MISSOURI DEPARTMENT OF SOCIAL SERVICES FAMILY SUPPORT DIVISION ACTION NOTICE – SHOW-ME HEALTHY BABIES

FROM	FSD TEAM MEMBER	TELEPHONE NUMBER - -	DATE 2/9/2016
FSD OFFICE ADDRESS	CITY	STATE	ZIP CODE
TO	NAME	CASE NUMBER
ADDRESS (STREET)	CITY	STATE	ZIP CODE
This is to advise you the following person(s) are approved for the stated type of healthcare coverage:
NAME	TYPE OF HEALTHCARE	MO HEALTHNET #	EFFECTIVE DATE
***Additional information regarding Show-Me Healthy Babies on back.
Your approval for Show-Me Healthy Babies includes the following coverage:
All prenatal care and pregnancy related services which benefit the health of the unborn child
Labor and Delivery
Full post-partum coverage through the last day of the month that includes the sixtieth day after the pregnancy ends.
Limited post-partum coverage.
The following individual is not eligible for Show-Me Healthy Babies:
because:
MO HealthNet coverage for	will end on:
because:
NOTE: - It is important that you notify the Family Support Division when your child is born so your child’s eligibility can be re-determined. - Please notify us if you move, because your healthcare providers may change.
If you think we are wrong, call the FSD Information Center toll free at 1-855-FSD-INFO (1-855-373-4636) and ask to speak to an eligibility specialist or supervisor to review your case. or You can request a hearing on any decision the Family Support Division makes about your health coverage. To ask for a hearing, call the FSD Information Center 1-855-FSD-INFO (1-855-373-4636), visit any FSD office, or mail a written request to any FSD office. Remember you have 90 days from the date on this letter to ask for a hearing. If you request a hearing you may present the information yourself or you may be represented by your own attorney or by other persons who know your situation. You have the right to present witnesses on your own behalf and to question witnesses who appear at the request of the Family Support Division.
For the possibility of free legal services, call	.
You must report any change in situation within 10 days to the FSD Information Center at (855) 373-4636 or a FSD Resource Center. The law provides penalties for any persons who receive benefits to which they are not entitled through misrepresenting the facts or not reporting full information about their situation.
CONTINUED ON BACK	IM-32SMHB 02/02/16

COVERAGE FOR CHILDREN BORN UNDER SHOW-ME HEALTHY BABIES
All children under the Show-Me Healthy Babies program must have their eligibility re-determined at birth. Eligible children will be approved for coverage under the appropriate level of care until their first birthday without having to pay a premium.
If a Show-Me Healthy Babies child is put in a CHIP premium level of care, the family may receive a premium invoice showing $0 premium owed. If this happens, disregard the invoice. If you should receive a second invoice please notify MO HealthNet Division Participant Services at (800) 392-2161.
HOW TO ACCESS HEALTHCARE
MO HealthNet cards for the above approved persons will be sent to you within five days from the date of this notice. If healthcare is required prior to receiving the card(s), use this letter to obtain services from a MO HealthNet approved healthcare providers. For information about approved providers in your area, call 1-800-392-2161. Depending on where you live, you will access your family’s health insurance through either a health plan or approved healthcare providers. The persons listed above will receive services through: A managed care healthcare plan; or MO HealthNet approved healthcare providers. If the “Managed care healthcare plan” is checked above, you will be mailed an information packet to help you choose a health plan in your area. Use MO HealthNet approved healthcare providers to obtain needed medical care until you receive a confirmation date of enrollment in a Managed care healthcare plan. If “MO HealthNet approved healthcare providers” is checked, you will need to call 1-800-392-2161 about approved providers in your area
Enclosure: Information Leaflet No. IM-4.
IM-32SMHB 02/02/16