Using MEDES Brian Kinkade Director Missouri Department of Social Services Alyson Campbell Director Missouri Family Support Division 1 Table of Contents Overview page 3 Background page 6 ID: 808005
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Slide1
Background information related to the Missouri Eligibility Determination and Enrollment System (MEDES)
Using MEDES
Brian Kinkade, Director, Missouri Department of Social ServicesAlyson Campbell, Director, Missouri Family Support Division
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Slide2Table of Contents
Overview – page 3
Background – page 6Implementation of New Requirements – page10 Using the New System – page 16Helping Others Use the New System – page 20
Authorized Representatives – page 25
Presumptive Eligibility Update – page 39
Transferring Records from FAMIS to MEDES – page 41 Implementing Non-MAGI Medicaid – page 43Medical Review Team Update – page 45 Attachments – page 46
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Slide3Overview
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Slide4Overview
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Basic information on the three phases of the planned implementation of the new system and the reorganization of the Family Support Division;
Information to assist the new Modified Adjusted Gross Income (MAGI) Medicaid population to complete the new single streamlined application;
Information to support those who help applicants complete the new MEDES application; and,
Information related to the eligibility processes for other populations and programs sharing this eligibility determination platform, including resource limit requirements and income standards.
Slide5Background
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Slide6Background: What Is Medicaid?
Medicaid is a joint federal-state program
Covers a broad range of medically necessary health care and long-term care services for certain low income populations. The Missouri Department of Social Services (DSS) administers the program in a partnership with the federal Centers for Medicare and Medicaid Services (CMS).
Eligibility determinations are made by the Family Support Division (FSD).
The Medicaid program is administered by the MO HealthNet Division (MHD).
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Slide7Background: What is MAGI?
Modifications to income include: (“total income less allowable tax deductions and credits), modified by adding back
(i) any foreign earned income or housing costs ; and(ii) tax-exempt interest received or accrued by the taxpayer.”
“The term ‘household income’ means the MAGI of the individual plus the MAGI of other individuals in the household who are required to file tax returns.”
A resource limit is not imposed for MAGI applicants
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Slide8Background: New Requirements
The Affordable Care Act (ACA) requires states to modernize their eligibility and enrollment systems to:
Allow a single streamlined application to serve as a single gateway to multiple health and human service programs across multiple IT platforms;
Accept applications through a public web portal and in person, by mail, or by phone;
Make real-time eligibility determinations;
Be paperless and available 24/7Be transparent and seamless to the applicant
Maximize the consumer’s ability to complete the application process
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Slide9Background: New Requirements
Beginning in 2014 FSD must use new MAGI rules to process all applications for parents, caregivers, pregnant women and children
2014 – 2015 – FSD will be phasing out its old eligibility determination system known as the Family Assistance Management Information System (FAMIS)
During that period eligibility for beneficiaries will be transitioned by FSD to the new Missouri Eligibility Determination and Enrollment System (MEDES); and,
During that period and beyond, processing of applications will occur at designated offices that specialize in specific case determinations. 9
Slide10Implementation of New Requirements
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Slide11Implementation of New Requirements: Project Phases
Project I
– incorporating Medicaid parents, caregivers and children (the new MAGI population) into the new system
Launch date:
July 2013
Expected completion date: September 2014Project II – incorporating the Medicaid aged, blind and disabled populations into the new systemLaunch date: May 2014
expected completion date:
August 2015
Project III
– incorporating the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance to Needy Families (TANF) and other human service programs into the new system
Launch date:
October 2014
Expected completion date:
September 2015
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Slide12Implementation of New Requirements:
Electronic Verifications
Remote ID Proofing – Launch date:
Not yet determined
Federal Hub Verifications:
Legal presence – operationalIncarceration status – operationalSocial Security Administration – operational IRS Income Verification –
pending
Confirmation of Minimum Essential Coverage (MEC) –
operational
State database verification real time –
pending
Account Transfers from the Federally Facilitated Marketplace (FFM) –
operational
Account Transfers to the FFM –
pending
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Slide13Implementation of New Requirements:
Electronic Verifications
Once all electronic verifications are in place we anticipate that eligibility determinations will be made real time
We anticipate that a significant part of the volume will be processed without the intervention of a caseworker
Caseworkers will use the caseworker portal to adjudicate claims
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Slide14Implementation of New Requirements: FSD Reorganization
Missouri is in the process of transitioning from a local county office structure where all offices provide a full range of services to a more specialized structure where some local offices will be organized to process only a specific type of case.
These specialized offices will be identified by the type of eligibility determination assigned to them.
Initially FSD will establish
10 MAGI Processing CentersLater FSD will add the following specialized processing centers:Non-MAGI Medicaid Processing Centers – 8 SNAP/Food Stamp Processing Centers – 5 TANF Processing Centers – 1
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Slide15Implementation of New Requirements: FSD Reorganization
The MAGI Processing Centers will be phased in beginning in late 2013, and throughout 2014, as existing MAGI populations are transferred/converted from the existing FAMIS eligibility determination system to the new MEDES system.
When the reorganization is completed, every county will have a local Resource Center.
At these centers individuals may obtain general information and submit
applications for all programs that FSD administers. 15
Slide16Using the New System
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Slide17Using the New System
Applicants may complete an electronic MAGI application on-line at
www.mydss.mo.govPaper applications are available over the internet or at local county resource centers. Applicants may pick up and drop off a paper application at any county resource center
Applicants may mail paper applications to the MAGI processing centers
Applicants may complete an application by phone by contacting FSD’s contact center (this method will not be fully functional until September 2014)
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Slide18Using the New System
Missouri receives Account Transfers from the FFM which allows applications to be transferred between the FFM and state Medicaid programs
MEDES is not yet sending Account Transfers to the FFMMissouri also confirms enrollment in Medicaid and other Minimum Essential Coverage (MEC) for the FFM
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Slide19Using the New System
Public Web Portal:
www.mydss.mo.gov The portal provides a MAGI calculator that allows visitors to the web site to estimate whether they are eligible for Medicaid coverage
If eligible for Medicaid, visitors to the portal will be able to complete the single streamlined application online
If not eligible for Medicaid, visitors to the portal will be able to click on a link to connect to the FFM.
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Slide20Helping Others Use the New System
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Slide21Helping others use the New System:
www.mydss.mo.gov
If you are assisting a client who appears to be eligible for a subsidy through the FFM, then click on the link to the FFM that is available on the mydss web portal.
Following are some of the choices that will be available to the client:
Complete the single streamlined application through the FFM web portal (preferred option); Create a “My Account” and return to the FFM web portal later to complete the single streamlined application; or,Use the FFM Call Center to complete an application.
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Slide22Helping others use the New System:
Applicants who are eligible for Medicaid are encouraged to use
www.mydss.mo.gov to create a “MyAccount.”
Password protected area where the Medicaid program and the applicant can exchange important information regarding Medicaid benefits and eligibility standards.
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Slide23Helping others use the New System:
Missouri’s consumer-centric system is designed to allow anyone to provide assistance to potential Medicaid beneficiaries who:
Are comfortable using internet web portals; and,Have access to the internet
Agents, Brokers, Navigators, Certified Assistance Counselors, provider employees who help patients complete Medicaid applications and other assistors are invited by FSD to provide assistance to potential Medicaid beneficiaries.
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Slide24Helping others use the New System:
Agents, Brokers, Navigators and Certified Assistance Counselors are required to complete the section of the application indicating they provided assistance to the applicant
All Certified Application Counselors, Navigators, Agents and Brokers are expected to comply with all applicable laws and regulations
Other individuals, including hospital and clinic employees assisting patients with Medicaid applications, providing assistance that includes establishing the “MyAccount” and creating a password for the “MyAccount” shall complete the
“
Authorized Representative” section of the application24
Slide25Authorized Representatives
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Slide26Authorized Representatives
By checking the appropriate box on the electronic application you can register as the patient’s Authorized Representative.
This status allows you to monitor the progress of the application through the approval process.
You will be authorized to receive copies of follow up communications between DSS and the client until a final determination has been made and any appeal period for the beneficiary has been exhausted. The original documents are directed to the beneficiary’s household.
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Slide27Authorized Representatives
Hospital and Clinic employees who assist patients with Medicaid applications should check the box indicating that they are an “Authorized Representative” of the beneficiary when helping patients complete the online application.
By checking this box
:
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Slide28Authorized Representatives
After checking the Authorized Representative box, you need to have the applicant sign FSD form IM-6AR confirming that they have designated you as their “Authorized Representative.”
Form IM-6AR must be submitted to FSD along with other verifying and supporting documentation
Form IM-6AR may be downloaded from:
http://dss.mo.gov/fsd/formsmanual/volume1/
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Slide29Authorized Representatives
Process for downloading IM-6AR
Click on link and go to FSD Forms Manual
Scroll down to “IM-6AR”
Click on “Word”
Click on “Run”“The Publisher could not be verified” message appearsClick on “Run”Eazy Zip Self-Extractor Box opens
On line that reads “Extract to:” and click on box with “3 dots”
Highlight Desktop as the area where the file should be downloaded and click “Ok”
Click on “Start”
Click on “Ok” after file is downloaded
Closeout FSD Forms Manual
Go to Desktop
Double click on “im-6ar”
Form opens
Click in shaded area and complete form
Have the applicant sign the IM-6AR
File the IM-6AR along with other verifications by emailing to:
FSD.MEDES@dss.mo.gov
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Slide3030
Slide31Authorized Representatives
Hospital and Clinic employees who assist patients with Medicaid applications will be asked: “Check the box if you are authorized to receive copies of notifications and communications sent to household.”
By checking this box:
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Slide32Authorized Representatives
You will be required to complete the “Sign and Submit” portion of the application in your name rather than the name of the beneficiary.
The two following slides illustrate that:Electronic applications are in the MEDES system as soon as you hit sign and submitPaper applications have to go through several additional steps before being entered in the MEDES system
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Slide3333
Slide34New Slide
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Slide35Authorized Representatives
As an Authorized Representative you will be able to electronically send along proof of identity, proof of pregnancy, verification of income and other required documentation by emailing such documentation to
FSD.MEDES@dss.mo.gov
.
Once your supporting documentation is received a casework will open the application and affix the supporting documentation to the case.At that point, if all required documentation is present, the application will be approved.
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Slide36Authorized Representatives
Please reference the client’s name and DCN or Social Security Number when submitting supporting documentation.
NOTE:
Materials submitted by email must be encrypted. When contacting MEDES about specific applications it is important to include the client’s name and DCN or Social Security Number.
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Slide37Authorized Representatives Submitting Supporting Documentation:
Submitting Supporting Documentation:
FSD.MEDES@dss.mo.gov
Submitting Emergency Medicaid Applications for Pregnant Women:
FSD.MEDES@dss.mo.gov
Submitting Newborn applications:
FSD.MEDES@dss.mo.gov
Text Telephone:
800-735-2966
FAX:
573-751-0282
Magi Processing Centers
:
1-855-373-9994
Link to Medicaid Application:
www.mydss.mo.gov
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Slide38Authorized Representatives Submitting Newborn Applications:
Report newborns on excel spreadsheet that can be found at:
http://dss.mo.gov/provider-services/health/hospital-report-mohealthnet-newborn-coverage.xlsx Enter required information on spreadsheetSubmit to
FSD.MEDES@dss.mo.gov
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Slide39Presumptive Eligibility Update
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Slide40Presumptive
Eligibility Update
State Plan Amendment Filed – March 31, 2014Regulation being draftedApplication DesignProcessStandards
Submit Presumptive Eligibility Applications To:
Presumptive.elig@dss.mo.gov
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Slide41Transferring Records from FAMIS to MEDES
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Slide42Transferring Records from FAMIS to MEDES
Applications will be processed using the new MAGI eligibility rules as required by the ACA.
As MAGI beneficiaries (parents, caregivers and children) who are already enrolled in Medicaid through the FAMIS system interact with the new system through redeterminations and changes in life events, their records will be transferred from the FAMIS system to the new MEDES system.
This will require caseworker intervention in one of the new MAGI Processing Centers. As a result the new MEDES system will not be fully automated until a beneficiary’s file has been moved to the new system.
It may take a full year to complete this process.
Such caseworker intervention also will be required in cases where newborns are being added to a Mother’s file that is located in the FAMIS system. The Mother’s file may need to be moved to the new MEDES system before the child is added to the file.
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Slide43Implementing Non-MAGI Medicaid
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Slide44Implementing Non-MAGI Medicaid
Non-MAGI populations will not be integrated into the new MEDES eligibility system until Project II is completed
August 2015Processing of Non-MAGI Medicaid applications remains unchangedIf you are helping someone complete an application for coverage as Non-MAGI Medicaid, you will still complete the single, streamlined application.
You will be expected to check appropriate boxes indicating the applicant is seeking assistance with one of the activities of daily living, etc.
Once you’ve completed the electronic application, it will be transferred to the worker portal where a caseworker will compile the balance of the information required for consideration for Non-MAGI coverage
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Slide45Medical Review Team Update
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Count of 1st Request
Total Unfilled Within 30 Days
Percent Unfilled Within 30 Days
57,954
14,819
26%
For the period: 12/1/2011 through 3/20/2014:
Slide46Attachments
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Contact Information
Confidentiality
MAGI Medicaid
Non-MAGI Medicaid
Newborn Instructions and Excel Spreadsheet
Slide47Contact Information
Attachment 1
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Slide48Contact Information:
Filing MAGI Applications Electronically:
www.mydss.mo.gov
MAGI Processing Centers:
1-855-373-9994
Mailing Address for MAGI Applications:PO Box 1010Union, MO 63084Link to Paper Application:http://dss.mo.gov/mhd Click on: MO HealthNet Application
Then click on: Download and print the application
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Slide49Contact Information:
Link to Newborn Form for Submitting Applications:
http://dss.mo.gov/provider-services/health/hospital-report-mohealthnet-newborn-coverage.xlsx Submitting Newborn applications:
FSD.MEDES@dss.mo.gov
- (See Attachment 3 for instructions related to filing newborn applications)
FAX: 573-751-0282 Text Telephone: 800-735-2966
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Slide50Contact Information:
MHD Contact Information:
MO HealthNet Division615 Howerton CourtP.O. Box 6500
Jefferson City, MO 65102-6500
Telephone: 573-751-3425
Link to MO HealthNet Division:http://dss.mo.gov/mhd/ Frequently Asked Questions:
https://mydss.mo.gov/CitizenPortal/FrequentlyAskedQuestionsPage.do#Question1
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Slide51Other Resources:
The Federal Health Insurance Marketplace
– www.HealthCare.gov – here you can get information regarding the Marketplace in your state, including Marketplace insurance plans, information for individuals who don’t have health insurance in 2014, and much more.
Missouri Children’s Division
– www.dss.mo.gov/cd Community health centers offer health care on a sliding scale basis to Missourians without insurance: http://findahealthcenter.hrsa.gov/Search_HCC.aspx?byCounty=1
Missouri Primary Care Association
:
http://www.mo-pca.org
Missouri Hospital Association:
http://www.mhanet.com
Missouri Rx Plan:
www.morx.mo.gov
GovBenefits.gov
- U.S. Department of Labor website providing information about social service programs in all states. This is especially useful for families relocating to another state.
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Slide52Confidentiality
Attachment 2
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Slide53Confidentiality
Confidentiality:
All Medicaid information is confidential. Anyone gathering or receiving information connected to a Medicaid application may share client information only for purposes directly connected with the administration of the Medicaid programs with other federal programs and certain entitled entities.
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Slide54MAGI Medicaid Populations
Attachment 3
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Slide55Attachment 3
MAGI Medicaid Populations
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Slide56Screening for Medicaid Eligibility
Ask the following questions to determine if the individual may fit into one of the groups described below:
MAGI Medicaid:Are you pregnant?Do you have related minor children in your home?
Are you under the age of 19?
Are you under the age of 26 and a former foster care child?
Non-MAGI Medicaid:Are you 65 or older?Have you been determined disabled through Social Security?56
Slide57Who Might Be Eligible for MAGI Medicaid:
Parents and Caregivers with dependent children, who have income under about 19% of the Federal Poverty Level (FPL):
$ 241/month or $ 2,892/year for a family of two$ 353/month or $ 4,236/year for a family of fourPregnant women who have income of 196% FPL or less:
$1,907/month or $22,884/year for an individual
$2,570/month or $30,840/year for a family of two
Children under age 19 may be eligible for MO HealthNet for Kids with incomes at or below 148% FPL:$ 1,941/month or $ 23,292/year for a family of two$ 2,942/month or $ 35,304/year for a family of fourChildren’s Health Insurance Program (CHIP) Children under age 19 if family income is under 300% FPL: $ 3,933/month or $ 47,196/year for a family of two
$ 5,963/month or $ 71,556/year for a family of four
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Slide58Who Might Be Eligible for MAGI Medicaid:
Women with certain cancerous or precancerous conditions of the breast and/or cervix with income of 201% FPL or less:
$1,955/month or $23,460/year for an individual$2,635/month or $31,620/year for a family of twoFormer foster care children who are currently less than 26 years old and who left foster care on or after their 18
th
birthday regardless of income
Women age 19-55 who are not currently pregnant may be eligible for Family Planning services with income of 201% FPL or less:$1,955/month or $23,460/year for an individual$2,635/month or $31,620/year for a family of two
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Slide59MAGI POPULATIONS:
Temporary MO HealthNet During Pregnancy
(TEMP) — Pregnant women may be determined eligible by qualified providers for temporary eligibility during pregnancy until they can apply for and begin receiving full MO HealthNet benefits. TEMP is "state only" from the time a participant is found ineligible for regular MO HealthNet until the end of the TEMP eligibility period. The designation may be used only once during a pregnancy.
Presumptive Eligibility
For Children.
Provides a period of presumptive eligibility to children in families with income below 150% of the Federal Poverty Level. Children under the age of 19 may be determined eligible by qualified entities for MO HealthNet on a temporary basis prior to having a formal eligibility determination completed.For Adults. Under the ACA adults may be determined eligible by qualified entities for MO HealthNet on a temporary basis prior to having a formal eligibility determination completed.
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Slide60MAGI POPULATIONS:
Women’s Health Services Program
(1115 Demonstration Waiver) — Uninsured women who lose MO HealthNet healthcare coverage sixty (60) days after the birth of their child are covered for women’s health services for an additional year, regardless of the income level. Coverage is limited to family planning, and testing and treatment of Sexually Transmitted Diseases. Also, women who are age 18 through 55, have a family income at or below 196 percent of the federal poverty level, have assets totaling less than $250,000, and are not otherwise eligible for Medicaid, the Children's Health Insurance Program, Medicare, or health insurance coverage that provides family planning services are eligible for this program.
Newborn - Automatic Eligibility
— Newborns are automatically eligible for assistance if their mother is receiving a federally matched category of assistance at the time of birth (except TEMP - See Temporary MO HealthNet During Pregnancy below).
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Slide61MAGI POPULATIONS:
MO HealthNet for Kids
(MHK) — Includes the following: Infants under the age of one whose family income is less than 196% of the federal poverty level may be eligible; children under the age of six at 148%; and,
children ages six through eighteen at 100%.
Uninsured children with gross family income up to 300 percent of the federal poverty level.
"Uninsured Children" are persons under nineteen years of age who have not had employer-subsidized health care insurance or other health care coverage for six months prior to application.MO HealthNet for Families (MHF) — The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) eliminated the link between Aid to Families with Dependent Children (AFDC) and Medicaid and replaced it with Section 1931 of the Social Security Act to provide Medicaid to low-income families with children.
Transitional MO HealthNet
(TMH) — Provides healthcare coverage to a family for up to 12 months, after the closing of an MHF case due to employment or increased earnings.
MO HealthNet for Pregnant Women
(MPW) — This program
is intended to provide MO HealthNet benefits to low-income pregnant women. A woman whose family income does not exceed 196% of poverty may qualify.
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Slide62Non-MAGI Medicaid Populations
Attachment 4
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Slide63Attachment 4
Non-MAGI Medicaid
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Slide64Who Might Be Eligible for Non-MAGI Medicaid:
Adults age 65 or older – these are generally beneficiaries who meet Medicaid requirements to receive long-term care and in-home care services through the Medicaid program
Individuals who have been determined to be blind or disabled by the Social Security Administration or by the Medical Review Team (MRT)
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Slide65NON-MAGI POPULATIONS:
MO HealthNet for the Aged, Blind, and Disabled
(MHABD) MO HealthNet coverage for persons who meet the requirements of: Old Age Assistance (OAA); Permanently and Totally Disabled (PTD) and Aid to the Blind. — Persons must be over age 65 or meet the Supplemental Security Income (SSI) definition of disabled or the state definition of blindness. Persons receiving Supplemental Security Income (SSI) or Social Security based on age or disability are automatically qualified for Medical Assistance on those factors. Persons determined by Social Security to meet 1619 A or B status are eligible as non-spend down.
Homeless, Dependent, Neglected Children
— Provides assistance for children in care and custody of the Children’s Division (CD).
Medical Assistance for Children in Care — Children in the custody of Division of Youth Services (DYS) or a juvenile court. Breast and Cervical Cancer Treatment Program — MO HealthNet coverage for uninsured women under age 65 screened for breast or cervical cancer by Missouri’s Breast and Cervical Cancer Control Project (BCCCP). (Note: The BCCCP Program has requirements including income limits that must be met to get the screening. Screening services are provided by the Department of Health and Senior Services.)
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Slide66NON-MAGI POPULATIONS:
Supplemental Nursing Care
— Provides a state grant and MO HealthNet benefits to elderly, blind, and disabled persons in licensed residential care facilities and non-MO HealthNet nursing homes.Supplemental Aid to the Blind — Provides assistance to needy blind persons.
Qualified Medicare Beneficiary
— Pays for Medicare premiums, deductible and coinsurance for eligible persons enrolled in Medicare part A with income up to 100% of poverty.
Specified Low Income Medicare Beneficiary — Provides payment of Medicare Part B premiums to individuals who would be eligible for the Qualified Medicare Beneficiary program except for excess income. Income must be more than 100% of the Federal Poverty Level, but not exceed 120%. 66
Slide67NON-MAGI POPULATIONS:
Refugee Assistance
— Persons who are admitted to the United States with an immigration status of refugee or asylum may qualify for a short period of time in order to establish self-sufficiency if they do not meet eligibility for another category. MO HealthNet for Disabled Children (MHDC) — A disabled child may be eligible for Medical Assistance. The income and resources of the parents are taken into consideration.
Psychiatric Services 21 years and under
— Provides assistance to individuals under 21 in a psychiatric facility.
IV/E Alternative Care — provides assistance to children in the CD foster care and adoptive homes.67
Slide68Newborn Instructions and Excel Spreadsheet
Attachment 5
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Slide69Attachment 5
Newborn Instructions and Excel Spreadsheet
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Slide70Role of Authorized Representative – Submitting Newborn Applications:
Report newborns on excel spreadsheet that can be found at:
http://dss.mo.gov/provider-services/health/hospital-report-mohealthnet-newborn-coverage.xlsx Enter required information on spreadsheetSubmit to
FSD.MEDES@dss.mo.gov
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