Newborn 1 Year Level of Care

For Newborns, MEDES determines if sufficient information exists to move the child to the appropriate Level of Care (LOC). An ex parte is completed when, based on the rules, there is sufficient information available. Meaning there ia nothe MO HealhtNet program that is active in the child’s household and the child can be reassessed in that program. Exceptions are MPW, Newborn, EWHS and UWHS programs. If sufficient evidence does not exist, a notice (IM-31A) is generated 10 days prior to the participant’s first birthday for more information to determine continued eligibility. If information is not received, Newborn coverage ends.

If the case falls into one of the patterns below, there is no need for staff to do anything.

  1. If you open the Application Details for the child and the Newborn sufficient information exists box is checked
  2. If you open the Application Details for the child and there is NO Newborn sufficient information exists box (participants entered in MEDES prior to August 22, 2016 will not have this field)

If the information is returned prior to the newborn’s first birthday, the Eligibility Specialist (ES) must follow the steps indicated below.

 

TO ACTIVATE CHANGE IN NEWBORN LOC

If completing this task as part of a returned IM-1U, or if the case is Under Renewal, you must first follow steps to To Create a Manual Renewal and To Complete Manual Renewal.

NOTE: DO NOT end date any other evidence for the participant being removed from the home.

    1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder
    2. Click on the Application Details hyperlink
    3. Toggle open the newborn participant’s evidence
    4. Click the List Actions menu
    5. Click New
    6. Check the Newborn sufficient information exists box. This tells MEDES that sufficient information exists to redetermine the Newborn LOC.

NOTE: MEDES will automatically decide which version of the evidence to use based on the Received Date.

    1. Click Save Save Button
    2. Close the Application Details page tab
    3. Complete Verifications
    4. Apply, Review, and Authorize Changes

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 finalization process again.

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

NOTE: MEDES will determine eligibility for the newborn based on the updated information.