Add MO SMHB Insurance Self Attestation Evidence

If a pregnant family member is not enrolled or does not have access to maternity insurance, MO SMHB Insurance Self-Attestation evidence must be created for each new pregnancy where she is ineligible for MPW for either excessive income, citizenship, or a combination of these two factors.

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.

See 3.21.3 Continuous Eligibility for Pregnant Women

Related Evidence: MO Insurance Self Attestation

TO ADD MO SMHB INSURANCE SELF ATTESTATION EVIDENCE

    1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder
    2. Hover your mouse cursor over MO SMHB Insurance Self Attestation until the Create Evidence icon appears
    3. Click the Create Evidence icon
    4. Enter the Received Date. The received date should match the date the FSD received the evidence from the participant
    5. Select the pregnant participant without any insurance coverage from the Participant drop down menu
    6. Select Yes from both Self Attestation Details drop down menus

NOTE: If you select No, you are indicating this pregnant participant is enrolled, or does have access to insurance.

    1. Enter the Start Date. The start date is the date of the start of the pregnancy
    2. Click Save
    3. Verify all Outstanding Evidence
    4. 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:
      1. All actions taken
      2. Participant with override entered
    2. Review Notice Queue to make sure appropriate forms generated
      1. IM-80PRE: Generates in the event of coverage changes that result in a complete loss of coverage
      2. IM-80: Generates in the event of negative coverage changes
      3. IM-33C: Case Action Notice