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.