Add MO Covered Member Evidence

If a household member is covered by or has access to Employer Sponsored Insurance (ESI), evidence is created on the MO Employer Sponsored Coverage screen.(SMHB specific). Use the following to add MO Covered Member evidence.

By policy, SMHB eligibility is granted as continuous coverage. However, if you enter a CiC that enrolls the participant in, or grants access to insurance that covers all three phases of maternity services, MEDES will end SMHB coverage. If this happens, follow the steps in Adding MO Override Eligibility Evidence to grant SMHB coverage through the applicable end date.

The MEDES application intake script does not capture evidence when one participant is enrolled in ESI and other participants are entitled to ESI. Check the MO Covered Member evidence to ensure all enrolled and entitled participants are listed. If not, you will need to manually add all excluded participants following the steps below.

You will need to Add MO Employer Sponsored Coverage evidence prior to adding MO Covered Member evidence

If you are adding a pregnant woman to this evidence, and she previously self-attested to not having maternity services, you will first need to End MO Insurance Self Attestation Evidence.

See 3.6.9 Show-Me Healthy Babies (SMHB) for additional information

Related Evidence: Employer Sponsored Coverage

TO ADD MO COVERED MEMBER EVIDENCE

    1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder
    2. Hover your mouse cursor over MO Covered Member until the Create Evidence icon appears
    3. Click the Create Evidence icon
    4. In the New MO Covered Member wizard, select the radio button for the ESI coverage
    5. Click Next
    6. Enter the Received Date. This is the date the FSD received the evidence.
    7. Select the participant covered under the ESI coverage from the Participant drop down menu
    8. Select either Enrolled or Entitled from the Coverage Status drop down menu
    9. Enter the date the participant was either enrolled or entitled to the ESI coverage in the Start Date
    10. For those entitled to the ESI, enter the Monthly Cost to Enroll this Participant in the Plan (the monthly cost for participants enrolled in ESI will have already been captured in the MO Employer Sponsored Coverage evidence.)

NOTE: When the person selected is shown as entitled, the premium entered on MO Covered Member is added to the amount listed on MO Employer Sponsored Coverage to determine CHIP affordability for the entitled person.

NOTE: When the premium amount is captured from the client, system creates a verification item upon submission of application and the ES verifies this item as self-attested.

    1. Click Finish
    2. Verify all Outstanding Evidence
    3. Apply Changes, Check Proposed Determination, Finalize Proposed Determination

NOTE: MEDES may generate an additional proposed determination, especially in cases with income changes, adding a person, or removing a person. If the system generated an additional proposed determination, you must run the Finalize Proposed Determination again

    1. Make a comment on the HoH Person Page to include:any Coverage Changes
    2. Review Notice Queue to make sure appropriate forms generated
      1. IM-80PRE: Generates in the event of coverage changes where coverage is completely lost.
      2. IM-80: Generates in the event of negative coverage changes
      3. IM-33C: Case Action Notice