Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: MANDI ADAMS, INTERIM DIRECTOR
SUBJECT: NURSING HOME COVERAGE FOR PARTICIPANTS ON QUALIFYING MODIFIED ADJUSTED GROSS INCOME (MAGI) LEVELS OF CARE
MANUAL REVISION #
0815.005.00
0815.030.00
1040.010.00
1040.015.15
1040.020.10
1040.020.40.15
1040.020.40.20
DISCUSSION:
Participants on MAGI levels of care, with the exception of Uninsured Women’s Health Services (UWHS) and Extended Women’s Health Services (EWHS), can qualify for nursing home services if they meet specific medical criteria. The medical certification for these individuals is made by the Department of Health and Senior Services (DHSS). Participants eligible for nursing home services under MAGI levels of care are subject to transfer penalties but are not subject to resource limits or a surplus.
The Family Support Division (FSD) Nursing Facility (Vendor) Unit is notified when a participant meets the medical criteria for nursing home services. A new piece of evidence, MO Vendor Facility, has been added to the Missouri Eligibility Determination and Enrollment System (MEDES). This evidence provides the Nursing Home (Vendor) Unit a streamlined way to notify MO HealthNet Division (MHD) when individuals on MAGI levels of care meet the criteria for nursing home services.
There is no change in how MAGI staff process applications. The requirement, for participants claiming a disability and approved for Adult Expansion Group (AEG) coverage to also have eligibility explored for Mandatory Non-MAGI programs, has not changed. See Appendix K to determine which levels of care are considered mandatory.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
MA/rc