IM-117 November 15, 2021; IM-95 September 21, 2021
Eligibility for PQ coverage is effective on the first day of the month that an individual attested to receiving medical services and was eligible at any time during that month. Staff should explore PQ coverage if requested at time of application or if requested within 12 months of application. Individuals may apply or reapply for PQ for up to one year after the application. They may apply for PQ in person, by telephone, or in writing. The eligibility for PQ months should be treated as if the person had applied in that 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 and 1865.020.00 Eligibility Requirements.
NOTE: PQ coverage shall not start prior to the implementation month of July 2021.
Example: Jane, 27 years of age, applies for MO HealthNet on August 5, 2021 and requests PQ coverage. She has attested to medical bills in May 2021, June 2021, and July 2021. Jane meets all eligibility factors for the Adult Expansion Group (AEG) for ongoing and PQ months. The prior coverage for AEG can only be determined for July 2021 as the effective date of the AEG program is July 1, 2021.