Suspended Participants

 

MAGI Definitions for Suspension:

    • Remaining Adult – the responsible adult who is still in the home when there is an incarcerated head of household.
    • Incarcerated Participant – someone who is actively receiving MO HealthNet and becomes incarcerated.
    • Incarcerated Individual – eligibility unit member who is incarcerated and not receiving MAGI.

 

Processing Elements:

A specialized unit has been established to manage suspension of incarcerated participants and incarcerated individuals who are the HOH. The specialized unit will only need to complete CIC/Annual Renewal actions when:

    • Suspended participants will not be returning home after incarceration.
    • HOH is incarcerated and household members are currently receiving MHN.

Note: FSD Field Staff are expected to complete case actions if there is a suspended participant who remains in the household when a change is reported or an Annual Renewal

 

Incarcerated head of the household (HOH) and household members are currently receiving MHN: When the HOH becomes incarcerated, the active members will continue to receive benefits as long as the HOH intends to return to the home. However, FSD will gather additional information regarding the living arrangements for the active household members (see 1885.040.00 Suspension of MAGI Benefits for Incarcerated Individuals – Processing Elements – Incarcerated Individuals)

 

Follow the below instructions when it is reported during a CIC or Annual Renewal that the suspended participant is not returning home after incarceration, or the HOH is incarcerated while household members are currently receiving coverage:

 

Encountering Suspended Participants Not Retuning Home:

    1. FSD receives a CIC or Annual Renewal
    2. FSD Field Staff review comments and there is a household member who is suspended:
        1. Example Suspension Comment:
            1. Subject Line: Suspension of MO HealthNet [Date of Action, mm/dd/yy] – [Participant’s Name]
            2. Comment Body: Upon release, FSD will redetermine eligibility for MHN, and add a comment with a subject line of Redetermination of MO HealthNet – [Date of Action, mm/dd/yyyy] – [Participant’s Name].
    3. FSD Learns the suspended participant will no longer return to the home after incarceration.
    4. FSD Field Staff will complete an IM-150 Suspending Incarcerated Participants form and email it to the appropriate email address listed on the form.
        1. Prior to completing hand off FSD Field Staff are expected to:
            1. Upload documents to the ECM appropriately
            2. Comment on the HOH Person Page:
                1. Subject Line: Suspended participant who will no longer return to the home after incarceration.
                2. Comment Body: Name of the suspended participant, how it was reported to FSD, who is the HOH, who is currently receiving MHH, other details regarding the information learned & an IM-150 was submitted.
    5. FSD Field Staff will NOT take further case actions after the IM-150 has been sent.

 

Encountering Incarcerated Head of Household:

    1. FSD learns the HOH is incarcerated and household members are currently receiving
    2. FSD Field Staff confirm the HOH is currently incarcerated
        1. Review VineLink and DOC Offender Search, then contact the facility
        2. If contact cannot be made with the facility proceed to Step Three
        3. If it is confirmed with the correctional facility that the HOH is NOT currently incarcerated, then FSD Field Staff will NOT complete the IM-150. FSD Field Staff will proceed with processing the information and complete necessary work, do NOT proceed to Step Three – complete action
            1. FSD Field Staff will update the case with the information received
            2. FSD Field Staff will add to the comments made on the HOH Person Page the following information:
                1. Who was incarcerated
                2. Dates of incarceration
                3. [Participant’s Name] is no longer incarceration as of the date of action, [current date].
    3. FSD Field Staff will need to submit an IM-150 Suspending Incarcerated Participants form including additional relevant information in the “Any other information or changes that you need to report” section of the form. Email the IM-150 to the appropriate email address indicated on the form.
        1. Prior to completing hand off FSD Field Staff are expected to :
            1. Confirm HOH is currently incarcerated.
            2. Upload documents to the ECM appropriately.
            3. Comment on the HOH Person Page:
                1. Subject Line: Incarcerated Head of Household
                2. Comment Body: Name of the incarcerated individual, how it was reported to FSD, who is currently receiving MHN, other details regarding the information learned that an IM-150 has been sent.
    4. FSD Field Staff will NOT take further case actions after the IM-150 has been sent.