Add MO Employer Sponsored Coverage

If a household member indicates s/he is enrolled in Employer Sponsored Insurance (ESI), evidence use the following guide to create new evidence.

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.

You will need to add MO Employer Sponsored Coverage evidence prior to Add MO Covered Member evidence

See 3.6.9 Show-Me Healthy Babies (SMHB) for additional information

Evidence: MO Employer Sponsored Coverage

ADD MO EMPLOYER SPONSORED COVERAGE

    1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder
    2. Hover over MO Employer Sponsored Coverage > click the Create Evidence Icon
    3. In the MO Employer Sponsored Coverage window, enter the date the insurance policy was reported to FSD in the Received Date field
    4. Enter the Received Date
    5. Select the participant who is the policy holder for the ESI in the Participant drop down menu

NOTE: If the policy holder is not in the household, complete the name and contact information required.

    1. Select Enrolled or Entitled from the Coverage Status drop down menu
    2. Enter the date the participant was either enrolled or entitled to the ESI coverage in the Policy Start Date.
    3. Enter how much the policy holder pays for any enrolled members monthly in the Employee Contribution field
    4. Select Yes or No from the Family Planning Services drop down menus to indicate the type of coverage offered by the ESI
    5. Select Yes or No from the Maternity Services drop down menus to indicate the type of coverage offered by the ESI
    6. Click Save
    7. Verify all Outstanding Evidence
    8. 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:any Coverage Changes
    2. Review Notice Queue to make sure appropriate forms generated
    • IM-80: Generates in the event of negative coverage changes
    • IM-33C: Case Action Notice