View Categories

Household Composition-MAGI

Tools #

 

Guidance #

Construct a MAGI Household #

Identifying the correct household composition for each household member requesting benefits is critical in having an accurate case outcome.

NOTE: The parent/caretaker relative must have an eligible child in the home and qualify as an eligible parent/caretaker relative to receive MO HealthNet for Families (MHF). The individual may be a parent/caretaker relative who files taxes, but does not claim the child as a dependent.

 

Construct a MAGI Household

    1. Step 1: Does the individual expect to file taxes?
      1. If no – continue to Step 2.
      2. If yes – does the individual expect to be claimed as a tax dependent by anyone else?
        1. If no – the household consists of the taxpayer, the taxpayer’s spouse (if applicable), and all persons whom the taxpayer expects to claim as a tax dependent.
        2. If yes – continue to Step 2.
    2. Step 2: Does the individual expect to be claimed as a tax dependent?
      1. If no – continue to Step 3.
      2. If yes – does the individual meet any of the following exceptions?
        1. The individual expects to be claimed as a tax dependent of someone other than a spouse or a biological, adopted or step parent.
        2. The individual is a child under age 19 living with both parents, but will only be claimed as a tax dependent by one because the parents don’t file jointly.
        3. The individual is a child under age 19 who expects to be claimed by a non-custodial parent.

 

NOTE: If the individual does NOT meet any of these exceptions, the household is the same as the household of the taxpayer claiming him/her as a tax dependent.

NOTE: If the individual is married, the household also includes the individual’s spouse.

If the individual meets any of the exceptions listed above – continue to Step 3.

 

    1. Step 3: For individuals who neither expect to file a tax return nor expect to be claimed as a tax dependent, as well as tax dependents who meet one of the exceptions from Step B-2, the household consists of the individual and spouse (if applicable), and if living with the individual –
      1. The individual’s biological, adopted and step children under the age of 19; and
      2. In the case of individuals under the age of 19, the individual’s biological, adopted and step parents and biological, adoptive and step siblings also under age 19.

 

Head of Household Correction – Application Case #

A MEDES case Head of Household (HoH) is the participant who filed the application. MEDES bases the HOH on the primary applicant listed in Application Details. The Application Filer and the Primary Applicant need to match for the HOH to be correct in MEDES.

When a participant registers a MAGI Application through the Citizen Portal and chooses a different household (HH) member as the HoH, follow the directions below to correct.

NOTE: This process is NOT TO BE USED to change a HoH due to a “change in circumstance” (i.e. moved out of household or death). It may be valid to change one adult HoH for another adult HOH, if the current HoH was chosen incorrectly.

 

Head of Household Correction – Application Case

NOTE: Correct the HoH on the application case before processing.

    1. From the Application Case > Evidence sub-tab > Dashboard
    2. Select the Application Filer evidence hyperlink to determine who filed the MO HealthNet application.

NOTE: The participant identified as the Application Filer must be identified as the HoH on the Application.

    1. Close the Application Filer
    2. Select the Application Details evidence hyperlink.
    3. Toggle Application Details evidence twice.
    4. Review the Primary Applicant The word Yes in this field identifies the participant identified as the HoH.

NOTE: Complete steps 4 through 6 for each household member. If the participant identified as the HoH in Application Details evidence does not match the person identified as the application filer in the Application Filer evidence, follow the steps below to ensure the HoH and participant identified as the application filer match.

    1. Toggle Application Details evidence of the participant incorrectly identified as the HoH.
    2. Click the List Actions menu
    3. Click Edit. This opens the Edit Application Details popup.
    4. Uncheck the Primary Applicant
    5. Click Save.
    6. Toggle Application Details evidence for the participant who is identified as the application filer in the Application Filer
    7. Select Edit. This opens the Edit Application Details popup.
    8. Check the Primary Applicant
    9. Click Save.
    10. Process the application following direction in Processing an Application Case in IM Resources.
    11. Make all comments on under the correct HoH Person Page follow guidance in the MEDES Notes and Comments SOP.
    12. Update Current™ task with the correct HOH’s DCN and name, add outcome and mark complete.

NOTE: If application was authorized prior to correcting HoH follow Head of Household Correction guide to correct the HoH on the IC. This must be done the same day the AC is authorized to avoid any breach of confidentiality.

 

Case Specific Scenarios:

If the application is to be used as a change in circumstance (CIC)

    1. Update the active Integrated Case (IC) for the correct HoH following direction in the Household Composition – MAGI.
    2. Withdraw the application following direction in the Withdraw an Application

NOTE: There is no need to re-register the application.

If the Primary Applicant is a duplicate or the application will pend for verification:

      1. Withdraw the application following direction in the Withdraw an Application</
    2. Mark Current™ task outcome as rejected.
    3. Re-register the application under the correct HoH following direction in Application Registration in MEDES.
    4. Search and claim the new NL App MAGI task.
    5. Process application following direction in Processing an Application Case.
      1. Merge any duplicate IDs following direction in the Duplicate DCN Field Process
      2. Send 31A from new AC. Following direction in the Generate Request for Information for Application Case or Integrated Case

 

Head of Household Correction -Integrated Case #

NOTE: This process should NOT BE USED to change a head of household due to a “change in circumstance” (i.e. moved out of household or death). It may be valid to change one adult HoH for another adult HOH, if the current head of household was chosen incorrectly. This process should also not be used to change the HoH on an Application Case. Continue following current processes.

Some things to consider before changing the HoH/Primary Applicant:

  • Review the Application Filer and Application Filer Consent evidence from the original application to determine the correct HoH/Primary Applicant
  • Once the Correct HoH/Primary Applicant action is completed, the coverage under the former head of household should end on the current date, and the coverage under the new head of household should start the next day. This should result in the proper open and close actions being sent downstream.

 

Head of Household Correction – Integrated Case

NOTE: From the Integrated Case > Dashboard, review the Application Filer and Application Filer Consent evidence to determine the correct HoH/Primary Applicant

    1. From the Integrated Case > Participant sub-tab, verify the incorrect person is displayed as the Primary Applicant
    2. From the Integrated Case > Application Details verify the incorrect HoH is marked as the Primary Applicant on all existing segments of Application Details

NOTE: If the incorrect HoH is marked as the Primary Applicant on all existing segments of Application Details, proceed to step 9.

NOTE: If the incorrect HoH is NOT marked as the Primary Applicant on all existing segments of Application Details proceed to step 3.

    1. From the Integrated Case > Application Details you must edit the existing Primary Applicant box on all Application Details for any case participant(s) other than the current primary applicant as determined in Step 1.
    2. Click the List Actions menu for each person(s) marked as the Primary Applicant and click Edit
    3. Uncheck the Primary Applicant checkbox for each person marked as the Primary Applicant
    4. Click Save Save Buttonafter editing each piece of Application Details evidence
    5. Update the Application Details for the incorrect Primary Applicant as determined in Step 1 marking his/her Primary Applicant box on all existing segments
    6. Apply Changes, Check Proposed Determination, Finalize Proposed Determinations

NOTE: Allow changes to process overnight. The next business day, proceed to step 9 to complete the correct Head of Household wizard.

    1. Click the Page Actions Menu
    2. Select Guided Change
    3. Select Correct Head of Household. This brings up a list of other HH members
    4. Select the correct HoH from the list of other HH members
    5. Click Save Save Button.

NOTE: If there is an Adverse Action pending on the case (or any member of the case) an error message appears in the ‘Correct Head of Household’ window. This prevents the ES from correcting the HoH until the Adverse Action has expired.

    1. Click Yes if you wish to finalize the proposed change in the HoH

NOTE: You must have all outstanding evidence verified (if applicable) before you can complete the change in HOH.

    1. Apply Changes, Check Proposed Determination, Finalize Proposed Determinations. After the proposed determinations are finalized, the following occurs:
    • All notices generated from the correction of the head of household should go out under the new adult head of household. (Normally a “No Change” notice.)
    • If there is a “change in circumstance” that results in an adverse action, that adverse action will be completed under the new adult head of household.

NOTE: If any household members have a current, active LOC or Managed Care; an email must be sent to MHD at MHD.MCOPERATIONS@dss.mo.gov when the HoH is corrected listing:

    • Subject Line:  Head of Household Correction – CHIP (if there is a premium on the case the subject line must include “CHIP” so the premiums unit will pick up and apply the premium paid to the correct person)
    • Date of Change
    • Incorrect or Minor Head of Household Name and DCN
    • Correct Head of Household Name and DCN
    • Name and DCNs for all Household Members who are eligible for MHN coverage

NOTE: Review MXIX the next business day to ensure coverage has ended correctly under the incorrect HoH and started correctly under the correct HoH for the correct coverage(s) and time period(s).

Was this guide helpful?