802.010.80.15 MO HealthNet Applications for Incarcerated Individuals – DSS Manuals#

(magi)(1802-000-00)(1802-010-00)(1802-010-80)(block-1)1802.010.80 Specialized Application Procedures – DSS Manuals#

(magi)(1802-000-00)(1802-010-00)(block-1)1802.010.00 Requests for Benefits – DSS Manuals#

(magi)(1802-000-00)(1802-010-00)(block-2)Online Application#

(magi)(1802-000-00)(1802-010-00)(block-3)Phone Application#

(magi)(1802-000-00)(1802-010-00)(block-4)Application Form#

(magi)(1802-000-00)(1802-010-00)(block-5)FQHC, DSH, and Other Contract Agencies#

(magi)(1802-000-00)(1802-010-00)(block-6)In Home Request#

(magi)(1802-000-00)(1802-020-00)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-00#

(magi)(1802-000-00)(1802-020-00)(1802-020-05)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-05#

(magi)(1802-000-00)(1802-020-00)(1802-020-05)(block-1)1802.020.05 Application With No Signature – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-10)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-10#

(magi)(1802-000-00)(1802-020-00)(1802-020-10)(block-1)1802.020.10 Signing by Mark – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-15)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-15#

(magi)(1802-000-00)(1802-020-00)(1802-020-15)(block-1)1802.020.15 Electronic Signature – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-20)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-20#

(magi)(1802-000-00)(1802-020-00)(1802-020-20)(block-1)1802.020.20 Telephonic Signature – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-30)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-30#

(magi)(1802-000-00)(1802-020-00)(1802-020-30)(block-1)1802.020.30 Signing by an Authorized Representative – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-35)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-35#

(magi)(1802-000-00)(1802-020-00)(1802-020-35)(block-1)1802.020.35 Signing by a Relative – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-40)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-40#

(magi)(1802-000-00)(1802-020-00)(1802-020-40)(block-1)1802.020.40 Signing by a Legal Guardian or Conservator – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-45)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-45#

(magi)(1802-000-00)(1802-020-00)(1802-020-45)(1802-020-45-05)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-45-05#

(magi)(1802-000-00)(1802-020-00)(1802-020-45)(1802-020-45-05)(block-1)1802.020.45.05 Death After Application – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-45)(1802-020-45-10)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-45-10#

(magi)(1802-000-00)(1802-020-00)(1802-020-45)(1802-020-45-10)(block-1)1802.020.45.10 Application for Deceased Persons – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-45)(1802-020-45-15-absence-from-the-home-at-application)Missouri Family MO HealthNet (MAGI) Manual: 1802-020-45-15-absence-from-the-home-at-application#

(magi)(1802-000-00)(1802-020-00)(1802-020-45)(1802-020-45-15-absence-from-the-home-at-application)(block-1)1802.020.45.15 Absence From the Home at Application – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(1802-020-45)(block-1)1802.020.45 Signing on Behalf of a Deceased Participant – DSS Manuals#

(magi)(1802-000-00)(1802-020-00)(block-1)1802.020.00 Signing the Application – DSS Manuals#

(magi)(1802-000-00)(1802-030-00)Missouri Family MO HealthNet (MAGI) Manual: 1802-030-00#

(magi)(1802-000-00)(1802-030-00)(block-1)1802.030.00 Filer Consent – DSS Manuals#

(magi)(1802-000-00)(1802-050-00)Missouri Family MO HealthNet (MAGI) Manual: 1802-050-00#

(magi)(1802-000-00)(1802-050-00)(1802-050-10)Missouri Family MO HealthNet (MAGI) Manual: 1802-050-10#

(magi)(1802-000-00)(1802-050-00)(1802-050-10)(block-1)1802.050.10 Cancel Rejections – DSS Manuals#

(magi)(1802-000-00)(1802-050-00)(block-1)1802.050.00 Application Timeframes – DSS Manuals#

(magi)(1802-000-00)(block-1)1802.000.00 Applications – DSS Manuals#

(magi)(1805-000-00)Missouri Family MO HealthNet (MAGI) Manual: 1805-000-00#

(magi)(1805-000-00)(1805-000-02)Missouri Family MO HealthNet (MAGI) Manual: 1805-000-02#

(magi)(1805-000-00)(1805-000-02)(block-1)1805.000.02 Federal Hub Calls – DSS Manuals#

(magi)(1805-000-00)(1805-000-05)Missouri Family MO HealthNet (MAGI) Manual: 1805-000-05#

(magi)(1805-000-00)(1805-000-05)(block-1)1805.000.05 Reasonable Opportunity (RO) – DSS Manuals#

(magi)(1805-000-00)(1805-005-00)Missouri Family MO HealthNet (MAGI) Manual: 1805-005-00#

(magi)(1805-000-00)(1805-005-00)(block-1)1805.005.00 Resident of Missouri – DSS Manuals#

(magi)(1805-000-00)(1805-010-00)Missouri Family MO HealthNet (MAGI) Manual: 1805-010-00#

(magi)(1805-000-00)(1805-010-00)(block-1)1805.010.00 Age and Date of Birth – DSS Manuals#

(magi)(1805-000-00)(1805-015-00)Missouri Family MO HealthNet (MAGI) Manual: 1805-015-00#