0840.015.05 Pre-closing Ex Parte Review – DSS Manuals

IM-04 January 11, 2024 ; IM-45 May 3, 2023 ; IM-193 December 28, 2000

Under 42 CFR 435.916, before stopping a participant’s coverage under most MO HealthNet (MHN) categories and for most reasons, it is mandatory for Family Support Division (FSD) to explore possible eligibility under all other MHN programs.

This pre-closing review must be completed ex parte (which means without contacting the participant), if possible. However, if there is information that suggests eligibility for another program but eligibility cannot be determined during the ex parte review, FSD must attempt to contact the participant and collect additional information before closing the participant’s coverage.

If the participant is eligible under another category, move the individual to the appropriate category without requiring a new application.

EXCEPTION: A signed MO HealthNet Application Addendum: Request to Add Cash Benefits ( IM-1MAC ) is required to apply for Supplemental Nursing Care (SNC), Supplemental Aid to the Blind (SAB), or Blind Pension (BP). See 0804.025.00 MO HealthNet Application Concurrent With MHABD Cash Programs .

When determining eligibility under another category:

Do not ask the participant to provide information that is available to FSD, or to re-verify current case information.

Use all available data sources to verify eligibility criteria.

Move the participant to the MHN benefits with the highest level of care for which they qualify, or if they are eligible for multiple programs, you must notify the participant and allow them to make a choice.

Do not end current coverage before approval in another category or until the participant is determined ineligible for all MHN programs.

If ending eligibility from one eligibility system and approving in another, close the active benefits and then the next day approve the new benefits to prevent any disruption in healthcare coverage.

NOTE: If the participant remains eligible for the current MHN program, but requests to be switched to another program, complete an eligibility determination as an ex parte review, if possible.

If no other eligibility exists, initiate action to close the case by sending an Adverse Action Notice. If a hearing is not requested, close the active MHN case after the Adverse Action Notice expires and notify the participant with an Action Notice.