Reasons Why a Case Can’t be Automatically Closed

This guide is only applicable after 2.2 implementation

Following the guidelines of the Affordable Care Act (ACA), Family Support Division must re-determine annually the eligibility of existing clients in Missouri Eligibility and Determination and Enrollment System (MEDES) receiving certain MOHealthNet (MHF, MHK, CHIP, and UWHS) benefits.

When the MEDES Auto Renewals batch process is not able to automatically renew the household, a case is pushed to manual renewals, the system triggers a pre-populated IM-1U to be sent to the client.

Policy References:

    1. When the attested income in the system is zero and income is returned from one of the external sources.
    2. When the attested income in the system and income returned from external sources is zero.
    3. When the income sources of two people from the external services do not match.
    4. When the income types of the attested income and the external income do not match.
    5. When the Federal Data Hub Response batch is unsuccessful in retrieving information from the Hub or DOLIR after a maximum of 10 tries.
    6. When there is insufficient information to continue with an auto renewal, for example, all the required data for all the members in the HH are not retrieved from the Hub. The following are scenarios for inconsistent information retrieved by External Sources:
      1. Equifax/DOLIR data not available for all the people in the HH
      2. Additional Equifax/DOLIR data retrieved for one of the people in HH
    7. When there is a source of income that is Net Self Employment (SE) other than child care or Child Care Self Employment (Net) a pre-populated renewal form is necessary if we can’t hit the Fed Hub for the SE income on the tax return, or if no taxes are filed.
    8. When the level of care determined by projected eligibility is MHF from MHK, due to low or no earnings.
    9. If the income from the external service is over 305% of FPL.
    10. If a case goes from CHIP non-premium to CHIP premium.
    11. During the Auto Renewals process, the case will be pushed to Manual Renewals
      1. If the income attested from the client as a part of CiC is not applied yet on the case (or)
      2. If there is an on-hold determination on the case
    12. During Auto Renewals, If the attested income type in the case cannot be verified by the External services, the system identifies this case as “Manual Renewals” case

(E.g. if the attested income type in the case is “Rental income” and if Equifax cannot verify it, the case is a “Manual Renewals” case).

    1. During projected Eligibility, if the level of care changes from MHF to MHF-MHK (CHIP 0), the system should consider this case for manual renewals. This is because projected eligibility is done at a product level and not at a coverage category level. It is to be noted that MHF MHK (CHIP 0) is a CHIP category under MHF product case. Therefore, this cannot be identified during projected eligibility.

Manual Renewals can also be explicitly initiated by the ES anytime during the eligibility period. The system will provide functionality to do the following:

    1. ES will manually trigger IM-1U to be sent to the client.
    2. The system also queues up IM-80 and IM-33c along with IM-1U. At this time a regular review will begin.

ES may manually trigger IM-31A for further information from the client. The system will follow the Adverse Action process for IM-31A.