Notice Triggers

Note: This is a list of common notices generated by MEDES. It is not all-inclusive. If you encounter a notice in MEDES that is not on this list, do not delete the notice. Consult your supervisor for further instruction.

 

IMPORTANT: If evidence is verified that affects the adverse action, do not delete the IM-80 and IM-33C. MEDES will re-assess and take the appropriate action.

 

Resources:

NOTICE TYPE ACTION THAT TRIGGERS THE NOTICE COMMENTS
IM-33AR New At least one participant eligible, others ineligible, any benefit
IM-33A New All participants eligible, any benefit
IM-33R New No participants eligible, any benefit
IM-80, IM-33C CiC Decrease in Benefit
IM-33C CiC Increase in Benefit
IM-33C CiC No Change in Benefit
IM-80PRE, IM-80, IM-33C CiC Termination of benefit
IM-33C Age Out Newborn sufficient information exists
IM-31A, IM-33C Age Out Newborn sufficient information does not exist If child’s information is still insufficient at age one, adverse action process will begin and IM-33C will be sent.
IM-33C Pregnancy New benefit increase Note: Notices are suppressed when MPW coverage changes from MPW-HIF to MPW.
IM-80, IM-33C Pregnancy Incarceration
IM-33C Pregnancy Closure in writing
IM-80, IM-33C Pregnancy Closure not in writing
IM-33C Unable to Locate n/a
IM-80PRE, IM-80, IM-33C Death Head of Household deceased Notice sent to other HH members who will need to reapply
IM-80, IM-33C Death Participant deceased
IM-33C Death Other participant’s benefit did not change
IM-80PRE, IM-80, IM-33C Death Other participant’s benefits terminated
IM-80, IM-33C Death Other participant’s benefits decreased
IM-33C Death Other participant’s benefits increased
IM-33C Voluntary Closure Closure in writing
IM-80, IM-33C Voluntary Closure Closure not in writing
IM-80PRE, IM-33C Incarceration Head of Household is incarcerated
IM-80, IM-33C Incarceration Participant is incarcerated
IM-33C Incarceration Other participant’s benefits did not change
IM-80PRE, IM-80, IM-33C Incarceration Other participant’s benefits terminated
IM-80, IM-33C Incarceration Other participant’s benefits decreased
IM-33C Incarceration Other participant’s benefits increased
IM-80PRE, IM-80, IM-33C Remove Participant Participant was receiving benefits
IM-33C Remove Participant Other participant’s benefit did not change, participant was NOT receiving benefits
IM-80PRE, IM-80, IM-33C Remove Participant Other participant’s benefits terminated, participant was NOT receiving benefits
IM-80, IM-33C Remove Participant Other participant’s benefits decreased, participant was NOT receiving benefits
IM-33C Remove Participant Other participant’s benefits increased, participant was NOT receiving benefits
IM-80PRE, IM-80, IM-33C Remove Participant Other participants benefits are terminated, includes HoH removal
IM-33C Add Participant Other participants benefits are terminated, includes HoH removal
IM-33C Add Participant One or more participants stay the same and one or more

participants have an increase in benefits
IM-80OPRE, IM-80,

IM-33C

 Add Participant Other participants are terminated
IM-80, IM-33C Add Participant One or more participants stay the same and one or more participants

have a decrease in benefits
IM-33AR Add Participant Of those added: at least one participant eligible,

others ineligible

 The rest of HH can be affected by the
new participant and
MEDES will re-evaluate
the case and send notices accordingly
IM-33A Add Participant Of those added: All participants eligible The rest of HH can be affected by the new participant and MEDES will re-evaluate the case and send notices accordingly
IM-33R Add Participant Of those added: No participants eligible The rest of HH can be affected by the new participant and MEDES will re-evaluate the case and send notices accordingly
IM-80PRE, IM-80, IM-33C Student Child losing benefits due to unverified student evidence
IM-80, IM-33C Student Child moving to a lower LOC due to unverified student evidence
IM-31A, IM-10 Student When a child is receiving MHF/MHK/CHIP and the child has active student evidence, these notices are sent on the day before child’s18th birthday:

  • If the graduation end date is between the 18th birthday and the 19th birthday

OR

  • The graduation end date is empty and expected graduation date is between dates

OR

  • Both the graduation end date and expected graduation date are empty

AND

  • School type = Secondary or Home School or Equivalent Vocational School

AND

  • Status = full-time

AND

  • The most recent verification item = “Unverified student evidence”

OR

  • There is no active verification item attached

AND

  • Change is visible within the current certification period
 If student benefits won’t change regardless of student evidence, no notice will go out on 18th birthday
IM-31A ONLY New Application Request for Information
IM-31A, IM-80, IM-33C CiC Request for Information Termination notices are queued and sent if verification not received timely
IM-80PRE, IM-80, IM-33C Annual Renewals(AR) – Manual Renewals One or more benefits were terminated If the result is a weekend or holiday, go to the next available business day
IM-80, IM-33C Annual Renewals(AR) – Manual Renewals One or more benefits were decreased
IM-33C Annual Renewals(AR) – Manual Renewals One or more benefits either stayed at the same level or increased. If the result is a weekend or holiday, go to the next available business day.
IM-33C Annual Renewals(AR) – Automatic Renewals Household benefits got auto-renewed
IM-FTI Annual Renewals(AR) Sent along with the IM-33C unless the case is closing.
Voter Registration form(MO 231-0167 ) Annual Renewals(AR) Whenever IM-1U notice is sent to a participant
IM-33APE Presumptive Eligibility(PE) All participants are eligible for PE
IM-33RPE Presumptive Eligibility(PE) All participants are found ineligible for PE
IM-33ARPE Presumptive Eligibility(PE) HH has both eligible and ineligible participants for PE
IM – 55A Transitional MO HealthNet(TMH) Participant to report his income for the first three months of his TMH eligibility.

Sent on the 21st day of the third month

 If it is the 12th month of the TMH eligibility for the case there will be no more notices triggered.

If the result is a weekend or holiday, go to the next available business day.
IM – 33TMH-R Transitional MO HealthNet(TMH) Sent if IM-55A has not been returned by the 12th day of the fourth month. If the result is a weekend or holiday, go to the next available business day.
IM – 55B Transitional MO HealthNet(TMH) The IM-55B will only queue up if the Household Income is below 201% FPL. It will queue for different dates based on when the IM-55A is returned:

a. If the 1st Quarterly TMH report is entered and it is the 7th month:
IM-55B with a due date of 10 days or 21st of the seventh month (whichever is later).

b. If it is entered the 8th month of the TMH eligibility :
IM-55B with a due date of 10 days.

c. If it is entered the 9th month of the TMH eligibility:
IM-55B with a due date of 10 days AND trigger IM-55C with a due date of 21st of the 10th month.

d. If it is entered the 10th month of the TMH eligibility:
IM-55B with a due date of 10 days and trigger IM-55C with a due date of 10 days or 21st of the 10th month (whichever is later).

e. if it is entered the 11th month of TMH eligibility:
IM-55B with a due date of 10 days and trigger IM-55C with a due date of 10 days.

 The notices will ONLY queue after month 7 if the 1st quarterly income report is returned late with good cause.
IM-55C Transitional MO HealthNet (TMH)

The IM-55C will only queue up if the Household Income is below 201% FPL. It will queue for different dates based on when the IM-55B is returned:

If reporting Late with Good Cause

  1. If the 2nd Quarterly TMH report is entered the 9th month of the TMH eligibility :
    1. IM-55C with a due date of 21st of the 10th month.
  2. If it is entered the 10th month of the TMH eligibility:
    1. Timeline : IM-55C with a due date of 10 days or 21st of the 10th month (whichever is later).
  3. If it is entered the 11th month of the TMH eligibility:
    1. Timeline : IM-55C with a due date of 10 days.
  4. If it is entered the 12th month of the TMH eligibility:
    1. Timeline : IM-55C with a due date of 10 days.

If reporting Late with No Good Cause:

  1. If the 2nd Quarterly TMH report is entered the 9th month of the TMH eligibility:
    1. Timeline: IM-55C with a due date of 21st of the 10th month.
  2. If it is entered the 10th month of the TMH eligibility:
    1. Timeline : IM-55C with a due date of 10 days or 21st of the 10th month (whichever is later).
  3. If it is entered the 11th month of the TMH eligibility:
    1. Timeline : IM-55C with a due date of 10 days.
IM-33C Transitional MO HealthNet (TMH)

TMH eligibility ends.

Timeline : last day of the sixth month (initial eligibility)
OR last day of the 7th month (IM-55A returned timely)

OR last day of the 10th month (IM-55B returned timely)

OR last day of the 12th month (IM-55C returned timely

If these reports are turned in late with good cause, the eligibility timeline will extend.

This is only if income eligibility limits are met.
IM-33AR Show Me Healthy Babies (SMHB)

Participant not eligible for MPW due to income or citizenship,

but eligible for SMHB

 See SMHB Note Below

When the HH income exceeds 305%, the IM-33AR will display the MHF upper limit, instead of the MPW upper limit. In this instance, allow MEDES to send the IM-33AR, but then manually send a corrected IM-33AR.
IM-33R Show Me Healthy Babies (SMHB) Participant not eligible for MPW or SMHB Coverage See SMHB Note Below
IM-33A and IM-33C* Show Me Healthy Babies (SMHB) SMHB Newborn is eligible (ME97, ME62, ME74, ME75) *If there are any other participants in the HH whose benefits are changing.

See SMHB Note Below
IM-80PRE, IM-80, IM-33C** Show Me Healthy Babies (SMHB) Ineligible Alien’s Newborn with HH income greater than 305% FPL or access to affordable insurance See SMHB Note Below

When the child of an ineligible alien has access to affordable insurance, MEDES will send an incorrect IM-80PRE. In this instance, delete the IM-80PRE and manually send a corrected notice
IM-33C Show Me Healthy Babies (SMHB) If the child born to an ineligible alien mother moves to a better LOC See SMHB Note Below
IM-80 and IM-33C Show Me Healthy Babies (SMHB) If the child born to an ineligible alien mother moves to a lower LOC See SMHB Note Below
IM-33C Show Me Healthy Babies (SMHB) ME97 Newborn and change in circumstances(CIC) on case, but no change in coverage See SMHB Note Below
IM-33APQ Prior Quarter (PQ) All participants eligible for PQ Benefits for all requested months Note: There is a known issue with MEDES that when a participant has previously been determined ineligible due to excessive income, and a CiC changes income to favorably grant PQ, the IM-33APQ is not sent, and the IM-33C does not have the correct verbiage.
To resolve this issue, please take the following steps:

  1. Allow MEDES to send the IM-33C
  2. Send a manual IM-33APQ and a manual IM-33C with the correct verbiage
IM-33ARPQ Prior Quarter (PQ) At least one participant eligible, others ineligible for PQ Benefits Note: When the participant applies for both Ongoing and PQ benefits, but then withdraws the request for ongoing, MEDES may send out an IM-33C and an IM-33ARPQ instead of an IM-33C and an IM-33APQ. In this instance, allow MEDES to send the IM-33ARPQ and also send a corrected manual IM-33APQ
IM-33ARPQ Prior Quarter (PQ) Prior Quarter Benefits Approved for some months, and rejected for some
IM-33RPQ Prior Quarter (PQ) No participants eligible for PQ Prior Quarter Benefits
IM-33APQ Prior Quarter (PQ) All participants eligible for Prior Quarter Benefits and Ongoing Benefits is “Pending”
IM-33ARPQ Prior Quarter (PQ) Some participants eligible for Prior Quarter Benefits and some participants not. Ongoing Benefits “Pending”
IM-33RPQ Prior Quarter (PQ) No participants eligible for Prior Quarter Benefits and Ongoing Benefits “Pending”
IM-33A Prior Quarter (PQ) All participants eligible for Ongoing Benefits and Prior Quarter Benefits is “Pending”
IM-33AR Prior Quarter (PQ) Some participants eligible for Ongoing Benefits and some participants rejected for Ongoing Benefits. Prior Quarter Benefits “Pending”
IM-33R Prior Quarter (PQ) No participant eligible for Ongoing Benefits and Prior Quarter Benefits “Pending”
IM-33A and IM-33APQ Prior Quarter (PQ) All participants eligible for Ongoing and Prior Quarter Benefits
IM-33AR and IM33APQ Prior Quarter (PQ) Some participants eligible for Ongoing Benefits and some participants Rejected for Ongoing Benefits. All participants eligible for Prior Quarter Benefits
IM-33A and IM-33ARPQ Prior Quarter (PQ) All participants eligible for Ongoing Benefits. Some participants eligible for Prior Quarter Benefits some participants ineligible for Prior Quarter Benefits
IM-33A and IM-33RPQ Prior Quarter (PQ) All participants eligible for Ongoing Benefits. No participant eligible for Prior Quarter Benefits
IM-33AR and IM-33ARPQ Prior Quarter (PQ) Some participants eligible for Ongoing Benefits and some participants ineligible for Ongoing Benefits. Some participants eligible for Prior Quarter Benefits and some participants ineligible for Prior Quarter Benefits
IM-33R and IM-33APQ Prior Quarter (PQ) No participants eligible for Ongoing Benefits and all participants eligible for Prior Quarter Benefits
IM-33R and IM-33ARPQ Prior Quarter (PQ) No participants eligible for Ongoing Benefits . Some participants eligible for Prior Quarter Benefits and some participants ineligible for Prior Quarter Benefits
IM-33R and IM-33RPQ Prior Quarter (PQ) No participants eligible for Ongoing and Prior Quarter Benefits
IM-33C Prior Quarter (PQ) Ongoing benefits and PQ Benefits requested for a participant from the IC Note: When a participant applies for PQ and Ongoing coverage, and one of the HH applicants is a mother pregnant in the first month of PQ, and a newborn is also included as an applicant, MEDES will grant the correct coverage, but the IM-33C will incorrectly list the start date of the newborn’s coverage as the date of application, instead of the newborn’s DOB. In this instance, allow the IM-33C to be sent, but send a corrected manual IM-33C

SMHB NOTE: IM-33Cs sent out for SMHB do not always include all exclusions reasons. Allow MEDES to send the IM-33C, consult the PDC for the determination and send a corrected manual IM-33C with the correct exclusion criteria on the following day.