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.