03.4 – Interviewing / Processing (Vehicle thru Closing the Interview)

Vehicle #

Tools

• Accessing the GRS / Marine Systems
• Promissory Note Guide
• www.nadaguides.com/cars

Screen Help

Vehicle / FMW3

Guidance

Non-MAGI

Exclude one automobile or truck as a resource if it is the only vehicle owned. If more than one vehicle is owned, use personal judgment based on family needs to determine whether to exclude additional vehicles.

Note: If a resource has ended see 04 CIC End Dating Resource for Non-MAGI (Excluding Vendor/Supplemental Nursing Care)

TA

The equity value of one vehicle is excluded from consideration as a resource in the Temporary Assistance program. If a second vehicle is owned, $1500 in equity in the second vehicle is excluded from consideration as a resource. The full equity value of any additional vehicles is counted in determining the EU’s total resources.

Capture the participant’s statement regarding vehicles owned by the EU:

• • FAMIS Begin Date is the date the participant obtained the vehicle
  • Enter current value and any debt
  • Enter usage code for all vehicles
  • Enter MHABD EXCL Reason for Non-MAGI participants
  • Begin date is the date the value was accurate

Add Joint Owner using F16=JTOWNER – Establish percentage

Verification

Non MAGI

Participant’s statement is acceptable as to the number of vehicles, how those vehicles are used and the value of vehicles, unless questionable.

TA

If only one vehicle is claimed, accept the client’s statement.

If more than one vehicle is claimed, confirm each vehicle’s declared value is reasonable by accessing the “Consumer” guide on www.NADA.com. or www.KBB.com. The average trade in value should be used for comparison. The debt owed on each vehicle must also be verified. This can be accomplished by viewing the payment book, monthly statement, or by contact with the lender. Record the basis for determination of value and equity in a comment.

In the event the claimant’s statement of vehicles owned is questionable, access the GRS or Marine System to obtain information on all vehicles titled in the state of Missouri. See the Procedure Guide linked above for instructions.

Procedure to Verify Values Online

1. 1. Type in the address www.nadaguides.com/cars.
   2. Select the appropriate make of vehicle.
   3. Select the model year.
   4. Select the model.
   5. It is not necessary to enter the mileage or options of the vehicle. Just leave it blank.
   6. Click ‘Continue’ to view the estimated value of a vehicle. The ‘Average Trade-In Value’ is used for comparison.

Comment

Comment on Vehicle/FMW3, access via SELFRES, to record and explain

• Describe verification provided/needed
• All information necessary to explain how the resource affects eligibility
• Joint ownership details, such as non-EU member name and phone number, conditions of ownership

Real Property #

Tools

• Accurint (AfGE)
• Promissory Note Guide
• Non-MAGI: When to send an FA-325

Screen Help

Real Property / FMW4

Guidance

Non-MAGI and Vendor

• Exempt the home, regardless of its value, as a resource as long as the home is the primary residence of the recipient, recipient’s spouse or dependent child. Only one home may be established as primary residence.
• If participant owns additional property count the value of the property as a resource.
• When a claimant owns real property and a ‘Y’ answer is entered on the Real Property driver question during the controlled flow, the Real Property screen appears to capture details. Each property is captured separately. Document joint ownership of all real property.
• During an Non-MAGI/Vendor application or annual review, access the Accurint (AfGE) portal Guide if additional information is needed to confirm ownership of real property, boats or aircraft.
• Note: If a resource has ended see 04 CIC End Dating Resource for Non-MAGI (Excluding Vendor/Supplemental Nursing Care)

Vendor

• For real property in which the vendor claimant has lived, other factors are involved. Those factors include how long ago the claimant left the property, and where s/he has lived since leaving the property. See 10.4.1 Non-MAGI MHN Real Property as an Available Resource for details.
• Effective with Vendor, PACE and HCB applications received January 1, 2006 and later: Individuals with home equity which exceeds $730,000 (effective 01/01/2025, see Appendix J) are not eligible for long term care services.  The home equity policy does not apply in the following conditions:
  • The spouse of the claimant is residing in the claimant’s home.
  • The claimant’s child who is under 21, residing in the home.
  • The claimant’s child, who is 21 or over, is blind or permanently and totally disabled is residing in the claimant’s home.

TA

• Equity in real property owned by members of the Temporary Assistance Eligibility Unit, unless exempt, is counted as a resource. Exempt real property includes the home in which the EU resides and the land on which it is located, up to 40 acres. When the home is located on property exceeding 40 acres, two FAMIS entries will be required.

Verification

Accept participant’s statement as to the value of the primary residence, unless questionable. Non-exempt real property requires verification of ownership. The participant’s statement of its value may be accepted, if not questionable. Follow FCR steps to verify.  See Non-MAGI When to Send FA-325 for more information.

• Can we get it?
  • Missouri State Assessors Association (contact information for local assessor’s offices)
  • Accurint (AfGE) (for MO HealthNet only, see NOTE below
    • NOTE:  Access the Accurint (AfGE) portal ONLY if additional information is needed to confirm the participant/applicant’s statement and ONLY during an Non-MAGI or MAGI application or annual review. The Accurint (AfGE) portal should only be accessed after all other cost-free electronic means of gathering the required information are exhausted. Accurint (AfGE) Verification Codes:
      • GS: Accurint (AfEG) Statement – additional information or verification is needed.  This would prompt an FA325 to be generated.
      • GC: No additional verification is needed after accessing Accurint (AfGE) or updates GS to GC after the additional information or verification is received from the client.
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Tax bill
    • Deed to verify ownership
    • Statement to verify debt
    • Value of property may be verified by purchase offer or statement from real estate agent or someone well acquainted with real estate values in the community.
    • If an appraisal is needed, use IM-43/IM-43A.
    • Verify equity of countable property by viewing mortgage or payment schedule, or by FA-305.
  • Accept client statement (Verification Code CC) of Resources when no other verification is available.
    • DO NOT DENY or adversely impact a participant’s benefits due to the failure of a person outside of the household to cooperate in providing the necessary information.
      • When all attempts to verify resources have failed because the person or organization providing the resource failed to cooperate with the household and agency staff, and all other sources of verification are unavailable, arrive at an amount per a discussion with the participant using the best information available.
      • Record all attempts to verify the information, including the discussion with the participant and why their statement is being accepted.

Comment

Comment on Real Property/FMW4, access via SELFRES, to record and explain

• Describe verification provided/needed
• All information necessary to explain how the resource affects eligibility
• Joint ownership details, such as non-EU member name and phone number, conditions of ownership

Personal Property #

<Tools

• Accurint (AfGE)
• Non-MAGI: When to send an FA-325
• Promissory Note Guide

Screen Help

Personal Property / FMW2

Guidance

Equity in personal property owned by Eligibility Unit members, unless exempt, is counted as a resource. Examples of exempt personal property include:

• Household Furnishings in use (property in storage & not in use is not excluded)
• Jewelry of limited value (costume), wedding and engagement rings
• Personal Effects and Household Goods
• Farm surpluses
• Livestock
• Farm or business machinery or equipment
• Burial Plots

Note: If a resource has ended see 04 CIC End Dating Resource for Non-MAGI (Excluding Vendor/Supplemental Nursing Care)

Enter all personal property declared by the EU into FAMIS on the Personal Property (FMW2) screen. Codes indicating how the property is used/not used can determine whether the value is considered. Use these codes to exclude property that is income producing, or to indicate property is not in use.

Verification

• Follow FCR steps to verify.  See Non-MAGI When to Send FA-325 for more information.
  • Can we get it?
  • Watercraft Registration: GRS/Marine Systems
    • Value: Kelley Blue Book; NADA-boats
    • Accurint (AfGE) (For MO HealthNet only, see note below)
    • CS = Client Statement
    • GS = Accurint (AfGE) Statement
    • GC = Accurint (AfGE) Confirmation
  • Accept client statement (Verification Code CC) of Resources when no other verification is available.
    • DO NOT DENY or adversely impact a participant’s benefits due to the failure of a person outside of the household to cooperate in providing the necessary information.
      • When all attempts to verify resources have failed because the person or organization providing the resource failed to cooperate with the household and agency staff, and all other sources of verification are unavailable, arrive at an amount per a discussion with the participant using the best information available.
      • Record all attempts to verify the information, including the discussion with the participant and why their statement is being accepted.

Comment

Comment on Personal Property/FMW2, access via SELFRES, to record and explain

• Describe verification provided/needed
• All information necessary to explain how the resource affects eligibility
• Joint ownership details, such as non-EU member name and phone number, conditions of ownership

Transfer of Property #

Tools

• Transfer of Property

Screen Help

Driver Question/FMRB

Transfer of Property/FMWC SELTRANS/FMWL

Guidance

Households (EUs) that have transferred resources in the three months before application, or during a certification period, to knowingly qualify for SNAP benefits are disqualified from the program for up to one year from the date of discovery. This includes property acquired and transferred during a certification period. Some transfers don’t affect eligibility, including:

• Sold or traded at or near fair market value
• Transferred between members in the same SNAP Household
• Transferred for reasons other than qualifying for SNAP, such as repaying on a bona fide loan
• Not counted as a resource, such as a car
• When added to other household resources, are less, at the time of transfer, than the household’s resource limit

The length of the disqualification period is based on the value of the transferred resource, plus other countable resources, which exceeds the resource limit. See 10.10.9 SNAP Transfer of Resources in the FSD Policy Manual for disqualification period specifics.

Comment

Comment on Transfer of Property/FMWC to record when and why property was sold/transferred and verification provided/requested

Life Insurance #

Tools

• HOT TIP, 06/08/2018: VERIFICATION OF CASH SURRENDER VALUE (REVISED)
• Applying the $1500 Exemption
• Pre Need Burial and Life Insurance Entry
• Whole Vs Term Life Insurance
• Non-MAGI: When to send an FA-325

Screen Help

Life Insurance / FMW1

Guidance

Non-MAGI: Each person whose resources are considered is allowed to have life insurance, pre-paid burial plans, designated burial funds, or a combination of such plans. The values of these funds may be considered available resources. Each person is allowed an exemption of $1500 on the Cash Surrender Value (CSV) of life insurance, pre-paid burials, or designated burial funds, or a combination of these. Claimants for AB do not receive this cash surrender value exemption. These resources are captured at different times in the controlled flow, but all work together.

Note: If a resource has ended see 04 CIC End Dating Resource for Non-MAGI (Excluding Vendor/Supplemental Nursing Care)

• LIFE INSURANCE:
  • • Life Insurance has its own driver question in the controlled flow.
    • If entering a new life insurance at the time of an Non-MAGI application, the FAMIS begin date field must be date at least the first month of the prior quarter unless the plan was issued after this date.
    • Cash surrender values of Life Insurance policies may also be exempt. There are two types of life insurance, Whole Life and Term Life insurance. Term Life has no cash surrender value, as it pays a benefit only once a person is deceased. Whole Life insurance accumulates cash value which may be accessible by the owner.
• PRE-PAID BURIALS:
  • • Pre-paid burial has its own driver question in the controlled flow.
    • Pre-paid burial agreements may be considered available resources depending on the type of agreement. See Prepaid Burial for more info.
    • During the controlled flow, you must identify whether the pre-paid burial is irrevocable or funded by a life insurance policy.
      • • When an irrevocable burial plan is funded by a life insurance policy, complete the following in FAMIS: At the Prepaid Burial screen enter and record the current value of the irrevocable burial policy in the cash surrender value (CSV) field; enter the begin date; enter Y for irrevocable; enter Y for funded by life insurance; and make comments.
        • At the Life Insurance screen enter the life insurance policy and record 0.00 in the cash surrender value (CSV) field; enter the begin date; and make comments.
• DESIGNATED BURIAL FUNDS:
  • • A claimant may designate funds to be set aside for burial. These designated funds must be identified separately from other funds. Example: Funds designated for burial cannot be included in a checking account used for other purposes. If the claimant wishes to designate funds for burial purposes, they must sign the Burial Fund Resource Designation form (IM-99) in order for these funds to be considered an exempt resource. (Form IM-99 is currently available only in hard copy, not via the intranet or Word template.)

TA: The cash surrender value (CSV) of any life insurance policies owned by members of the Temporary Assistance Eligibility Unit counts as an available resource.

Verification

Follow FCR steps to verify.  See Non-MAGI When to Send FA-325 for more information.

• Can we get it?
  • No EVS Portals Available
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Current letter from company
    • If the insurance funds a preneed burial policy, provide contract to verify. This can be an agreement that:
      • Transfers ownership of policy to funeral home
      • Names funeral home as beneficiary
      • Assigns policy as collateral
    • FA-307 (Life Insurance Information Request)
  • Accept client statement (Verification Code CC) of Resources when no other verification is available.
    • DO NOT DENY or adversely impact a participant’s benefits due to the failure of a person outside of the household to cooperate in providing the necessary information.
      • When all attempts to verify resources have failed because the person or organization providing the resource failed to cooperate with the household and agency staff, and all other sources of verification are unavailable, arrive at an amount per a discussion with the participant using the best information available.
      • Record all attempts to verify the information, including the discussion with the participant and why their statement is being accepted.

Comment

Comment on Life Insurance/FMW1, access via SELFRES, to record and explain

• Describe verification provided/needed (if other than CS)
• All information necessary to explain how the resource affects eligibility not captured in screen fields
• Joint ownership details, such as non-EU member name and phone number, conditions of ownership

Supercase Eligibility Unit Summary #2 #

Tools

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

Screen Help

FM30

Guidance

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

• Resolve all ISDs

Dependent Care Expense #

Screen Help

DCEXP/FMXM

Guidance

Dependent care is an allowable expense when it is necessary to enable an EU member to:

• Seek, accept or continue employment
• Attend training
• Pursue education to get a job
• Participate in SkillUP or other case management activities
• Dependent care expenses can only be deducted if care is provided by someone outside of the EU

SNAP:

• • Enter allowable expenses on Dependent Care Expense (DCEXP/FMXM) for the adult who is incurring the expense. Enter expenses separately for each dependent, choosing the appropriate child/adult in the repeating group, except for mileage. Mileage may be added to one dependent, it does not need to be divided between them.
  • Dependent care expenses can only be deducted if care is provided by someone outside of the SNAP household. Allow only the out-of-pocket portion the household incurs or is billed for care.

TA:

• • Allow as an earned income expense any dependent care costs (not to exceed the maximum) incurred due to employment or participation in a paid training program (where wages are received).
  • Dependent care costs may only be allowed for members of the TA EU.
    • • The maximum deduction for a child under 2 is $200.  The maximum deduction for anyone over age 2 is $175.
  • Obtain a medical statement to substantiate the need for care of an incapacitated parent.

Mileage:

• • Explore Mileage/Transportation costs from home to the provider (round trip).
    • • What is the name of the provider?
      • How many miles is it from your home to the provider?
      • If more than 1 child, do all children attend the same provider?
        • •  If not, how many miles from home to the closest provider?
          • How many miles from 1st provider to the 2nd provider?
      • How many days per week do you take your child(ren) to the provider?
  • Include mileage OR transportation even when:
    • • The parent/caretaker works at the same dependent care facility the dependent attends
      • The dependent care facility is located at the parent/caretaker’s work, school or training location
      • Transportation costs (bus, taxi, ridesharing services, like Uber, Lyft, etc.)
  • Mileage Calculation Example (mileage is calculated for a monthly total):
    • • Question: How many miles is it to the Provider from your home?
      • Answer: 6 miles
        • • Math: 6 miles x 2 = 12 daily round-trip miles
      • Question: How many days per week do you travel to this provider:
      • Answer: 4 days per week
        • • Math: 12 daily miles x 4 days a week = 48 miles per week
          • Math: 48 miles a week x 4.333 weeks a month = 207.98 monthly miles. Rounded up to 208 monthly miles.

Verification

Follow FCR steps to verify.

• Can we get it?
  • No EVS Portal Available
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Expense:
      • TA: Statement or receipt from provider indicating amount and frequency of expense. Participant can request Sliding Fee and Co-Pay verification from DESE.
      • SNAP: Accept customer’s statement
    •  Mileage:
      • TA: Statement or receipt from provider indicating frequency of attendance (Accept customer’s statement on number of miles)
      • SNAP: Accept customer’s statement

Comment

Comment on DCEXP/FMXM when an expense is reported, has started, stopped, changed, or is reviewed and is continuing unchanged. Also document in your comment:

• Verification provided/needed
• Details not entered or needed clarification, such as how mileage is calculated (show your math) and provider names

If Dependent Care Expenses are claimed for a reason the deduction is not allowed, add a comment explaining why on EUMEMROL.

Cash Diversion #

Tools

• Cash Diversion
• 18.7.3 TA Maximum Grant Amounts and Maximum Diversion Amounts

Screen Help

DVERSION/FMDK

Guidance

Temporary Assistance Cash Diversion is a single lump sum benefit an applicant may opt to receive instead of monthly Temporary Assistance benefits. This payment is intended to resolve a one-time financial need and to prevent the EU from becoming dependent upon monthly benefits. Prompt-out in Reason for Diversion Payment field and select the appropriate code and continue processing the application to complete the controlled flow. You MUST take the application through the end of the controlled flow as one of the eligibility factors for Cash Diversion is to be eligible for Temporary Assistance on all other eligibility factors. Request verification of the need reason AND the amount. Cash Diversion may only be approved by specified members.

• Call Center and Resource Centers should complete the TA Diversion Transmittal Form and send to FSD.GroupB@dss.mo.gov for processing and changes/updates (exception is for demographic changes such as phone number and address changes).
  • Email subject line: TA Processing Center Transmittal Form

Diversion Quick Facts:

• All other TA eligibility factors must be met, including the lifetime limit
• TA Diversion recipients are not subject to the Work Activity Requirement and are not referred to MWA
• TA Diversion payments do not count toward TA Lifetime Limits
• TA Diversion may only be received once in a twelve month period and five times in a lifetime

Verification

Request verification of the need reason AND the amount after completing the Controlled Flow. Eligibility for TA Diversion is determined only by certain staff members upon receipt of TA Diversion Transmittal Form, sent to FSD.GROUPB@dss.mo.gov

• Email subject line: TA Processing Center Transmittal Form

Comment

Comment on DVERSION/FMDK and TA EUMEMROL/FM3Z to record:

• Customer’s reason to request TA Diversion payment
• Whether the reason meets Good Cause requirements
• Verification requested/received of the reason AND amount requested
• The request was forwarded to the Processing Center

Earned Income Disregards #

Tools

• $30 + 1/3 Disregard
• 2/3 Disregard
• New Spouse Disregard

Screen Help

DISREGRD/FMXT

Guidance

Employed Temporary Assistance EU members may qualify to have a portion of their earned income disregarded in determining the amount of the Temporary Assistance grant. Disregards are important for accurate issuance of the TA grant amount. This screen should be reviewed any time income stops, starts or changes. Once this screen is reviewed, weekly hours should also be updated on COMPACT.

Comment

Comment on DISREGRD/FMXT when an earned income disregard allowed or ended.

• Explain why the disregard is allowed or the circumstances ending it
• Record date and details, including verification used to make the decision to end or not allow

Medical Expense #

Tools

• Post Eligibility Medical Expense (PEME) Manual Notice Guide
• Adding/Updating Private Insurance Information Using the TPL-1 Form

Screen Help

 MEDEXP/FMXA

Guidance

Medical expenses are captured on the Medical Expense screen (MEDEXP/FMXA) and attached to the EU member incurring the costs.

Enter all medical expenses incurred by the EU, including transportation/mileage costs, even if it may not be a countable deduction for the EU.

If an expense exists for more than one EU member, each person is entitled to their share of the expense, such as a health insurance premium.

Mileage can only be entered using the frequency of Monthly. Enter the monthly miles the EU travels for medical purposes. If a frequency other than monthly is reported by the participant, convert the mileage to a monthly amount and show your math in the comment.

The number of miles traveled does not need to be verified (client statement of the distance traveled is acceptable) but the reason for the visit must be verified before the expense is allowed.

If prior quarter coverage is requested for Non-MAGI or Vendor cases, make sure that the begin dates include the prior quarter, if applicable.

Determine whether the EU has health insurance and what their portion of the medical expenses are. If they have insurance, document this on the SELINS/FM8L screen.

SNAP:

An excess medical deduction may be allowed for SNAP EUs with an elderly or disabled member.

At each application, recertification and mid-certification review:

• Enter the most current spend down amount or TWHA premium as shown on MEDHIST
• End date past medical expenses the participant is no longer responsible for
• Make sure all reported, current medical expenses are entered
• Review all previous comments on medical expenses that do not have an end date and make sure the expense should still be budgeted

Verification

If the household claims medical expenses, they must be verified. Client Statement is not acceptable for any program.

Follow FCR steps to verify.

• Can we get it?
  • IIVE for SMI premium
  • MPNI showing Spend Down and Ticket to Work premiums; even if not paid
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Copy of insurance card showing premium amount and frequency
    • Statement from Insurance provider
    • Pharmacy or doctor printout; only enter patient responsibility in FAMIS
    • Mileage – Must verify customer’s visit to medical provider and the frequency. (Can accept customer’s statement on the number of miles.)
    • FA-106 (Authorization for Release of Information)

Note for SNAP: For expenses under $35, leave the verification field blank. FAMIS will not pend for verification. If expenses are claimed in the future, which add up to more than $35, FAMIS will recognize all verification required at that point. Round trip mileage and transportation for medical reasons, such as going to the doctor and picking up prescriptions, are allowable expenses. Verification of these expenses is two-part:

• Take the client’s statement for the mileage distance, the miles traveled
• Hard copy verify the medical reasons for the trip. Verifying the medical expense usually satisfies this requirement
• For transportation, also verify the reason and frequency. Cost verification varies, depending on transportation type.

Comment

Comment on MEDEXP/FMXA when an expense has started, stopped or is reviewed and continuing unchanged

• Describe verification
• Explain any questionable information
• Explain all offline mileage/transportation information and calculations (A x B = C)
• Explain for all premium prorations and calculations (A / B= C)

Select Health Insurance #

Tools

• Adding/Updating Private Insurance Information using the TPL-1 Form
• FSD HIPAA Information page

Screen Help

 SELINS/FM8L

 Health Insurance Detail

 MTPR

Guidance

Insurance policies are captured on the Select Insurance Screen (SELINS/FM8L) and Health Insurance Detail (FMXY). Health Insurance information is captured for three reasons.

1. 1. Medical insurance premiums as paid by the recipient (and spouse, if married and living together) are allowable deductions. Do not allow Supplemental Medical Insurance (SMI) if the premium is being paid by Qualified Medicare Beneficiary (QMB).
   2. MO HealthNet is considered last payer. If participant has private or government insurance (Medicare), MO HealthNet pays after the private or government insurance pays.
   3. If it is cost effective, the participant may be able to have some or all of the premiums paid by Health Insurance Premium Payment (HIPP) program.

After SELINS and Health Insurance Detail screens are completed, review MTPR screen to determine the Policy Holder, if an updated TPL-1 is needed, or if prior insurance needs to be ended. Since Medicaid is a secondary insurance to those EU members with a primary policy on file, it is important to complete this process for billing purposes.

Note: Medicare Part A must be recorded and verified with HC in order for FAMIS to explore Medicare Savings Programs (MSP).

Verification
Follow FCR steps to verify.

• Can we get it?
  • IIVE for Medicare Part A and Part B
• If customer needs to provide verification, common verifications are:
  • Ask participant to upload to mydssupload.mo.gov.
    • Insurance provider statement
    • Health Insurance ID card

Comment
Comment on Health Insurance Detail/FMXY, access via SELINS, to document

• Describe verification provided/needed
• All information which is not captured in screen fields that is provided verbally or with hard copy, about the coverage, such as provider’s addresses and phone numbers
• Whenever updating or ending
• If Medicare Part A is verified by IIVE, make a comment on the participant’s Health Insurance Comment page summarizing the Medicare information received from IIVE

Prior Quarter Resource Screen #

Screen Help

PQRESCFM/FMWZ)

FMD6/QMB Decision Screen #

Tools

• Field Processes:
  • Eligible for both AEG and Non-MAGI
• Handoffs:
  • Use Non-MAGI Specialized Unit > Spend Down Hand Off for Medical Expenses submitted for Spend Down and for Spend Down Inquiries
  • When QMB/SLMB “Buy In”/Over 90 Days Hand Off when QMB is over 90 days and is still being taken from SSA check
• Customer Info: Participant FAQs for CSCs & RCs

Screen Help

QMBDEC/FMD6

Guidance
During the application controlled flow, participants choose whether to apply for QMB/SLMB only, or in addition to MO HealthNet for Adults programs as well as AEG. It is important to have a conversation and explain the possible impacts on the participant’s coverage so they may make an informed decision. This choice is up to the participant, DO NOT make the decision for them. For MHSD and AEG comparison, see Spend Down vs Adult Expansion Group Comparison Guide. If you are unable to reach the participant, see guidance in Eligible for both AEG and Non-MAGI.

Step 1: QMB/SLMB Decision
Responses are first required for the Add QMB/SLMB, QMB/SLMB Only fields. A response is needed for each participant and the response may be different for each participant.

• • Add QMB/SLMB:
    • • Y asks FAMIS to determine eligibility for QMB or SLMB in addition to the programs requested on Application Detail. This includes all IM-1SSLs, web apps and phone apps.
  • QMB/SLMB Only:
    • • Y asks FAMIS to explore QMB/SLMB eligibility only. This is only for IM-1MSP or LIS applications. This overrides the option selected on Application Detail.
  • Unable to make contact to discuss option with participant:
    • • After every effort to contact the participant and/or their authorized representative has been exhausted, a Request for Contact FA-331 letter must be sent allowing the participant 10 days to respond. If a decision is not received after 10 days, staff must decide based on current benefits, coverage history, or the best level of care (lowest cost) option.

QMB/SLMB

Step 2: MHABB/AEG Decision
Responses are first required for the MHABD/AEG field. A response is needed for each participant and the response may be different for each participant.

• • MHABD/AEG:
    • • A: Use this code when the participant is found eligible for AEG and chooses to receive AEG instead of a non-mandatory Non-MAGI program
      • M: Use this code when the participant is:
        • • Ineligible for AEG;
          • Eligible for a mandatory Non-MAGI program (such as Non-Spend Down); or
          • Eligible for AEG and a non-mandatory Non-MAGI program and chooses to receive Non-MAGI
          • Note: AEG benefits must be rejected or closed immediately to prevent dual eligibility
      • W: Use this code when the Non-MAGI application is:
        • • Pending for any outstanding verification; or
          • Pending a MRT Disability Decision and it is unknown if the participant will be eligible for Non-MAGI
          • Note: Once a Non-MAGI determination is made, staff will update this field to A or M
      • Leave Blank: Use this code when a participant is determined eligible for a non-mandatory Non-MAGI program and for AEG, as the participant must be given the option between programs they are eligible for
        • • • Staff must contact the participant by phone to request their choice

          Added:

          • Medical insurance premiums as paid by the recipient
          • If staff are unable to contact by phone, staff must send a Request for Information (FA-325) to notify the participant that a choice must be made.
          • Once the participant’s decision is received staff will update this field to A or M

Spend Down

Once you’ve completed the FMD6/QMB Decision screen, you can see the determination and impact to the case by pressing F20=RESULT. The results must be reviewed prior to moving forward with case processing, or an ISD (insufficient data) outcome will occur in the QMB column. The decision may be updated repeatedly to view possible outcomes until a final decision is reached. Again, it is important to have a conversation and explain the possible impacts on the participant’s coverage so they may make an informed decision. If a participant is ineligible for QMB, but eligible for SLMB1/SLMB2, prior quarter MUST be explored.

Comment
Comment on QMB Decision/FMD6 to record discussion with customer regarding QMB/SLMB and MHABD/AEG decisions and type of coverage the participant chooses.
Note: Pressing F18=COMMENT on QMBDEC takes you to EUMEMROL to enter your comment.

MHABD AG Options #

Tools

• Customer Info: Participant FAQs for CSCs & RCs

Screen Help

FMD2

Guidance
The MHABD AG Options screen only appears when the applicant needs to make an informed choice between TWHA and Spend Down coverages. It is the responsibility of FSD staff to contact the participant to discuss their coverage options and record the participant’s coverage choice in FAMIS. If the participant does not respond to a Request for Contact FA-331 within 10 days, FSD staff enter a decision reflective of past coverage history or the lowest cost option. See 3.21.1 Program Options- Personal Choice.

The premise of the TWHA program is to help those disabled individuals who wish to work to continue to work without negatively affecting them due to the income they receive. If we did not have the TWHA program, the earned income of a disabled participant could change the participant’s Non-MAGI benefit:

• • If individual was a Non-Spend Down, the individual may become a Spend Down.
  • If individual was a Spend Down, the Spend Down amount might increase.

Applicants/Participants must choose which program they wish to participate in; Spend Down or Ticket to Work. Explain coverage options to participant: MO HealthNet Spend Down vs Ticket to Work Guide

• • TWHA MO HealthNet coverage is the same coverage that the Spend Down program provides.
  • TWHA participants may or may not have a premium to pay instead of a meeting a monthly Spend Down.
  • TWHA participants may not use medical expenses to ‘spend down’ the TWHA premium. TWHA participants pay the monthly premium and have coverage or they don’t pay it and they do not have coverage.
  • TWHA coverage begins the month of application if no premium is required.
  • TWHA coverage begins the month in which the premium is paid, if a premium is required. TWHA participants must pay the premium, if applicable.

Examples of when a participant might choose Spend Down over TWHA:

• • Some agencies will pay a participant’s Spend Down, but not a TWHA premium. In this instance, a participant may choose to stay with the Spend Down coverage even if Spend Down is higher than the TWHA premium.
  • A participant may be required to meet their Spend Down at least once per year to qualify for additional benefits through Department of Health and Senior Services.
  • An individual may choose Spend Down one month and TWHA the next month.

FAMIS presents a MHABD AG Options screen for individual months because the Spend Down amount and TWHA premium can vary from month to month. Update each month’s screen with the applicant’s decision by entering the applicant’s choice in the Option Selected field.

NOTE: When processing an application or annual renewal, review the Medical Expense (MEDEXP) screen to record or update the participants current spend down or TWHA amount. Couple case/both receiving coverage, enter only under one person. Couple case/only one person receiving coverage, enter under the person receiving coverage. This must be entered whether the spend down or TWHA premium is paid or not.

Comment
Comment on EUMEMROL to capture the participant’s selection.

Supercase Eligibility Unit Summary FINAL #

Tools

• Evaluating FAMIS Results-Non-MAGI
• Evaluating FAMIS Results-SNAP and TA
• Retrieving Archived Eligibility Determinations (EDs)
• SNAP and TA Income Tests
• SNAP Basis of Issuance Tables
• SNAP Standards History Chart
• SNAP Worksheet (Manual Budget)
• TA Earnings Disregards
• TA Payment and Amount of Grant
• Field Process: Reviewing Budget for Spend Down with Participant

Screen Help

• Supercase Eligibility Unit Summary/FM30 Budget Summary with Calculation Steps
• SNAP – FSBUDSUM
• Non-MAGI – Spend Down/Non Spend Down
• Non-MAGI – QMB/SLMB
• Non-MAGI – Ticket to Work
• Temporary Assistance – TABUDSUM
• Vendor – Surplus Allotment

Guidance
Evaluate the eligibility results for each program. Make corrections if the results are not correct. Resolve any unexpected PEND, FAIL or ISD results. All ISDs must be resolved before authorizing any case actions.

• Note: Non-MAGI Processing: If there is an ISD under AG RSLT, select the month with ISD and press F6=MHABD to resolve the issue. If processing an application or case with Prior Quarter (PQ) coverage, ensure the PQ month outcomes are correct.

Use the function keys to look at Technical (F14=TECH), Resource (F15=RESOURCE) and Income (F16=BUDSUM) factors and review all budgets and make corrections, before authorization.

Outstanding Verification #

Tools

• 3 Way Calling
• Accuity
• Accurint (AfGE)
• Authorizing an Action
• FAMIS Fastpath Reference List
• Non-MAGI: When to Send an FA-325
• Verification Matrix
• Non-MAGI When to Send FA-325
• SOP: First Contact Resolution SOP

Screen Help

OUTVERF/FM3M

Guidance
Pending applications and active cases for more information is a last resort. Cases should only pend when the 5 Steps to First Contact Resolution (FCR) is unsuccessful. See FCR SOP for complete details of the 5 steps.

FAMIS tracks all outstanding verification by reading the verification fields and then creating a list on Outstanding Verification (OUTVERF). For more info on verification codes, see the Verification Matrix or the specific item’s Verification Section within IM Resources.

Use OUTVERF to generate and print a Request for Information (FA325) and any necessary verification forms. To request the verification from the household:

1. 1. Generate the FA325 in FAMIS (there may be more than one FA325 if the household has an active or pending case for another program)
   2. Edit the FA325 to clearly explain to the participant the specific verification requested
   3. Ensure the participant receives the FA325 by:
      • • Printing and giving it to the participant
        • Allowing FAMIS to batch print and mail the edited FA325 from Central Office
          • • FAMIS does not batch print other documents, such as an FA106 or FA302, those documents must be printed manually
        • Printing and mailing to the participant
        • Note: If the participant is in a Resource Center, notify the Resource Center the FA325 (and other potential documents) are ready to print and be provided to the participant.

The FA325 gives the household ten days to provide the requested verification. A list of outstanding verification items and the due date is printed on the FA325.

Staff must send a second FA325 in the following situations:

• • The applicant provided part, but not all, of the information requested on the original FA325 (during the ten-day period),
  • The applicant has provided the information requested, but it is insufficient to be used in determining eligibility, or
  • The applicant has shown a good faith effort in obtaining the information but has requested more time.

The second FA325 give the participant an additional ten-day period to provide the missing verification. The second FA325 must list, in detail, what verification has been received and what is still needed, including why previously submitted information is insufficient.

• • The second FA325s must be manually generated and edited

If all verification is provided during the second ten-day period, ensure the application/case action is properly processed.

• • If FAMIS closes the case during the second ten-day period, and the additional verification was provided, cancel close the case and then process the case with the provided verification

Example Initial FA325

Second FA325

DOCQUE #

Screen Help

DOCQUE/FMVM

EDITDOC/FMVT (FA-325)

Tools

• 3 Way Calling
• Accuity
• Accurint (AfGE)
• Authorizing an Action
• FAMIS Fastpath Reference List
• Request for Contact FA-331
• Verification Matrix
• SOP: First Contact Resolution SOP
• Hand Off: Use Mail Out Request Hand Off for offices that do not send out their own mail

Guidance
View, edit and print documents generated in FAMIS. See more information for specific guides.

• Does the document need to be created/generated?
  • • If yes, see Generating FAMIS Documents, then continue to the next step
      • • A Request for Contact FA-331 will only be used when all other methods of contact have failed or when a Request for Info FA-325 cannot be generated. SNAP only: Once a FA-331 is printed, FAMIS will automatically take action in the household does not respond by the due date on the form.
    • If no, continue to next step
• Does the document need to be edited?
  • • If yes, see Editing FAMIS Documents, then continue to next step
      • • If you prefer a Flow Chart, see Generating, Editing and Printing FAMIS Documents, The FLOW CHART!
        • FA-325 text for MRT Packet (The FA-325 MUST be edited in order to stand up in a hearing):
          • • • IN ORDER TO DETERMINE YOUR ELIGIBILITY FOR NON-MAGI MO HEALTHNET COVERAGE, WE ARE REQUIRED TO COMPLETE A MEDICAL DETERMINATION. PLEASE COMPLETE THE ENCLOSED MEDICAL REVIEW TEAM PACKET COMPLETELY AND SIGN/DATE WHERE INDICATED. PLEASE RETURN THIS COMPLETED PACKET TO: 101 PARK CENTRAL SQUARE, SPRINGFIELD, MO 65806, FAX 417-895-6152, OR UPLOAD AT MYDSSUPLOAD.MO.GOV.
    • If no, continue to next step
• Does the document need to be printed?
  • • If yes, see Printing and Preparing FAMIS Documents
      • • If you prefer a Flow Chart, see Generating, Editing and Printing FAMIS Documents, The FLOW CHART!
• Do unprinted, duplicate forms need to be deleted?
  • • If yes, see Delete Unprinted, Duplicate Forms
• Need to view a document generated over 30 days ago?
  • • If yes, see Retrieving Archived Documents in FAMIS

Select Authorization #

Tools

• FAMIS Authorization Codes
• FAMIS Reason Codes

Screen Help

SELAUTH/FM3G

Guidance
Need to Authorize?

• When approving expedite benefits, capture the Date of Discovery on the Action Authorization screen (FM3H). This is the date it was discovered the household is expedite. If the application is processed the same day it is received, the system defaults to the application date. If the application is processed any other day, the Date of Discovery must be entered manually. If expedite is determined at anytime other than the application date you must make a comment to explain how and when it was discovered
• See Authorizing an Action when authorizing a new approval, rejection, re-certification or change to an active case Note: If case is delayed due to the fault of the EU, see the REQUEST screen popup prior to authorizing case

Review the authorization decision thoroughly prior to authorizing. Use function keys to review eligibility determinations. If prompted, add a Management comment to FS EUMEMROL, unless it has already been done and is still accurate. Leave nothing in RTA or ISD status. The controlled flow ends at this screen

Closing the Interview/Finishing the Controlled Flow #

Tools

• 14.10 Availability of Benefits
• SNAP Interview Required Notices

Guidance
Before ending the interview, be sure the participant understands what is being asked of them and how/when they will receive their benefits.

• • Rejection reason, OR
  • Status of Application; and
  • What verification is required to finish processing (if any); and
  • Benefit amount (if known) and timing of payments/receipt of card; and
  • Length of certification period
  • Change reporting requirements

Provide information about other programs/assistance as appropriate:

• • EBT: If the participant is new to SNAP or has questions about using SNAP benefits, Review the IM-4EBT with the participant and mail them one
  • Other FSD benefits: Discuss other programs if participant appears potentially eligible
  • Other needs: If caller expresses a need for other types of assistance, then search/refer to familyresources.mo.gov

SNAP

• Non-MAGI approvals & pends:
  • • If an IM-61 MRT Medical Review Team Packet is being requested, include the applicant’s name, DCN and date of birth where applicable on each form. Use the Mail Out Request Hand Off to request the appropriate forms be mailed to the participant (for offices that do not send out their own mail)
    • For Spend Down approvals, review:
      • • IM-4 Spend Down Flyer
    • For QMB/SLMB approvals, review:
      • • IM-4 MSP Flyer
    • For TWHA approvals, review:
      • • IM-4 TWHA Flyer
• TA approvals:
  • • Forward CS-201 Referral/Information for Services to FSD Child Support following office procedure, or by email to FSD.IntakeCenter@dss.mo.gov.
      • DO NOT forward the IM-2E Part 1 or IM-2E Part 2 (Notice of Requirement to Cooperate & Right to Claim Good Cause). These are internal IM documents only. IM makes the good cause determination, not FSD Child Support.
    • Forward PRP to MWA via email to MWAPersonal@dss.mo.gov.
    • Forward any documents to support exclusion claims to MWAEXCLUDE@dss.mo.gov

Comment
Add a Summary comment to all program specific EUMEMROL/FM3Z screens summarizing all actions taken, discussions with the customer, forms mailed out, and what steps remain to process the action.

Add a Management comment on FS EUMEMROL when a SNAP household’s expenses are more than their net income to explain how the household is paying, or plans to pay for shelter, child support, dependent care and medical expenses with the reported income. Add this comment after reviewing the budget on the last EU Summary screen.

• • Management Comment Examples:
    • • Comment Label: Management
      • Comment: Budget shows expenses exceed income on initial application. Ms. Yee says they have depleted their bank account and are now behind on rent and utilities. They have not paid the full amounts since Mr. Nolasco lost his job two months ago. Mr. Nolasco is looking for work and applied today for UC. The household’s income is not sufficient to cover their expenses. Review management again at recertification.
      • Comment Label: Management
      • Comment: Budget shows incurred expenses exceed income on initial application, due to utility standard. Actual utilities are $237, utility standard is $441. Household’s income is sufficient to cover expenses.
      • Comment Label: Management
      • Comment: 09-2021 recert budget shows a zero income. Management comment made 10-05-2021, says Corrie Earnhardt expected to get more hours and a raise at Treetop Inn. As of 09-26-2022 this has not happened. Discussed management with Corrie, discovered her mother, Becca Ridgeway, gives her up to $200 a month, when she is short on rent money. Entered the contribution on Income and pended for verification of amount and frequency of contribution from Becca Ridgeway.

Pre-Authorization Criteria (SNAP) #

To reduce the number of SNAP payment errors, error-prone cases should be submitted to the CCIU Pre-Authorization Review Team prior to approval of benefits. Any case that meets the criteria listed in the CCIU Pre-Authorization Review Process SOP should be submitted