Section 208.990

Title XII PUBLIC HEALTH AND WELFARE

Chapter 208

Effective - 28 Aug 2013   

  208.990.  MO HealthNet eligibility requirements. — 1.  Notwithstanding any other provisions of law to the contrary, to be eligible for MO HealthNet coverage individuals shall meet the eligibility criteria set forth in 42 CFR 435, including but not limited to the requirements that:

  (1)  The individual is a resident of the state of Missouri;

  (2)  The individual has a valid Social Security number;

  (3)  The individual is a citizen of the United States or a qualified alien as described in Section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 8 U.S.C. Section 1641, who has provided satisfactory documentary evidence of qualified alien status which has been verified with the Department of Homeland Security under a declaration required by Section 1137(d) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 that the applicant or beneficiary is an alien in a satisfactory immigration status; and

  (4)  An individual claiming eligibility as a pregnant woman shall verify pregnancy.

  2.  Notwithstanding any other provisions of law to the contrary, effective January 1, 2014, the family support division shall conduct an annual redetermination of all MO HealthNet participants' eligibility as provided in 42 CFR 435.916.  The department may contract with an administrative service organization to conduct the annual redeterminations if it is cost effective.

  3.  The department, or family support division, shall conduct electronic searches to redetermine eligibility on the basis of income, residency, citizenship, identity and other criteria as described in 42 CFR 435.916 upon availability of federal, state, and commercially available electronic data sources.  The department, or family support division, may enter into a contract with a vendor to perform the electronic search of eligibility information not disclosed during the application process and obtain an applicable case management system.  The department shall retain final authority over eligibility determinations made during the redetermination process.

  4.  Notwithstanding any other provisions of law to the contrary, applications for MO HealthNet benefits shall be submitted in accordance with the requirements of 42 CFR 435.907 and other applicable federal law.  The individual shall provide all required information and documentation necessary to make an eligibility determination, resolve discrepancies found during the redetermination process, or for a purpose directly connected to the administration of the medical assistance program.

  5.  Notwithstanding any other provisions of law to the contrary, to be eligible for MO HealthNet coverage under section 208.991, individuals shall meet the eligibility requirements set forth in subsection 1 of this section and all other eligibility criteria set forth in 42 CFR 435 and 457, including, but not limited to, the requirements that:

  (1)  The department of social services shall determine the individual's financial eligibility based on projected annual household income and family size for the remainder of the current calendar year;

  (2)  The department of social services shall determine household income for the purpose of determining the modified adjusted gross income by including all available cash support provided by the person claiming such individual as a dependent for tax purposes;

  (3)  The department of social services shall determine a pregnant woman's household size by counting the pregnant woman plus the number of children she is expected to deliver;

  (4)  CHIP-eligible children shall be uninsured, shall not have access to affordable insurance, and their parent shall pay the required premium;

  (5)  An individual claiming eligibility as an uninsured woman shall be uninsured.

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(L. 2013 S.B. 127)