IM-117 November 15, 2021; IM-07 January 26, 2011; IM-30 April 4, 2008
Eligibility determination for PQ MO HealthNet coverage is separate from the eligibility determination for current MO HealthNet coverage. A participant does not have to be currently eligible for MO HealthNet coverage to be eligible for PQ coverage and vice versa. 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.
PQ coverage can be no earlier than the first day of the third month prior to the month of the application and can extend up to but not including the first day of the month of application.
To be considered eligible for PQ MO HealthNet coverage, the participant must, during the PQ:
- meet all eligibility factors; and
- have unpaid medical expenses.
If the participant becomes eligible for assistance sometime during the PQ, eligibility for MO HealthNet begins on the first day of the month in which the participant became eligible for assistance.
EXAMPLE: Mr. Mill applied for benefits on February 11th and had unpaid medical expenses for the months of November, December, and January. Mr. Mill had a checking account with resources exceeding the resource limit. During the month of December he spent the resources to under the allowable limit. Mr. Mill was determined eligible as of December 1st.
In those cases where the participant has unpaid medical expenses in the PQ and is determined ineligible for MO HealthNet during that time, but is eligible for MO HealthNet in the month of application and ongoing, include an explanation of the date of eligibility for MO HealthNet benefits in the electronic case record.
EXAMPLE: Ms. Smith applied for benefits on March 9th and had unpaid medical expenses for the months of December, January, and February. Ms. Smith had excess resources until March and was ineligible for benefits in the PQ. Ms. Smith was not approved for benefits until March 1st. Include an explanation regarding the request for benefits for the PQ and rejection in the electronic case record.
NOTE: If the participant is not eligible for PQ coverage because the participant was not in an SNC eligible facility, explore PQ coverage based on MHABD eligibility criteria. A separate application is not required.