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Federal Poverty Level (FPL): FAMIS Changes Due to FPL Adjustment

Tools: #

Budget Month Entries for Income Affected by Cola

FAMIS Changes Due to The Federal Poverty Level (FPL) Adjustments #

MO HealthNet for Aged, Blind and Disabled (MHABD) cases may be affected in several different ways when the Federal Poverty Level is adjusted each year.

 

FAMIS Adjustment #

If the FAMIS case has no outstanding verification or actions, FAMIS will process the changes and send notification to the recipients.

To view the changes made by FAMIS:

  • Locate the participant on FAMISPAR
  • Select the case you would like to view, then fastpath to EULOG
  • Tab down and select the action you want to view and press F17=INQUATH
  • Press F16= BUDSUM to view the MHABD Assistance Group Summary screen
  • To view specific budget information, select the individual and coverage type, then press F16=AGBUDSUMM

 

Conflict of Actions #

Cases that had a pending adverse action or other change at the time of the adjustment will now have conflicting actions. These conflicting actions must be resolved. To do this, complete these steps:

  • Locate the participant on FAMISPAR
  • Select the MHABD case, then fastpath to ACTRES
  • Review the actions and determine which pending adverse action period is most appropriate to void. Select an action and press F17= INQUAUTH, for further review, if needed. Example: If a case had an adverse action to close due to ineligibility and the customer is still ineligible, void the FPL action. Refer to “Changing an Adverse Action Status” guide for instructions.
  • After voiding the correct adverse action, complete a new eligibility determination (EDRES)
  • Authorize the adverse action
  • Enter a comment explaining why the other adverse action was voided

 

FAMIS Cases Not Adjusted #

FAMIS is not able to adjust any case that is listed on the Interrupted/Incomplete Controlled Flow (CONFLOWS) screen. Those cases will adjust once they are taken completely through the controlled flow.

MHABD cases that now have an option between MHABD Spend Down and TWHA or MHABD Spend Down and SLMB II coverage (and have not had that option before) will not be adjusted. The new FPL income guidelines will be applied once a coverage option is selected. Access the QMB/SLMB Decision (QMBDEC/FMD6) screen and MHABD AG Options (FMD2) screen to choose the coverage.

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