03.3 – Interviewing / Processing (DISABLED thru Supercase EU Summary #1)

Disabled #

Tools

• Guide to DISABLED Codes
• Using MRT Screens
• Adding Missouri Children With Developmental Disabilities (MOCDD) Coverage

• Hand Off: Use Non-MAGI Specialized Unit > MRT Hand Off for received MRT documents

Screen Help

DISABLED/FMMX

MRT Information

Guidance

For details on appropriate coding for the Disabled screen, see the Guide to DISABLED Codes.

• Non-MAGI:
  • • To qualify for Non-MAGI benefit under Permanent and Total Disability (PTD) criteria, a person must meet the Social Security definition of disabled. Disability, as defined by SSA and used by the Medical Review Team (MRT), is the individual’s inability to be gainfully and substantially employed for one year or longer due to a physical or mental incapacity. A participant’s disability must be verified. If a participant receives Supplemental Security Income (SSI) or Social Security based on disability, verification is obtain through IIVE, Award Letter, BENDEX, or SDX.
    • If a participant does not receive SSI or Social Security based on disability, disability must be established through MRT. However, a Social Security Favorable Decision (FD) letter can be used for 12 months after the date of the letter if an SSI or SSD benefit is not received. The disability start date may be stated in the FD letter, or by using the date of the letter, whichever is earlier.
    • Disabled children (under age 18) may receive Non-MAGI based on the same eligibility requirements as adults, but if that child lives with a parent(s), parental income and resources may be deemed in determining eligibility.
• SNAP:
  • • Household members only have to meet the SNAP definition of elderly or disabled. For work requirements, if a household member claims disability but does not currently meet the SNAP definition of disabled, we need an MRT decision. Complete the FS-61 SNAP Summary to Determine Fitness for Work and email the completed form to MRT.processingcenter@dss.mo.gov. Code 15 EXE on EMPLOY and enter a comment indicating we are waiting on MRT to determine fitness for work.
• TA:
  • • Enter each individual’s status with regard to disability on the Disabled screen. An individual with a pending application for Social Security Disability, SSI, or employer-related disability may be coded as disabled until a decision is reached. Individuals whose application is denied but continue to claim a disability must be evaluated by the Medical Review Team (MRT).

Capture disability information for each EU member.

Question 1: Does the participant claim disability?

• • • • • • If yes, use Guide to DISABLED Codes to select the correct Rsn and Ver codes. Make a comment identifying the reason for the entries. If processing an Non-MAGI application that has requested prior quarter, the begin date should be no later than the 1st day of the first prior quarter month.
          • If no, continue to the next question

Question 2: Does the participant currently receive Non-MAGI benefits?

• • • • • • If yes, do not change the Rsn field. Notify MRT of the disability status change, and MRT will determine if the participant still meets the disability eligibility factor. Make a comment indicating MRT was notified.
          • If no, continue to the next question.

Question 3: Is this an Non-MAGI application?

• • • • • • If yes, contact the participant by phone or send a request for information to determine if the participant is pursuing Non-MAGI benefits.
            • • An Non-MAGI application may not be rejected due to no disability unless the participant specifically indicates s/he is not disabled. If no disability exists, make a clear comment specifying why N was entered in the Y/N field.
              • To request a disability determination from MRT, use the Guide to DISABLED Codes to determine the appropriate code entry on the DISABLED screen
          • If no, continue to the next question.

Question 4: Is the participant providing care for a disabled EU member?

• • • • • • If yes, enter Y in the Y/N field and select NEE for the Rsn field. Use the Guide to DISABLED Codes to determine the appropriate Verification code entry. Make a comment identifying the reason for the entries.
          • If no, enter N in the Y/N field. No other entries are needed for this participant.

Verification

Follow FCR steps to verify.

• Can we get it?
  • IIVE showing receipt of SSDI or SSI due to participant’s own disability
  • MRT determination
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Completed MRT Packet

Comment

• Comment on DISABLED/FMMX to document verification or to explain entries on DISABLED.
  • Describe verification provided or requested
  • Do not record private medical information
• Comment on EUMEMROL/FM3Z if an MRT packet or Medical Records has been submitted to MRT.

Medical Review Team #

Tools

• Guide to DISABLED Codes
• Using MRT Screens
• Hand Off: Use Non-MAGI Specialized Unit > MRT Hand Off for received MRT documents

Screen Help

DISABLED/FMMX

MRT Information

Guidance

Non-MAGI: To qualify under Permanent and Total Disability (PTD) criteria, a person must meet the Social Security definition of disabled. Disability, as defined by SSA and used by MRT, is the individual’s inability to be gainfully and substantially employed for one year or longer due to a physical or mental incapacity. If the Non-MAGI applicant is applying on the basis of disability instead of age, but does not receive Social Security disability, SSI disability, or if the disability application has been rejected and the individual still claims a disability, request a disability determination from MRT. The MRT Processing Center enters decision information on the MRT screens and on the DISABLED screen. If disability is the only pending information, the MRT PC finishes the pending application/case. If additional information is pending, MRT reviews the ECM to determine if additional information is received and if so, enters the information in FAMIS. Medical records are maintained by MRT.

Note: Do not scan packets that include a Visual Field exam record for the visually impaired. Instead, mail the entire packet, including the Visual Field exam record to:

MRT-Processing Center

101 Park Central Square

Springfield, MO 65806

TA: The Disability status of an EU member can have an impact on several eligibility requirements for TA. When a payee or second parent states s/he is permanently disabled and has applied for disability benefits as described in the policy manual, s/he is exempt from work activity participation (COMPACT screen). If the disability application is rejected and the individual still claims a disability, a disability determination must be requested from MRT. Individuals claiming a disability who have not made application for disability benefits but claim a disability must also be referred to MRT. The MRT Processing Center enters decision information on the MRT screens and on the DISABLED screen, then sends the disability determination to the TA Processing Center. TA Processing Center staff complete the pending application and update the COMPACT screen. Medical records are maintained by MRT.

SNAP: For work requirements, if a household member claims disability but does not currently meet the SNAP definition of disabled, we need an MRT decision if their disability or unfitness for work is not obvious. Complete the FS-61 SNAP Summary to Determine Fitness for Work and email the completed form to MRT.Personnel@dss.mo.gov.

Verification

Follow FCR steps to verify.

• Can we get it?
  • IIVE showing receipt of SSDI or SSI due to participant’s own disability
  • MRT determination
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Completed MRT Packet

Comments

• Comment on DISABLED/FMMX to document verification or to explain entries on DISABLED.
  • Describe verification provided or requested
  • Do not record private medical information

• Comment on EUMEMROL/FM3Z if an MRT packet or Medical Records has been submitted to MRT

Driver Information #

Tools

• Driver Information
• Hand Off: Use Non-MAGI Specialized Units > Blind Pension Hand Off for BP/SAB inquiries

Guidance

BP applicant and/or recipients declare whether or not s/he possesses a valid driver’s license and whether s/he agrees to surrender the license

Ophthalmologist Information #

Tools

• Certified Mail
• Driver Information
• Spousal Support
• Hand Off: Use Non-MAGI Specialized Units > Blind Pension Hand Off for BP/SAB inquiries

Guidance

Record the applicant’s/participant’s referral to and decision from an FSD approved ophthalmologist to establish Non-MAGI eligibility based on Aid to the Blind criteria.

• Requirement:
  • To receive MO HealthNet benefits under the Aid to the Blind criteria, a participant must not have vision with or without glasses, up to 5/200, or best visual field is 5 degrees as tested by ophthalmologist or physician skilled in diseases of the eye.
  • The Ophthalmologist Details screen appears in the application controlled flow for any individual requesting coverage AB criteria. For any individual with ‘Benefit Options’ code ‘B’ on the MHABD Application Detail screen, FAMIS will explore Nong-MAGI/AB as well as Supplemental Aid to the Blind and Blind Pension.
• Procedure:
  1. Schedule an appointment with an FSD designated ophthalmologist following local procedures. Send a copy of the IM-68 to the examiner.
  2. Forward results to the State Supervising Ophthalmologist for review and decision.
  3. Update the Ophthalmologist Details screen with the decision and request a new eligibility determination. If decision indicates ‘eligible’, and participant meets all other eligibility criteria, case can be approved. If decision indicates ‘ineligible’, reject the application or close the case.
  4. If participant is eligible, a date for the next determination of visual eligibility is indicated.
  5. Update the DISABLED screen with new eligibility information, if necessary.
• Note:
  • For persons requesting MO HealthNet coverage solely on the basis of AB criteria, explore Supplemental Aid to the Blind or Blind Pension.

Verification

Obtain documentation from a designated or approved FSD ophthalmologist, a physician skilled in diseases of the eye.

• HC – Documentary Verification Required

Comment

Comment on OPTHINFO/FMJQ when an individual applies for health care coverage based on AB, SAB or BP criteria. Record

• All information regarding the ophthalmologist referral
• Verification of eligibility determination, whether eligible or ineligible

SSI Information #

Guidance

Applicants for Supplemental Aid to the Blind (SAB) and Blind Pension must apply for and pursue Supplemental Security Income (SSI) as a condition of eligibility. Completion of this screen is mandatory for all individuals applying for Blind Pension benefits. The SSI Information screen appears in the controlled flow only when there is an individual who has a “B” in the Benefit Requested Field on Application Detail screen.

Job Quit/Work Reduction #

Tools

• Job Quit/Work Reduction

Screen Help

JOBQUIT/FMMT

Guidance

JOBQUIT appears in the SNAP and TA controlled flow.

• SNAP, consider the past 60 days.
  • Job Quit does not apply if the individual is exempt from work registration, except for work registration exemption of employed 30 hours per week (code 10).
  • Work Reduction applies to individuals who were working 30 hours or more per week or had earnings that exceeded the Federal minimum wage x 30.
• Temporary Assistance, consider the past 30 days. This applies to two-parent households only.
  • Neither parent can have quit a job or refused a bona-fide offer of employment for which s/he is qualified without good cause within the 30 day period prior to the date of application
• The concern is voluntary job loss / work reduction. A “Yes” answer requires entry on Job Quit Detail (FMMN) or Work Reduction Detail (FMMN), capturing the date of the job quit and a “Y” or “N” code to indicate if the individual had good cause. If the individual claims good cause, a code is entered to capture the good cause reason.

Verification

Follow FCR steps to verify.

• Can we get it?
  • MWA
  • INTRFACE
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Verification of reduction of work effort is usually obtained in conjunction with the verification of income

Comment

Comment on Job Quit Detail/Work Reduction Detail when entering a job quit or work reduction:

• Participant’s statement about the situation
• Source of information and verification (who, what, when) provided/needed
• Whether good cause exists

Employment Assessment #

Tools

• EMPLOY Exemption and Exclusion Chart
• EMPLOY Screen vs ABAWD Screens
• SkillUP Quick Reference Guide
• SNAP Interview Required Notices
• Hand Off: Use SkillUP Referral Hand Off to refer the participant to the nearest provider when coding an interested mandatory (MAN) participant or a volunteering (code MIV or EIV) participant

Screen Help

 EMPLOY/FMMS

Guidance

SkillUP, formerly known as Missouri Employment and Training Program (METP), offers training, education, and job search help to SNAP recipients through Missouri’s Job Centers and other providers. Enter the employment assessment (SkillUP) code and status for each EU member aged 16 through 59 on the Employment Assessment (EMPLOY/FMMS) screen. FAMIS may automatically populate codes for some household members based on information entered on other screens (students, over 60, under 16, etc.).

If a participant appears mandatory, discuss whether they want to participate in SkillUP or not. If they do not want to participate, code them 22 MAN in the system, but do not refer them to SkillUP. When coding a participant mandatory (22 MAN) that wants to participate, or as a volunteer (MIV or EIV) you must use the SkillUP Referral Hand Off to refer the participant to the nearest provider.

If a participant claims disability but does not meet the SNAP Definition of disabled, obtain a medical statement to verify the exemption, unless their disability/unfitness for work is obvious. Use worker discretion when determining obvious disability/unfitness and make a thorough comment detailing the situation.

If the participant can’t get a medical statement, get an MRT decision. Complete the FS-61 SNAP Summary to Determine Fitness for Work with the participant and email to MRT.Personnel@dss.mo.gov. While the MRT decision is pending, code 15 EXE and enter a comment indicating we are waiting on MRT decision to determine fitness for work.

Explore and apply Exemptions (EXE) before Exclusions (EXC). If an individual is exempt (EXE) on EMPLOY, they are exempt from ABAWD. An individual who is excluded (EXC) on EMPLOY is not automatically excluded from ABAWD.

• • If an individual meets the definition of homeless and is not Exempt for another reasons, code them 42 EXE.
  • If an individual claims disability but does not meet the SNAP definition of disab
  • If an Exempt individual wants to volunteer, code them 24 with an EIV status and record their telephone number on their PRSNDTL screen.
  • If an Excluded individual wants to volunteer, code them 22 with a MIV status and record their telephone number on their PRSNDTL screen.
  • If an individual does not meet any of the Exempt or Excluded criteria, code them 22 with a MAN status.

The Good Cause field is not currently used, as SkillUP does not impose sanctions. Effective June 24, 2014, people are not sanctioned for failure to participate in SkillUP. If an individual moves from being exempt to being mandatory, explore and update Training/Work Requirements on the WORKREQ /FMMR screen.

Determine for each household member, age 16 to 59:

Verification

Many codes can be verified with client statement or worker’s judgment, but some codes require verification and/or comments for further explanation. Check the EMPLOY Exemption and Exclusion Chart for a complete list of the verification and commenting requirements for each code.

Comment

EMPLOY(FMMS) to record

• • Pertinent information not recorded in screen fields
    • • Reason for using exemption or exclusion, if not apparent
      • Reason for updating exemption or exclusion
  • Describe verification provided/needed to verify exemption or exclusion
  • Document the discussion had with the participant regarding their work registration requirements, their willingness to participate and whether a SkillUP referral form was completed.

EUMEMROL(FM3Z)

• • Subject: Work Requirement Notice
  • Comment: Discussed work requirement notice with applicant

ABAWD #

Tools

• • ABAWD Determination Tool

Screen Help

WORKREQ / FMMR

Guidance

SNAP participants identified as Able Bodied Adults Without Dependents (ABAWD) are eligible to receive SNAP benefits for a maximum of 3 months within a 36-month period unless certain work criteria are met. The current 36-month period runs from 7/1/2023 through 6/30/2026.

Individuals not exempt from ABAWD must work, volunteer, or participate in a qualified training program for at least 80 hours per month to continue to receive SNAP benefits beyond the 3-month limit.

Once a person has exhausted their 3-month limit, they may qualify for a one-time extension and regain eligibility for an additional 3-month period if they can show they met the 80 hour requirement within any subsequent 30-day period.

Use the ABAWD Determination Tool to determine whether a participant is ABAWD and how to code them. See 5.7 ABAWD – Time Limit on Benefits to Able-Bodied Adults Without Dependents for more info.

Has the individual previously been coded an ABAWD?

• If no, look at Initial Eligibility

Is an ABAWD participant no longer meeting the work requirement and exhausted their three non-work months?

• If yes, see Losing Eligibility

Has the ABAWD participant previously lost eligibility but is now meeting the work requirement or an exemption?

• If yes, see Regaining Eligibility

Has the ABAWD participant previously regained eligibility but is no longer meeting the work requirement?

• If yes, see After Regaining Eligibility

Has the ABAWD participant verified their work hours?

• If yes, see Tracking Work/Training Hours

Have non-work months been entered in error?

• See Deleting Non-Work Months

Verification

Follow FCR steps to verify.

• Can we get it?
  • Work Requirement for SNAP
    • MRT (Code 50)
    • If participant is not disabled, per SNAP definition, obtain a medical statement, unless the issue is obvious
      • If the physical or mental issue is obvious, ensure the comment documents the situation
      • Benefit Program Technician (BPT) discretion may be used. A worker does not need to see the person to make a determination.
    • If an MRT decision is needed, use the FS-61 SNAP Summary to Determine Fitness for Work. Only complete the FS-61 if unfitness for work is not obvious and needs to be determined through the Medical Review Team
    • Email completed form to MRT.Personnel@dss.mo.gov
      • Type ABAWD in the subject
      • Mark email as high importance
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • ABAWD
      • Paystubs
      • Employer letter
    • Work Requirement for SNAP
      • Code 02 and 03:
        • Paystubs
        • Work Schedule
        • Employer letter
      • Code 50:
        • Documentation confirming no longer ABAWD

Comment

ABAWD Work Requirement

• Comment on WORKREQ to
  • Explain SNAP ABAWD work requirement code
  • When deleting non-work months, identify which months were deleted and why (e.g. deleted 10-2023 because SNAP benefits were pro-rated and 10-2023 should not been entered as a non-work month)
  • What was used to verify adding or deleting non-work months
  • Document out of state non-work months verification, record the state, non-work MM/YYYY and how verified
  • Regained eligibility
    • Describe verification used to verify regained eligibility
    • Identify the additional non-work month (MMYYYY), after the person regained eligibility, was entered

ABAWD Work & Training Hours

• Comment on DAILY WORK/TRAINING HOURS/FMJW, accessed via WORKREQ, to explain SNAP ABAWD hours entered, what was used to verify the work/training hours and eligibility decisions
• Comment on MONTHLY ABAWD WORK/TRAINING HOURS/FMJX, accessed via FMJW, to explain SNAP ABAWD hours entered, what was used to verify the work/training hours and eligibility decisions

Teen Parent #

Guidance

A Minor Parent (under the age of 18) who is not married must live with his/her own parent(s) or in another adult supervised supportive living arrangement. Several requirements in the Temporary Assistance program apply only to parents under the age of 18.

• Is the Minor Parent married?
  • If yes, the EU does not have to meet this eligibility factor.
  • If no, the EU must meet this eligibility factor. Continue to the next question.
• Does the Minor Parent reside with his/her own parents or adult supervised living arrangement?
  • If yes, see Minor Parent in an Adult Supervised Setting.
  • If no, continue to the next question.
• Does the Minor Parent claim an exception to the Minor Parent living arrangement?
  • If yes, see Exceptions to Minor Parent Living Arrangement.
  • If no, see Minor Parent Not in an Adult Supervised Living Arrangement.

All teen parents without a high school diploma or the equivalent are required to participate in education as their required work activity. During summer vacations, teen parents must participate in other work activities. Eligibility determination for Minor Parents living with their own parents requires FSD to assess this parental income.

Verification

Follow FCR steps to verify.

• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Written statement from the applicant explaining good cause AND
    • Verification of the good cause for the exemption

Comment

Record details about the supervised living arrangement or explain the good cause reason, and any verification provided/requested

Pregnancy #

Screen Help

Pregnancy Driver Question

Pregnancy Detail PREGNANT/FM8E

Guidance

Pregnancy is not a requirement for the Non-MAGI programs. However, this question appears in the controlled flow for any female EU member between age 5 and 65 requesting coverage.

If pregnant, attempt to transition active MHN participants, excluding those covered under Supplemental Aid to the Blind (SAB) or Blind Pension (BP), to MPW or SMHB upon being notified that they are pregnant.

• SAB and BP participants will not be transitioned to MPW or SMHB unless they specifically request to be moved, because this transition would end their monthly cash grant.

If FSD cannot transition the participant to MPW due to excess income or SMHB due to excess income and/or having health insurance, such as employer-sponsored insurance or Medicare, their level of care will not be changed.

Participants who do not qualify for MPW or SMHB but are currently active under a federally funded MHN program, such as Non-MAGI Spend Down or Ticket to Work Health Assurance (TWHA), will have continuous eligibility under their current level of care from the first time they meet their Spend Down or pay their premium, while pregnant, through the end of the 12^th month after their pregnancy ends.

Note: Participants can have active Qualified Medicare Beneficiary (QMB) or Specified Low-Income Beneficiary (SLMB) and MPW coverage at the same time.

Verification

Follow FCR steps to verify.

• Take customer’s statement on pregnancy, unless questionable.

Comment

Details describing verification of pregnancy and information not captured on Pregnancy Detail screen.

Child Support Assignment/Referral & Cooperation #

Tools

• Entering a Sanction or Disqualification
• Deleting a Sanction or Disqualification
• Updating/Ending a Sanction or Disqualification
• Inquiring About a Sanction or Disqualification
• Forms:
  • IM-2E Part 1
  • IM-2E Part 2
  • CS-201: (Instructions) (These forms are incorporated into Section 40 of the IM-1TA Application for Temporary Assistance Cash Benefits)
  • IM/CS-2PV Voluntary Paternity Establishment (instructions)
  • VS-465; VS-465D; VS-465F; VS-465M (instructions)
    • Is a VS-465 Needed?

Screen Help

ASSIGN/FM86

Guidance

The applicant assigns his/her rights to child support payments from non-custodial parents to the Family Support Division when the application for Temporary Assistance is signed. Assignment becomes effective the day after TA approval. The client must cooperate in obtaining child support for each child in the assistance group, unless s/he has established good cause.

Assignment of child support rights means that any child support payments made to a Temporary Assistance recipient are collected by FSD Child Support. The recipient may not collect both child support and Temporary Assistance for a child in the same month.

Cooperation with FSD Child Support means the payee must provide information about the absent parent(s) and work with FSD to obtain child support for the child(ren). Failure to cooperate results in sanction and reduction of benefits. The CS-201 may be completed over the phone with the participant and sent to CS on the participant’s behalf if the participant is not claiming good cause.

VS-465 forms may be required to add the father’s name to a child’s Missouri birth certificate. (See Is a VS-465 Needed?)

The Assignment/Referral (FM86/ASSIGN) screen occurs in the controlled flow. A “Yes/No” answer is required indicating the applicant’s agreement to cooperate, as stated in the application. If the customer claims good cause, the appropriate good cause reason is entered in the Good Cause field.

Steps for Child Support Assignment and Referral

Steps for Child Support Assignment and Claims of Good Cause

Steps to Explore Good Cause:

Comment

Comment on ASSIGN/FM86 when a CS-201, IM-2E Part 1 & 2, Good Cause or VS-465 series form is completed or updated:

• Record each form number discussed, completed/updated and the date
• Record the name, DOB, address, etc. of each Non-Custodial Parent (NCP)/Parent Paying Support (PPS)
• Date the VS-465 was signed and sent to BVR
• Discussion of good cause reason for the customer’s non-cooperation and the steps taken to document it
• All verification provided/requested

Deprived of Parental Support #

Guidance

To be eligible for Temporary Assistance, the children must be deprived of the support of one or both parents by reason of death, continued absence from the home, a parent’s physical or mental incapacity, or the parents’ financial need.

Children in two-parent households are presumed to be deprived of parental support if the Eligibility Unit meets the factor of financial need.

The factor of deprivation of parental support becomes critical to a correct eligibility determination in “blended family” situations, or households where each parent has his/her own children, as well as a child/children in common.

First, the ES must determine eligibility for the entire family as one eligibility unit. If not eligible on the basis of financial need, then the in-common child/children are not deprived of parental support. The ES would then determine eligibility for each parent and his/her own children in separate eligibility units, excluding the in-common child/children.

Note: the parent is always payee for his/her own children.

Example: Jack and Laura Phillips (a married couple) are applying for Temporary Assistance benefits for themselves and their children. The household consists of:

Jack Amy, Jack’s daughter Laura Jason, Laura’s son Andrew, Jack and Laura’s son in-common

Upon processing of the application, the ES determines that the family’s gross income exceeds the maximum for a 5-person eligibility unit. Andrew is, therefore, not deprived of parental support. The ES would next register Temporary Assistance applications for:

Since Jack and Laura are married, both EUs would be evaluated considering the stepparent’s income and dependents, per policy section 4.2.2 Mandatory TA Household Members subsection Stepparent in the Home. If the couple were not married, each parent’s role would be EX, excluded, in the other parent’s EU. Andrew is ineligible for Temporary Assistance in either EU, as he is not deprived of parental support.

TAINFO #

Screen Help

TAINFO/FM8D

Guidance

The TA/MA Information (FM8D/TAINFO) screen captures information for federal reporting requirements for Temporary Assistance program, and information to determine the amount of income to deem to the Temporary Assistance or Medical Assistance EU in households which include a Stepparent or a Minor Parent living with his/her own parent (Major Parent).

Indicate the subsidized housing status of the Temporary Assistance Eligibility Unit for federal reporting requirements:

• NON – None
• PUB – Public Housing
• REN – Rent Subsidy, such as Section 8

For deeming income:

REQUIREMENT FOR MINOR PARENT EUs:

When a Minor Parent lives with his/her own parent/s (Major Parent/s) and those Major Parent/s are eligible for Temporary Assistance, the Minor Parent may be included in the Major Parents’ EU, or may be considered as a separate Eligibility Unit from the Major Parent/s.

If the Minor Parent is considered as a separate Eligibility Unit from his/her own parent/s, special budgeting procedures apply. A portion of the income of the Major Parent/s is counted as income (deemed) to the Minor Parent’s TA Eligibility Unit.

REQUIREMENT FOR STEPPARENT EUs:

When the Temporary Assistance applicant is married and his/her spouse is not the parent of the child for whom assistance is claimed, a portion of the stepparent’s income is counted as “deemed” income to the Temporary Assistance Eligibility Unit.

For newly married participants, see Earnings Disregards in this guide and 10.17.3  TA Disregards & Deductions in the FSD Policy Manual.

On the Temporary Assistance/MA Information (FM8D/TAINFO) screen

• In the “deemed person” field, identify the person whose income is to be deemed.
• In the “number of persons” field, identify the number of persons (excluding EU members) living in the home whom the deemed person can claim as dependents for Federal tax purposes.
• Do not include the individuals requesting TA as dependents of the deemed person. (See the manual references above for examples.)

This screen does not appear in the TA Rein flow. Fastpath to review this screen if the EU has moved, housing type may have changed. Update deeming if no longer living with this stepparent or major parents. Or if the deemed individual has a change in the number of dependents.

Comment

Comment on TAINFO/FM8D identifying the people, by name, in the # Persons field.

Residing in a Care Facility #

Tools

• • • Change of Facility Type
    • Determining Spousal Share / Countable Assets for Vendor
    • Facility and Placement Information Details
    • FAMIS Changes Due to MMMNA and Shelter Standard Adjustments
    • Institutionalized Spouse
    • Month of Assessment
    • Non-MAGI Vendor Allotments
    • Nursing Home/Vendor Inquiries
    • Participant Leaves the Vendor Facility
    • Submitting Preadmission Screening
      • Level of care assessment is now automated. More information is located on the COMRU’s webpage: https://health.mo.gov/seniors/nursinghomes/pasrr.php
        • Level One Form or Level One Nursing Facility Pre-Admission Screening is for mental illness, intellectual disability, or related condition.
        • Level of Care Form or Nursing Facility Level of Care Assessment is used to determine if the participant is in the correct placement for care.
    • Type of Facility and Type of Bed Combinations
    • Vendor Requests from Active Non-MAGI Participants
    • Hand Off: Use Non-MAGI Specialized Unit > Nursing Home/Vendor/SNC > Hand Off for Vendor/SNC applications

Screen Help

 FACPLACE/FMJ4 – Residing in an SNC Facility

FACPLACE/FMJ5 – Residing in a Vendor Facility

Guidance

Vendor:

Individuals who qualify for Non-MAGI and who live in a care facility may qualify to have all or part of their institutional costs paid by MO HealthNet directly to the facility. These payments are called “vendor payments.”

Benefits are not payable to any claimant who ‘is an inmate of a public institution, except as a patient in a public medical institution’. Refer to the policy cited above for specific definitions.

When an individual enters a nursing facility (NF), state mental hospital (MHC), or institution for the mentally retarded (IMR), payments may be made directly to the facility that is providing care to the individual.

To be eligible for vendor benefits, the individual must:

• • • • Occupy a Medicaid certified bed, also known as a Title XIX bed (T19 in FAMIS).
      • Have received a preadmission screening.
      • Be certified as needing the level of care the facility provides.

For persons not receiving any type of assistance, a MHA application would be taken and eligibility for Vendor would be established based on MHA requirements.

Participants currently receiving benefits from one of the Adult programs (not conversion cases) need not make a new application. Vendor eligibility would be established and benefits issued under the type of assistance the individual is already receiving.

If participant is married and living in a nursing facility explore Assessment and Division of Assets, Community Spouse, and Allotments. If community spouse exists, address on SCMBR is the community spouse’s address. Facility name and address is captured on the Facility Placement screen.

Supplemental Nursing Care:

To be eligible for Supplemental Nursing Care (SNC), an individual must reside in a basic Residential Care Facility (RCF-I or RCF-II); an Assisted Living Facility; or an Intermediate or Skilled Nursing Facility, when ineligible for vendor payments.

For persons not receiving any type of assistance, a MHA application would be taken and eligibility for Vendor would be established based on MHA requirements. Participants currently receiving benefits from one of the Adult programs (not conversion cases) need not make a new application. Eligibility would be established and benefits issued under the type of assistance they are receiving.

SNC grant amounts are based on levels of licensure for the nursing facility (7.3.4 SNC Payment and Grant Amount):

• • • • Skilled nursing facility or intermediate care facility (substantiated by level of care determination from DHSS DA-124)–$390 monthly benefit
      • Skilled nursing facility or intermediate care facility (NOT substantiated by level of care determination)–$292 monthly benefit
      • Assisted living facility or Residential care facility II (still in compliance with former RCF II requirements)–$292 monthly benefit
      • Residential care facility (formerly residential care facility/RCF I)–$156 monthly benefit

SNC participants also receive MHA coverage and a Supplemental Nursing Care Personal Expense Allowance of $50.

When the driver question for residing in a care facility is answered yes, the dynamic screen “Facility and Placement Information Detail” appears in the flow. Entries on this screen determine whether FAMIS explores Vendor or SNC.

The top half of the screen is displayed first. The following fields must be completed:

• • • • DVN – promptable field which populates facility name and address
      • Facility Type – promptable, verified by the nursing facility
      • Date Entered Facility – as verified by the nursing facility
      • Date Left Facility (if applicable)
      • End Reason (if individual has left the facility) promptable for reason code
      • Type of Bed – promptable, verified by the nursing facility
      • DMH Placement – (Y/N) verified by the nursing facility
      • Placement Detail Verification – verification code for information in these fields
      • Expected to Stay Less Than 30 Days – (Y/N) verified by DA-124 or doctor’s statement

After completing these fields, press control and additional fields appear, with a message in purple “SNC benefits will be explored”. Those fields that will appear are:

• • • • DA-124 A/B Level of Care
      • FSD Date
      • Payment start date
      • Payment stop date

These fields are completed with information obtained from DHSS by pressing F14=I124. Print the I124 (DA-124) information for the case file, and press F12=RETURN, using the printed information to complete FAMIS entries. If the information is not available from DHSS, set a reminder to check back for a DHSS medical determination.

DHSS level of care is only needed when a person is in a skilled nursing facility or intermediate care facility.

Two additional fields display when a person is less than 22 years of age, resides in a medical facility, and is in need of psychiatric care. Complete the entries to document the IM-71 Certification of Need for Psychiatric Services.

NOTE: While the DHSS determination is pending, the applicant may be approved for other Non-MAGI coverage. FAMIS will not generate a reminder to follow up and complete an eligibility determination for vendor benefits upon receipt of the DA-124 information. The Eligibility Specialist must manually set a reminder to check the I124 screen for a level of care decision. Non Spend Down or Spend Down benefits do not pay for Vendor, HCB or SNC care costs. When the DHSS level of care determination is received, approve the Vendor, HCB or SNC benefit back to the original application date.

Verification

If an individual is requesting vendor payments, verification of residence in a care facility is received from the individual, family member, or care facility via telephone, fax, or mail. Documentary evidence (HC) is not necessary.

Comment

Comment on Facility and Placement Information Details/FMJ5 when a customer is residing in a care facility to record details of the discussion and verification provided/requested.

Division of Assets #

Tools

• Division of Assets
• Forms:
  • IM-78, Declaration and Assessment of Assets (FAMIS equivalent = FA-478)
  • IM-79, Intent to Transfer Assets Agreement (FAMIS equivalent = FA479) (Used when Division of Assets is completed outside FAMIS.)
  • IM-79A, Notification of Requirement to Transfer Assets

Guidance

Division of Assets is a policy which allows a spouse who remains in the community to retain a portion of the couple’s assets while an institutionalized spouse becomes eligible for Non-MAGI.

Vendor, HCB, and SNC have the same resources limits as MHA. However, with Vendor and HCB benefits for married couple case the “institutionalized spouse” is viewed as a single individual with regard to resources. The married couple initiates a Division of Assets, which allows a spouse, who remains in the community, to retain a portion of the couple’s assets while the institutionalized spouse becomes eligible for MO HealthNet institutional coverage (Vendor or HCB).

When entering an application which requires a Division of Assets, FAMIS will present a PEND outcome for Technical Eligibility. The Division of Assets must be completed in order to reach an eligibility outcome. Division of Assets may also be requested independent of any MHA application.

A division of assets involves the steps shown below. Click on each step for detailed instructions.

• Determining if one member of the couple is considered institutionalized
• Determining the month for which an assessment of the couple’s assets must be completed
• Completing an assessment of assets
• Determining the spousal share/Determining countable resources and deducting the spousal share when the institutionalized spouse applies for Non-MAGI Vendor
• Determining intent to transfer assets when approving for Vendor

All countable assets require Hard Copy verification for a Division of Assets determination.

TA Work Requirement/COMPACT #

Tools

• COMPACT Code Flowchart
• MWA Portal: https://dssapp.state.mo.us/MissouriWorkAssistance/ to see if customer is complying with MWA for TA

Screen Help

 COMPACT/FM8B

Guidance

Each applicant/recipient of Temporary Assistance who is at least age 18 and teen parents under age 18 must participate in work activities, unless determined to be exempt or excluded. The goal is to help TA recipients move toward self-sufficiency.  During the interview, inform applicants of the requirement to register with jobs.mo.gov. If no interview is completed, use the special instructions section in the FA-325 to inform applicants of this requirement. Mandatory applicants’ registration with jobs.mo.gov populates in the ‘Engaged in Work Activity’ field. Until this field populates, the application will PEND. If this field is not populated and the participant claims to have registered, email FSD.E&Tinquiry@dss.mo.gov and refer to the policy for Online Work Registration.

• • Standardized Orientation – Applicants are informed of the work requirements.
  • www.jobs.mo.gov – Those subject to TA Work Activities must register here.
  • Personal Responsibility Plan – Must be completed prior to approval of the TA application.

At each application, review, or interim change, each caretaker/parent must be assessed to determine work activity participation status. The result of this assessment is entered on the TA Work Requirement (FM8B/COMPACT) screen. Those determined to be mandatory and volunteers are referred to the Missouri Work Assistance program electronically for employment and training services.

NOTE: If the applicant’s Temporary Assistance closed due to a Full Family Sanction, they must engage with MWA and participate in work activities PRIOR TO APPROVAL or meet an exemption or exclusion. See Conciliation and Sanction. Eligibility Team Members must determine proper entries on COMPACT based on the PRP, weekly hours worked and discussion with the participant:

• Question 1: Does the participant meet an exemption?
  • If YES, see the TA Work Requirement: Exemption User Guide
• Question 2: Does the participant meet an exclusion?
  • If YES, see the TA Work Requirement: Exclusion User Guide
• Question 3: Does the participant meet an extension?
  • If YES, see the TA Work Requirement: Hardship Extension User Guide
• Question 4: Is the participant a Teen Parent?
  • If YES, see the TA Work Requirement: Teen Parent User Guide
  • If NO, see the Work Activity Participation and COMPACT User Guide. The individual is mandatory for participation.

Work Requirement Indicator Codes:

Verification

• Can we get it?
  • • IIVE (for disability)
    • MRTINFO
    • Active with Children’s Division
      • FACESINQ
      • Contact CD to confirm if the participant has an active case, the anticipated duration of the active case, and whether the participant’s involvement in the case prevents the recipient from participating in work activities.
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Needed in the Home to Care for a Disabled Individual:
      • Written statement from a physician, psychologist, or psychiatrist to verify the need for a parent/caretaker to care for a family member
    • Permanent Disability:
      • Employer-sponsored disability insurance
      • Application for SSI, SSA
      • MRT Packet
    • Temporary Disability:
      • Determined by a physician, psychiatrist, or psychologist
    • Hardships:
      • Domestic Violence:
        • Self attestation
        • Court Documentation
      • Substance Abuse:
        • Diagnosis: A physician, other medical professional or Licensed Clinical Social Worker (LCSW)
        • Treatment: Short term residential, day treatment, counseling, support groups, group education, group counseling, C-STAR, Alcoholic Anonymous (AA), Narcotic Anonymous (NA)
      • Mental Health:
        • Diagnosis: A physician or licensed psychologist may make the diagnosis. Vocational Rehabilitation (VR)
        • Treatment: Short term residential care, counseling, support groups, mental health case management with a community support worker or targeted case manager
      • Family Crisis:
        • Home destroyed by fire
        • A temporary disability and the participant is unable to work for a period of time
        • Accidental injury in which a child or other family member is injured keeping the participant from being able to seek work or maintain present employment
        • Job loss due to company layoff, downsizing or closing
        • Crime victim
        • Multiple crises

Comment

Comment on COMPACT/FM8B recording IM3PRP information when the reason for work requirement code is not obvious or needs explanation such as:

• Date the IM3PRP forwarded to MWA at TA approval
• Clarify and explain the work requirement code, if the code is not obvious
• Pending or current registration with jobs.mo.gov when verification has been received, stating what verification was provided, or if client states they have already registered, and staff send an email to FSD.E&TInquiry@dss.mo.gov to verify registration.
• Clearly explain the reason for exploring exemption, exclusion or extension and the verification provided/needed to support it
• Explanation of re-evaluation date
• Work hours calculation (if applicable) and document verification
• Requests for extension and verification provided/requested to support it

Comment on COMPACT/FM8B and EUMEMROL/FM3Z when an individual is at or near the TA Lifetime Limit

• Record information related to hardship extensions
• That the information was forwarded, with the IM-2EH to the Processing Center

HCB Waiver Services/ PACE #

Tools

• Home and Community Based Services (HCB) Quick Reference Guide
• Appendix E- HCB Income Maximum
• PACE
• Hand Off: Use Non-MAGI Specialized Unit > HCB Hand Off for HCB request

Screen Help

HCBINFO/FMJ7

Guidance

Home and Community Based Services (HCB) waiver is part of the Missouri’s nursing home diversion program. Through this program, individuals are offered in-home services that may allow them to remain in their own homes, rather than going to a care facility. Individuals must meet certain criteria and be determined medically eligible by the Department of Health and Senior Services, Division of Senior and Disability Services (DHSS/DSDS)

If a participant requests HCB, staff will not make entries on HCB related screens but use F9 to continue in the controlled flow. Staff will then complete a Hand Off: Use Non-MAGI Specialized Unit > HCB Hand Off so the specialized unit can process the HCB request.

All HCB cases are handled by a specialized unit located in Butler County. Staff in the HCB Specialized Office send and receive the IM-54 forms to and from DHSS. Staff in Butler County also process SNAP applications in an HCB household.

In some situations, a participant who with an active MO HealthNet Spend Down case may be determined eligible for HCB through DHSS. When a claimant becomes eligible for HCB, s/he is no longer required to meet a monthly spend down. HCB eligible claimants have no cost sharing of medical coverage. An Assessment and Division of Assets is completed when one person of a married couple is requesting HCB coverage.

PACE

Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive health care services to Medicare/Medicaid recipients 55 years of age or older, who otherwise would require the level of care for coverage of a nursing facility. This program is currently available only in St. Louis. FSD does not determine PACE eligibility.

• • Current PACE provider in St. Louis Area: New Horizons PACE
  • New Horizons PACE contact information: 833-654-7223
  • PACE provider begins enrollment process and is coordinated by the MO HealthNet Division (MHD).
  • PACE eligibility/enrollment is identified in Medicaid Management Information System (MMIS). Review the “Lockin” information when completing a Participant Inquiry in MMIS.
  • PACE organization pays the participant’s spend down directly to MHD and bills the participant for the charges used to meet spend down.
  • Processes for vendor coverage has not changed. Participants continue to pay their surplus to the nursing facility.
  • Hearings for PACE enrollment are conducted by MHD. Forward all hearing request for PACE enrollment determinations to:
    • • Email:statefairhearings@dss.mo.gov
      • Phone: 800-392-2161
      • Mail: MO HealthNet Division Attn: Hearings PO Box 6500 Jefferson City, MO 65109
  • FSD continues to determines MO HealthNet coverage and does NOT determine PACE eligibility.
  • FSD eligibility system is no longer used to authorize PACE eligibility.
  • DO NOT use PACE type code in the Type field on the Home and Community Based/PACE Information (HCBINFO/FMJ7) screen.
  • FSD staff may send PACE eligibility questions to MHD.PACE@dss.mo.gov.

DHSS also offers a separate program, HCBS, for Non-MAGI applicants/participants who are eligible for Non-MAGI benefits but ineligible for HCB due to age.

Verification

HCB: DHSS/DSDS determine if the individual is medically eligible to receive HCB waivers. Refer individual to DHSS/DSDS using the IM-54A (Home and Community Based Referral). DHSS/DSDS make their determination and notify FSD on the IM-54A.

• HC = Documentary Evidence

Comment

Comment on HCBINFO/FMJ7 to record the discussion with customer

• The date the IM-54 is received from DHSS
• Eligible or ineligible decision made by DHSS
• IM-54 was scanned to the ECM

Transfer of Property #

Manual References

10.10.1 MO HealthNet Transfer of Resources

Tools

• Transfers of Property Prior to February 8, 2006
• Transfers of Property On or After February 8, 2006
• Transfer of Assets
• Adding Adult MA Transfer of Property and/or a Penalty
• Promissory Note Guide
• 18.3.3 Non-MAGI MO HealthNet Appendices – Average Private Nursing Home Rates
• AfGE Portal Guide

Screen Help

Transfer of Property (MA) Driver Question

MATRAN/FMWP List MA Transfer of Assets

Adult MA Transfer of Assets

Guidance

Individuals and couples who transfer property within the past 5 years without receiving fair and comparable compensation may be subject to a penalty period prior to Vendor, HCB, or MOCDD coverage begins. They may still be eligible for Non-MAGI. The penalty period begins the date the transfer occurred, or the date the individual would have been eligible for Vendor, HCB, or MOCDD services if not for the transfer, whichever is later.

A transfer of property will not affect eligibility for non-vendor Non-MAGI. However, the transfer still must be explored, because the penalty must be applied in the event the participant later meets the state’s definition of institutionalized. A non-vendor application should not be delayed while exploring transfer of property.

Record applicant’s statement with regard to the last 5 years. If Y, enter details of sold/transferred property. During an Non-MAGI application or annual review, access the AfGE portal if additional information is needed to confirm the participant/applicant’s statement of ownership.

Verification

Follow FCR steps to verify.

• Can we get it?
  • Accurint for Government Eligibility (AfGE)
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Statement of the transfer of property

Obtain information establishing what property was transferred, value of that property and value received from transfer and enter a comment on Adult MA Transfer of Assets/FMWQ (accessed from MATRAN).

During an Non-MAGI application or annual review, access the AfGE portal Guide if additional information is needed to confirm ownership of the property.

• HC = Documentary Evidence
• CS = Client Statement
• TC = Telephone Call
• GS = Accurint Statement – Accurint for Government Eligibility information is used and additional information or verification is needed. This prompts FAMIS to generate an FA-325.
• GC = Accurint Confirmation – Use code GC if no additional verification is needed after accessing Accurint for Government Eligibility or update GS to GC if additional information or verification is received from the participant.

Comment

• Comment on Adult MA Transfer of Assets/FMWQ (accessed from MATRAN)
• Comment captures when and why property was sold/transferred and verification provided/requested

Supercase Eligibility Unit Summary #1 #

Use function keys to review Technical factors. Evaluate the results and explore/resolve any unexpected PEND, FAIL, ISD.

• Resolve all ISDs

Tools

• Evaluating FAMIS Results-Non-MAGI
• Evaluating FAMIS Results-FS and TA
• Retrieving Archived Eligibility Determinations (EDs)

Screen Help

FM30 Supercase Eligibility Unit Summary