0525.000.00 Annual Renewals and Change in Circumstance

0525.010.05 Transfer to Vendor Payments

IM-120 November 18, 2021

Participants who plan to enter or currently reside in a nursing facility, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), or State Mental Hospital may be eligible for MO HealthNet for the Aged, Blind, and Disabled (MHABD) or Blind Pension (BP) vendor payments made to the facility on their behalf.

When a BP recipient or blind applicant is residing in or plans to enter a nursing facility, ICF/IID, or Mental Health Center (MHC), eligibility for vendor must first be explored under MHABD. If ineligible under MHABD, BP vendor eligibility will be explored if the participant is in a nursing facility or MHC. ICF/IID coverage is not available under BP state-only medical assistance.

Refer to MHABD policy for information on determining eligibility and transferring a case to vendor payments. If eligible for MHABD vendor, close the BP case and open the MHABD case on the same day. If the BP participant cannot meet MHABD eligibility, change the BP case from cash to vendor for participants certified for Nursing Facility (NF) or MHC level of care. The process for determining vendor eligibility and level of care under BP is the same as the process for MHABD vendor, except:

  1. If a BP cash payment is more advantageous than vendor, the cash payment would be continued.
  2. Until the BP grant is stopped, it is counted in the surplus determination for BP or MHABD vendor.
  3. When a BP participant leaves one living arrangement for another, always explore eligibility under the program that is most beneficial to the claimant. The BP participant will always at least be eligible for a BP cash grant, UNLESS the participant is under age 65 and residing in a State Mental Hospital or is residing in an ICF/IIR. If this occurs, the BP (cash and medical) case must be closed.
  4. When a BP participant age 65 or older enters a State Mental Hospital, first explore MHABD vendor, then BP vendor and finally BP cash.