Family MO HealthNet (MAGI)

1830.020.00 PRIOR QUARTER

Eligibility determinations for prior quarter (also known as retroactive) coverage are separate from the eligibility determination for the month of application. Eligibility determination for each prior quarter month is completed individually.

NOTE: The individual DOES NOT have to be eligible in the month of application to be eligible for prior quarter benefits.

The effective dates of prior quarter benefits can be no earlier than the first day of the third month prior to the month of application.

To be eligible for prior quarter an individual must meet the criteria listed below for each month of prior quarter.

  1. Resident of Missouri (self-attestation)
  2. Citizenship/Immigrant Status
  3. Income eligible
  4. Attest to having unpaid bills for a prior quarter month
  5. Social Security Number
  6. Tax Filing Status (self-attestation) and Tax relationship
  7. Pregnant if requesting prior quarter for MPW

NOTE: Each Prior Quarter month has its own independent evidence for the following:  Prior Quarter Income, Prior Quarter Deductions, and Prior Quarter Medical Bills.

The start date of the Prior Quarter 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 Prior Quarter month.

Determine income for prior quarter 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 prior quarter months, use reasonable compatibility (RC) to confirm the self-attestation of income in each month. Please refer to manual section 1808.030.15 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, staff should attempt to contact the participant by phone prior to sending an IM-31A. Allow 10 days for the individual to provide the requested information.

  • If the individual returns the information, make an eligibility determination based on the information provided.
  • If the individual fails to provide the requested information within the 10 day IM-31A timeframe, prior quarter is rejected for all three months for Failure to Cooperate.EXAMPLE: Sue applied for benefits on her son, Austin, in July. She requested prior quarter coverage for April, May and June. Because Sue’s income statement was not reasonably compatible for May, and the Eligibility Specialist was not able to contact her by phone, an IM-31A was sent. Sue failed to provide the requested information within the 10 day IM-31A timeframe. All prior quarter months, April, May and June, were rejected for Failure to Cooperate. Since she provided all of the other necessary information, a determination can be made for application month and ongoing coverage.

The individual may apply or reapply for prior quarter for up to one year after the application date. If it is a reapplication, only request the unverified information from the previous application for prior quarter.

EXAMPLE: Sue returns in December and requests that prior quarter for her son be explored again for April, May and June. Sue is provided with the IM-31A and given 10 days to provide the outstanding income information from May that was previously requested and not provided.

Reasonable Opportunity is not allowed for prior quarter months. If citizenship is not provided at application and the individual goes into their 90 day Reasonable Opportunity period, reject prior quarter for citizenship. If the individual provides citizenship verification within the 90 day Reasonable Opportunity period, reopen the prior quarter application and run a determination if all the evidence has been verified.

Prior quarter for MO HealthNet for Pregnant Women (MPW) is treated differently.  Review policy on prior quarter for MPW applications, 1850.030.00 PRIOR QUARTER (PQ) AND MONTH OF APPLICATION ELIGIBILITY.