Managing an FFM Application in the Caseworker Portal

FFM Applications will be referred to MEDES as either Verified, Pend, or Inconsistent and include the FFM Eligibility Determination.

• • Verified: When the FFM was able to complete all verifications and make an eligibility decision it will send applicants as ‘Referred Verified’.

NOTE: At this time, these applications will only be processed by select staff or systematically authorized.

• • • Referred Verified applications do not require further review and are authorized based on the FFM’s eligibility decision.
    • The FFM eligibility decision for each participant will display in the Application Case Evidence Dashboard > External System > MO FFM Eligibility Determination evidence.
      • The evidence will display the FFM determination referral as Referred Verified ‘YES’ and Program as either ‘MAGI’, ‘CHIP’, or ‘Non-MAGI’.
      • Example:

• • Pend/Inconsistent: FFM was unable to complete all verifications.
    • Pend/Inconsistence applications received with pending evidence, are to be reviewed and pending evidence verified by the caseworker prior to completing the processing of the application through authorizing or rejecting.
    • When no income is reported on the application, explore potential flexibilities, if not applicable for a flexibility, view and save EOI to compare for Reasonable Compatibility.
    • Evidence verified by FFM does not need to be re-verified by the case worker.
    • The FFM eligibility decision for each participant will display in the Application Case Evidence Dashboard > External System > MO FFM Eligibility Determination evidence.
      • The evidence will be blank for the FFM determination referral Referred Verified and Program.
      • When an individual is potentially not eligible for MAGI, The evidence will be ‘NOT APPLICABLE’ for the FFM determination referral Referred Verified and Program.

Follow the same application processing steps as outlined in IM Resources to process a FFM application but use the below guidance when reviewing and verifying the evidence.

When the application is transferred to MEDES, some evidence may have discrepancies or may be missing as not all evidence is sent from the FFM or does not translate. FFM may have verified some or all evidence and generated an eligibility determination. Use the below guidance to edit/add any missing or incorrect evidence prior to determining eligibility.

NOTE: The PDF version of the original FFM application may provide data needed to update evidence that is missing or incomplete and can be reviewed by navigating to the HoH Person page > Information sub-tab > Applications folder > Pending Application Forms tab >click List Actions menu > select View PDF

1. 1. Address
      • Review all participants to confirm each Home and Mailing address is CD1P.
        • Edit incorrectly entered addresses.
        • Add Home or Mailing Address if either is missing.
   2. Citizen Status (only mandatory for HH members seeking coverage)
      • Citizenship status verified by the FFM does not need to be re-verified by staff.
   3. ID Details
      • SSN (only mandatory for HH members seeking coverage)
        • SSN verified by the FFM does not need to be re-verified by staff.
   4. Income
      • Income evidence fully verified by the FFM does not need to be re-verified by staff.
      • When the application contains at least one income not verified, then all income evidence added to the case will be unverified. Review and verify evidence manually.
        • Explore potential SNAP flex and/or run EOI to compare for Reasonable Compatibility.
      • When no income is reported by the applicant, review and verify the evidence manually.
        • Explore potential SNAP flex and/or run EOI to compare for Reasonable Compatibility.
      • Discrepancies with Employer Name can potentially be found on the PDF version of the original FFM application.
      • Update any Social Security Income (SSA/SSC/SSI) evidence discrepancies.
   5. Medicare Self-Attestation (only HH members seeking coverage)
      • This evidence is not sent from FFM. The system will add Medicare Self-Attestation evidence and default the answer to No.
      • Verify by viewing IIVE and update any discrepancies.

• • Tax Status 
    • If missing on the FFM application, the system will add tax status evidence and default to Non-Filer.

Evidence verified by FFM does not need to be re-verified.

• • ‘Verified Evidence via FFM’ will be noted in the evidence comment box.
  • Verification items used:
    • Income:
      • FFM Verification-Self-Attestation
        • For Referred Verified applications.
      • FFM- Verification- SSA Income
        • Used for SSA income.
    • Citizenship:
      • FFM Verification-SSA- Citizenship
        • Used when FFM provides a Verification Status Code.
      • FFM Verification- Self-Attestation
        • Used when FFM does not provide a Verification Status Code but is a Referred Verified applicant.
    • SSN:
      • FFM Verification-SSA- Citizenship
        • Used when FFM provides a Verification Status Code.
      • FFM Verification- Self-Attestation
        • Used when FFM does not provide a Verification Status Code but is a Referred Verified applicant.
  • Manually Verify all outstanding evidence.
    • If FFM did not verify income or no income was reported by the applicant, review for SNAP Flex and if not applicable, review EOI to check for Reasonable Compatibility.
    • Federal Data Hub evidence can be used as verification. For information and instructions on the following Hub evidence, see FFM Hub Information in MEDES:
      • Earned Income
      • Social Security Income
      • Social Security Number
      • Disability and/or Blindness
      • Annual Tax Return and Projected Annual Income
      • Non-Citizenship Status
  • Refer back to IM Resources to complete processing the application after all evidence has been verified.

Participants who purchase coverage through the FFM may also receive the Advanced Premium Tax Credit (APTC). Participants eligible to receive MHN, whether enrolled or not, are not eligible to receive the APTC. Participants are required to notify the FFM when they become MHN eligible because they are no longer qualified for APTC.

Participants can withdraw a MHN application that has not been processed or close MHN coverage at any time. However, FSD cannot remove MHN coverage that has already been granted. Voluntarily closing MHN will not make a participant eligible for the APTC if their household income is within the income limits to receive MHN. As long as a person is eligible for Medicaid, they are not eligible for APTC.