December 1973 Eligibility Requirements Manual

1025.015.16 Special Consideration For MHABD Vendor Approvals

IM-32,  March 12, 2013

MHABD vendor participants may have Medicare covered days when they enter a facility. Medicare may pay for all or part of the skilled nursing facility (SNF) covered services for the first 100 days of care if the resident is in a Medicare certified facility and meets certain other requirements. For any month in which part or all of the charge for every day is covered by Medicare, the participant will not have to pay their surplus amount to the nursing facility. Eligibility Specialists (ES) are not responsible for tracking Medicare covered days. However, ES must be aware that a vendor recipient who goes to a Medicare certified facility may not always be required to pay their surplus amount especially during the first part of their stay. A resident who is not paying the surplus amount may acquire resources which could exceed the limit of $999.99. In that event, when information is entered in FAMIS to show available resources exceed the maximum, the ES should authorize the adverse action closing. When an active MHABD participant has available resources that cause ineligibility, the client can choose to pay the MO HealthNet Division Third Party Liability Estate Recovery Unit to retain their eligibility. The participant or their representative would need to contact the MHD TPL unit to make the arrangements.