Annual Reviews

MO HealthNet Annual Reviews

All MO HealthNet (Medicaid) cases undergo an annual review of eligibility. The purpose of this review is to update the consumers current income and resources, and to make sure there have been no major life changes which may impact the client's case or eligibility. Sometimes this is referred to as an annual reinvestigation, reauthorization, or re-certification. This is a different and separate process than the MRT Disability Determination Process.

One month prior to the review month, the Family Support Division (FSD) mails an annual review form (the FA-402 or IM-1U MAGI) to the consumer that is due back on the first working day of the review month.

Do not wait for the consumer to receive the form mailed from FSD to start the process.
Staff should help the consumer complete the review form and submit it. Make sure the forms are completed and submitted to FSD between the 15th and the end of the month before the annual review is due.
ExampleFor an annual review due July 1, the review should be submitted between June 15-30.

The review forms can be sent to any FSD office, find a list of office contact information here: https://dss.mo.gov/offices.htm

MO HealthNet for the Elderly, Blind, and Disabled Annual Review

FA 402 - MO HealthNet for the Elderly, Blind, and Disabled

Use this annual review form for individuals who are elderly, blind, or disabled. 

ME Codes for MO HealthNet for the Elderly, Blind, and Disabled
  • ME 03
    • Aid to the Blind (AB)
    • Supplemental Aid to the Blind (SAB)
  • ME 12
    • MO HealthNet Assistance - Aid to the Blind (AB) 
  • ME 11
    • MO HealthNet Assistance - Old Age Assistance (OAA) 
  • ME 13
    • MO HealthNet Assistance - Permanently and Totally Disabled (PTD) 
  • ME 15
    • Supplemental Nursing Care - Aid to the Blind (AB) 
  • ME 14
    • Supplemental Nursing Care - Old Age Assistance (OAA) 
  • ME 16
    • Supplemental Nursing Care - Permanently and Totally Disabled (PTD) 
  • ME 86
    • Ticket To Work Health Assurance Program (formerly MO Workers With Disabilities/MAWD) - Non-Premium 
  • ME 85
    • Ticket To Work Health Assurance Program (formerly MO Workers With Disabilities/MAWD) – Premium 
  • ME 02
    • Blind Pension 
MO HealthNet for Families Annual Review

IM-1U MAGI - MO HealthNet for Families

Use this form for Parents, Pregnant Women, and Children not receiving based on disability.

ME Codes for Parents, Pregnant Women, and Children
  • ME 05
    • MO HealthNet for Families (MHF) – Adults 
  • ME 06
    • MO HealthNet for Families (MHF) – Children 
  • ME 40
    • MO HealthNet for Kids – Poverty 
  • ME 62
    • MO HealthNet for Kids – Health Initiative Fund (HIF) 
  • ME 71, 72
    • MO HealthNet for Kids, 101-150% Poverty, Age 6-18 
  • ME 73
    • MO HealthNet for Kids, SCHIP 151-185% Poverty, Age 1-18 (Premium) 
  • ME 74
    • MO HealthNet for Kids, SCHIP 186-225% Poverty, Age 0-18 (Premium) 
  • ME 75
    • MO HealthNet for Kids, SCHIP 226-300% Poverty, Age 0-18 (Premium) 
  • ME 18
    • MO HealthNet for Pregnant Woman 
  • ME 43
    • Pregnant Woman - 60-Day Assistance - MHF Criteria 
  • ME 44
    • Pregnant Woman - 60-Day Assistance – Poverty 
  • ME 45
    • Pregnant Woman – Poverty 
  • ME 61
    • MO HealthNet for Pregnant Woman - Health Initiative Fund (HIF) 
  • ME 95, 96, 97, 98
    • Show Me Healthy Babies 

 

Adverse Action for failure to return the Annual Review

If the form is not received and entered into the FSD computer system by the due date, a 10 day advance notice to close the Medicaid is sent to the consumer the next day. 

Time Frame to cancel closing action

Once FSD sends an adverse action notice the consumer has 10 days to provide the annual review: if it is not received the Medicaid case will close on the 10th day unless the consumer requests a hearing. If the annual review form is received within 30 days of the closing action the case may be reopened.  

Incorrect adverse action

If the annual review form has been submitted but the consumer received an adverse action or closing letter please email DMH.MedicaidEligibility@dmh.mo.gov so that we can check on the case for you.

 
DMH Report of Consumers Due for Annual Review

On 3rd of each month DMH produces a report listing cases due for a Medicaid annual review for each CMHC, behavioral health institution, DD regional office, and ADA provider. Agencies should use the report to assist consumers in submitting an annual review form to FSD by the due date on the report.

Accessing the monthly Annual Review Report

The reports are in the agency/facility’s Reports folder on the FTP Site:

  • In the agency/facility’s file, open the reports folder, then open the CPS or ADA folder.
  • Report name is "MedicaidReauths(MEIS)" preceded by the date of the report YYYYMMDD.

 

Reading the Report

The report has two parts: "Due Within Three Months” and “Overdue or Closed Within Last Three Months."

  • The "Due Within Three Months" section of the report shows the consumers due for a review in each of the next three (3) months.
    • For example, the July report shows the reviews due August 1, September 1 and October 1.
  • For those due the first day of the month following the report month (Nov. 1 on the October report), make sure the forms are completed and submitted to FSD between the 15th and the end of the month prior to the month the annual review is due.
    • The FSD systems are not capable of processing the review outside of their own internal time-frames and submitting the review within this 15 day time-frame ensures that they can be processed.
  • For those due in the months following the report (Dec. 1 and Jan. 1 on the Oct. Report) make plans to assist the consumer in completing the form to submit in the correct time-frame. 
  • Agencies should prioritize consumers on the report that have paperwork due the month of the report (in the overdue section) and the ones due the next two (2) months.
  • Those on the report that have a due date prior to the month of the report have either been closed or have remained open without a review. Check CIMOR to see if the Medicaid is closed.
    • If the case is closed and you know the form was submitted or it has been under 30 days since the closing action, email DMH.MedicaidEligibility@dmh.mo.gov.
    • Otherwise a new application should be submitted for the consumers that are closed.
    • No action is necessary on those that remain open.

 

The "Medical" column

The report has a “Medical” column, if Medical is in the column that means the consumer’s disability has been determined by the FSD rather than by Social Security. New medical records will have to be submitted at some point to FSD, but are NOT required at the time of the annual review. DMH is working on ways to let DMH agencies know when to submit the medical records.

 

August 7, 2019 Medicaid Annual Reviews: Guidance for Assisting Consumers Webinar recorded webinar and presentation