Eligibility determinations for PQ (also known as retroactive) coverage are separate from the eligibility determination for the month of application. Complete an eligibility determination for each PQ individually.
NOTE: The participant DOES NOT have to be eligible in the month of application to be eligible for PQ benefits.
The effective dates of PQ benefits can be no earlier than the first day of the third month prior to the month of application.
PQ Eligibility and Verification
To be eligible for PQ, a participant must meet the criteria listed below for each month of PQ.
- Resident of Missouri (self-attestation)
- Citizenship/Immigrant Status
- Income eligible
- Attest to having unpaid bills for a PQ month
- Social Security Number
- Tax Filing Status (self-attestation) and Tax relationship
- Pregnant if requesting PQ for MPW
NOTE: Each PQ month has its own independent evidence for the following: PQ Income, PQ Deductions, and PQ Medical Bills.
The start date of the PQ specific evidence will be the first day of that individual month and the end date will be the last day of that individual month. All other evidence will be backdated by the system to the first day of the earliest PQ month.
Determine income for PQ months using the same methodology as the month of application. These guidelines are in manual section 1805.030.00 Modified Adjusted Gross Income (MAGI) Methodology.
When completing income budget(s) for PQ months, use reasonable compatibility (RC) to confirm the self-attestation of income in each month. Refer to manual section 1805.030.15 Reasonable Compatibility for more information on RC.
Use electronic data sources when available to verify attested information. If evidence cannot be verified electronically or by existing case information, attempt to contact the participant by phone prior to sending a Request for Information. Allow 10 days for the individual to provide the requested information.
- If the participant returns the information, make an eligibility determination based on the information provided.
- If the participant fails to provide the requested information within the 10-day Request for Information timeframe, reject all three months for Failure to Cooperate.
EXAMPLE: Sue applied for benefits for her son, Austin, in July. She requested PQ coverage for April, May and June. Because Sue’s income statement was not RC for May, and she could not be reached by phone, a Request for Information was sent. Sue failed to provide the requested information within the 10-day Request for Information timeframe. All PQ months, April, May and June, were rejected for Failure to Cooperate. Since she provided all other necessary information, a determination can be made for the application month and ongoing coverage.
Reapplication for PQ
The participant may apply or reapply for PQ for up to one year after the application date. They may apply for PQ in person, by telephone, or in writing. If it is a reapplication, only request the unverified information from the previous application for PQ.
EXAMPLE: Sue returns in December and requests that PQ for her son be explored again for April, May and June. Sue is provided with the Request for Information and given 10 days to provide the outstanding income information from May that was previously requested and not provided.
Reasonable Opportunity (RO)
Allow RO for PQ months. If the citizenship or qualified immigrant status is not verified at application, approve the PQ with RO when the ongoing benefit is approved.
PQ for MO HealthNet for Pregnant Women (MPW) is treated differently. Review policy on PQ for MPW applications, 1850.030.00 Prior Quarter (PQ) and Month of Application Eligibility.