MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual

0800.000.00 MO HealthNet for the Aged, Blind, and Disabled obsolete

• 0800.000.05 Related Special Eligibility Groups obsolete
• 0800.005.00 Legal Basis obsolete

0803.000.00 Authorized Representative(s) for MO HealthNet

• 0803.020.00 Authorized Representative(s) for MO HealthNet
  • 0803.020.05 Legal Basis obsolete
  • 0803.020.10 Appointment of an Authorized Representative obsolete
    • 0803.020.10.10 Appointment of an Authorized Representative When There Is a Spouse or Second Parent in the Eligibility Unit obsolete
    • 0803.020.10.20 Duration of the Appointment of Representative obsolete
    • 0803.020.10.30 Authorized Representative Revocation obsolete
  • 0803.020.30 Signing by an Authorized Representative obsolete

0804.000.00 Application Processing

• 0804.005.00 MHABD Application Timeframes
• 0804.010.00 Voluntary Withdrawal
• 0804.015.00 Rejection Before the End of the Timeframe
• 0804.020.00 Canceling a Rejection
• 0804.025.00 MO HealthNet Application Concurrent With MHABD Cash Programs

0805.000.00 Eligibility

• 0805.005.00 December 1973 Eligibility Requirements
• 0805.010.00 MA/GR Dual Eligibility obsolete
• 0805.015.00 Financial Need
  • 0805.015.05 Persons Whose Income and Needs Are Considered
    • 0805.015.05.05 Couple Cases in the IMU5 System
  • 0805.015.10 Income Exclusions
    • 0805.015.10.05 Social Security Cost of Living Adjustment (COLA) Disregard
  • 0805.015.15 Overhead Expense of Producing Income
  • 0805.015.20 Determination of Gross Earned Income
  • 0805.015.25 Standard Deductions From Gross Earned Income
  • 0805.015.30 Unearned Income
  • 0805.015.35 Income Exemptions/Deductions
  • 0805.015.40 Types of Need Determination
  • 0805.015.45 Income Maximum
• 0805.020.00 Medical Assistance for Disabled Children (MADC)
  • 0805.020.05 Definition of Living With a Parent
  • 0805.020.10 Deeming Parental Resources
  • 0805.020.15 Deeming Parental Income

0810.000.00 MO HealthNet Coverage

• 0810.005.00 MO HealthNet Non-Spend Down Coverage
• 0810.010.00 MO HealthNet Spend Down Coverage
  • 0810.010.05 Processing Spend Down MO HealthNet Cases
  • 0810.010.10 Notification of Spend Down Amount
    • 0810.010.10.05 Notification of Spend Down on New Approvals
  • 0810.010.15 Meeting Spend Down With Incurred Expenses
    • 0810.010.15.01 Documentation of Incurred Medical Expenses
    • 0810.010.15.02 Determining Patient Responsibility After Third Party Liability
    • 0810.010.15.05 Allowable Medical Expenses for Spend Down
    • 0810.010.15.10 Authorizing Spend Down Coverage Based on Incurred Expenses
    • 0810.010.15.15 Preventing MO HealthNet Payment of Expenses Used to Meet Spend Down
      • 0810.010.15.15.05 Allowable Third Party Payment From State-Funded Programs
      • 0810.010.15.15.10 Identifying DMH Medical Services Allowable for Spend Down
      • 0810.010.15.15.15 Identifying DHSS NME CDS Participants
      • 0810.010.15.15.20 Verification of DMH Medical Expenses to Meet Spend Down
      • 0810.010.15.15.25 Verification of DHSS Medical Expenses
  • 0810.010.20 Spend Down Pay-In Option
    • 0810.010.20.05 Pay-In Option for New Approvals
    • 0810.010.20.10 Pay-In by Automatic Withdrawal
    • 0810.010.20.15 Pay-In by Other Agencies
    • 0810.010.20.17 Combination of Incurred Medical Expenses and Pay-In
    • 0810.010.20.20 Out-of-Pocket Expenses for Spend Down Cases
• 0810.015.00 Prior Quarter (PQ) Coverage
  • 0810.015.05 Prior Quarter (PQ) Non-Spend Down
  • 0810.015.10 Prior Quarter (PQ) Spend Down

• 0810.020.00 MO HealthNet Coverage End Date on Closings
• 0810.025.00 Eligibility for Buy-In (SMI Premium) for Medicare
• 0810.030.00 Healthy Children and Youth (HCY)
• 0810.035.00 Personal Care Program
  • 0810.035.05 Legal Reference (Personal Care Services)
  • 0810.035.10 Basic Eligibility Guidelines for Personal Care Services
  • 0810.035.15 Eligibility Determination (Division of Senior and Disability Services-DSDS)
  • 0810.035.20 Family Support Division Responsibilities
  • 0810.035.25 MO HealthNet Division (MHD) Responsibilities
  • 0810.035.30 Personal Care Service Provider Responsibilities
• 0810.040.00 The Respite Care Program (In-Home and Institutional)
  • 0810.040.05 In-Home Respite Care
  • 0810.040.10 Institutional Respite Care
  • 0810.040.15 Basic Eligibility Guidelines for Respite Care
  • 0810.040.20 Eligibility Determination (Division of Senior and Disability Services-DSDS)
  • 0810.040.25 Family Support Division Responsibilities
  • 0810.040.30 Respite Care Provider Responsibilities

0815.000.00 Vendor Eligibility

• 0815.000.05 Missouri Care Options
• 0815.000.10 Definitions for Vendor Coverage
• 0815.005.00 Eligibility for Vendor Payments
  • 0815.005.05 December 1973 Eligibility Requirements
  • 0815.005.10 MO HealthNet Certified Beds in Nursing Facilities
• 0815.010.00 Applications for Claimants Not Currently Receiving MO HealthNet
  • 0815.010.05 Application Processing Time Frames
• 0815.015.00 Participant Currently Receiving MO HealthNet Enters a Vendor Placement
  • 0815.015.05 Claimant Returns to Vendor Facility
  • 0815.015.10 Tracking MHABD to Vendor Requests
• 0815.020.00 Initial Assessment and Medical Certification
  • 0815.020.05 Verification of Medical Certification
  • 0815.020.10 Participant Not Medically Certified
  • 0815.020.15 Medical Recertifications (Utilization Reviews)
• 0815.025.00 Preadmission Screening for Entry Into Nursing Facilities
  • 0815.025.05 Preadmission Screening Process
  • 0815.025.10 Verification of Preadmission Screening
• 0815.030.00 Vendor Surplus Computation
  • 0815.030.05 Determining Adjusted Gross Income
  • 0815.030.10 Determining Total Allowable Deductions
    • 0815.030.10.05 Personal Needs Allowance
      • 0815.030.10.05.05 Increasing the Personal Needs Allowance Due to Child Support Payments
    • 0815.030.10.10 Allotments
      • 0815.030.10.10.05 Maintenance Standards for Allotments
      • 0815.030.10.10.10 Determining the Allotment to the Community Spouse
      • 0815.030.10.10.15 Hearing Officer or Court of Law Sets Allotment Amount
      • 0815.030.10.10.20 Allotments for Minors and Dependents Living With the Community Spouse
      • 0815.030.10.10.25 Allotments for Minors Not Living With the Community Spouse
    • 0815.030.10.15 Medical Deductions When Determining Surplus
    • 0815.030.10.20 Other Deductions
  • 0815.030.15 Effective Date of Surplus
  • 0815.030.20 Changes in Surplus Amount
• 0815.035.00 Effective Date of Vendor Coverage for Claimants in a Nursing Facility
  • 0815.035.05 Effective Date of Vendor Coverage for Applicant or Participant in a Nursing Facility When No Level II Screening Is Required
  • 0815.035.10 Effective Date of Vendor Coverage for Applicant or Participant in a Nursing Facility When Level II Screening Is Required and the Applicant or Participant Is Not Found to Be MR, MI or DD
  • 0815.035.15 Effective Date of Vendor Coverage for Applicant or Participant in a Nursing Facility When Level II Screening Is Required and the Applicant or Participant Is Found to Be MR, MI or DD
• 0815.040.00 Effective Date of Vendor Coverage for MHC or ICF/IID Level of Care
• 0815.045.00 Prior Quarter Vendor
• 0815.050.00 Claimant Not in Vendor Facility on the First Day of the Month of Application
  • 0815.050.05 Applicant or Participant Not in Vendor Facility in the Prior Quarter (PQ) Has Medical Expenses in the PQ
• 0815.055.00 Inpatient Psychiatric Services for Individuals Under 21 Years of Age
  • 0815.055.05 Applicants or Participants Under Age 18 Receiving Inpatient Psychiatric Services
  • 0815.055.10 Applicants or Participants Ages 18 to 21 Receiving Inpatient Psychiatric Services
• 0815.060.00 Applicants or Participants Between the Ages of 21 and 65 in State Mental Hospital
• 0815.065.00 Individuals Under Age 18 in an ICF/IID or NF
• 0815.070.00 Claimant Leaves the Vendor Facility
  • 0815.070.05 Vendor Facility to SNC Facility
  • 0815.070.10 Vendor Facility to Private Home, Not Receiving HCB
  • 0815.070.15 Vendor Facility to Private Home, Receiving HCB
• 0815.075.00 Claimant Moves From One Type of Vendor Facility to Another
  • 0815.075.05 Claimant Moves to a Nursing Facility From Another Type of Vendor Facility
  • 0815.075.10 NF or ICF/IID to a Mental Hospital
    • 0815.075.10.05 Participant Age 22 to 65 Goes From NF or ICF/IID to State Mental Hospital
    • 0815.075.10.10 Participant Age 65 or Older Goes From NF or ICF/IID to State Mental Hospital
  • 0815.075.15 NF or Mental Hospital to an ICF/IID
• 0815.080.00 Entering a Vendor Case Into IMU5
• Appendix A – Accessing Vendor Numbers for Licensed Nursing Homes
• Appendix B – Maintenance Standards for Allotments
• Appendix C – JCAHO Facilities
• Appendix D – July 1996 Percentage of Need Standard

0820.000.00 Eligibility Based on Receipt of HCB Waiver Services

• 0820.010.00 Overview of Eligibility Criteria
• 0820.020.00 Application Process
  • 0820.020.05 Application Processing Timeframes
    • 0820.020.05.10 Cancelling a Rejection obsolete
• 0820.030.00 Eligibility Requirements
  • 0820.030.05 Age
    • 0820.030.05.05 Permanent and Total Disability
  • 0820.030.10 Medical Need and Authorization for HCB Waiver Services
    • 0820.030.10.05 Referrals to DHSS/DSDS
  • 0820.030.15 Income and Budgeting
    • 0820.030.15.05 HCB With Non-HCB Spouse
      • 0820.030.15.05.05 Income of HCB Spouse When Non-HCB Spouse Applies for MO HealthNet
      • 0820.030.15.05.10 Spouse of HCB Is MHABD Spend Down
  • 0820.030.20 Available Resources
    • 0820.030.20.05 Division of Assets
      • 0820.030.20.05.05 Month of Institutionalization
      • 0820.030.20.05.10 Entry Into a MO HealthNet Certified Bed
  • 0820.030.25 Transfer of Property
  • 0820.030.30 Social Security Number
  • 0820.030.35 Citizenship
  • 0820.030.40 Residence
• 0820.035.00 HCB and QMB
• 0820.040.00 MO HealthNet Eligibility Date
  • 0820.040.05 Annual Renewal
• 0820.050.00 Entering an HCB Case Into IMU5
• Appendix E – HCB Income Maximums

0825.000.00 Eligibility Based on Receipt of Missouri’s Children With Developmental Disabilities (MOCDD) Waiver Services

• 0825.010.00 Overview of Eligibility Criteria
• 0825.020.00 Application Process
  • 0825.020.05 Application Processing Timeframes
• 0825.030.00 Eligibility Requirements
  • 0825.030.05 Age
  • 0825.030.10 Social Security Number
  • 0825.030.15 Citizenship
  • 0825.030.20 Residence
  • 0825.030.25 Disability
  • 0825.030.30 Medical Need and Authorization for MOCDD Waiver Services
  • 0825.030.35 Income and Budgeting
  • 0825.030.40 Available Resources
  • 0825.030.45 Transfer of Property
  • 0825.030.50 MO HealthNet Eligibility Under Other Categories
• 0825.040.00 MO HealthNet Eligibility Date
  • 0825.040.05 Annual Renewal

0830.000.00 Program of All-Inclusive Care for the Elderly (PACE) obsolete

0835.000.00 Application Processing Timeframes for the MO HealthNet for the Aged, Blind, and Disabled Programs obsolete

• 0835.010.00 Canceling a Rejection obsolete

0840.000.00 Annual Renewals and Change in Circumstance

• 0840.005.00 Annual Renewal
  • 0840.005.00.05 Application for Other Benefits at Annual Renewal
  • 0840.005.05 Reconsideration Period
• 0840.010.00 Changes in Circumstances
  • 0840.010.05 Adding a Spouse
  • 0840.010.10 Non-Spend Down to Spend Down
  • 0840.010.15 Spend Down to Non-Spend Down or MA-WD Non-premium obsolete
  • 0840.010.20 Change to MA-WD Premium obsolete
  • 0840.010.25 Increase in Spend Down Amount
  • 0840.010.30 Decrease in Spend Down Amount
  • 0840.010.35 Change in Coverage – Spend Down and Ticket to Work
• 0840.015.00 Closing of Cases
  • 0840.015.05 Pre-closing Ex Parte Review
  • 0840.015.10 Reopening Closed Cases
• 0840.020.00 Suspending Incarcerated Participants
• 0840.025.00 Returned Mail

0845.000.00 Location of Case Records

• 0845.005.00 Spouse Cases

0850.000.00 Individuals Qualifying Under Section 1619 of the Social Security Act

• 0850.005.00 Eligibility Requirements for MA Based on Section 1619 Status
  • 0850.005.05 SSA 1619 Status
  • 0850.005.10 Title XIX Eligibility in the Month Prior to Attaining SSA 1619 Status
  • 0850.005.15 Resources
  • 0850.005.20 Financial Need
• 0850.010.00 Case Processing Procedures Section 1619 Status Cases
• 0850.015.00 Annual Renewal
• 0850.020.00 Individuals Losing SSA 1619 Status

0855.000.00 Ticket to Work Health Assurance (TWHA) Program

• 0855.005.00 Eligibility Requirements for Ticket to Work Health Assurance (TWHA) Program
  • 0855.005.05 Age
  • 0855.005.10 Citizenship/Alien Status
  • 0855.005.15 Social Security Number
  • 0855.005.20 Residence
  • 0855.005.25 Disability
  • 0855.005.30 Employment
  • 0855.005.35 Available Resources
  • 0855.005.40 Income Limit
    • 0855.005.40.01 Social Security Cost of Living Adjustment (COLA) Disregard
    • 0855.005.40.05 Gross Income Limit
    • 0855.005.40.10 Net Income Limit
  • 0855.005.45 Premium Payment
    • 0855.005.45.05 Premium Collection Process
• 0855.010.00 Case Processing Procedures (TWHA)
  • 0855.010.05 Approval Notice
• 0855.015.00 Annual Renewal
  • 0855.015.05 MO HealthNet Coverage End Dates on Closings
• 0855.020.00 TWHA Couple Cases
• 0855.025.00 HIPP

0860.000.00 Qualified Disabled Working Individuals (QDWI)

• 0860.005.00 Eligibility Requirements
  • 0860.005.05 SSA QDWI Status
  • 0860.005.10 Enrollment in Part A Medicare (Hospital Insurance)
  • 0860.005.15 Need
    • 0860.005.15.05 QDWI Income Standard
    • 0860.005.15.10 Budgeting Procedures (QDWI)
  • 0860.005.20 Resources
  • 0860.005.25 Eligibility for Other Assistance
  • 0860.005.30 Citizenship
  • 0860.005.35 Residency
  • 0860.005.40 Social Security Number
• 0860.010.00 Application Processing (QDWI)

0865.000.00 Qualified Medicare Beneficiaries (QMB)

• 0865.005.00 Legal Basis
• 0865.010.00 Eligibility Requirements
  • 0865.010.05 Enrollment in Part A Medicare
    • 0865.010.05.05 Verification of Part A
    • 0865.010.05.10 Part A Eligibility and Enrollment Process
    • 0865.010.05.15 Part A Conditional Enrollment
    • 0865.010.05.20 Buy-In Eligibility for Persons in Alternative Care
  • 0865.010.10 Financial Need (QMB)
    • 0865.010.10.05 Assistance Group
    • 0865.010.10.10 QMB Income Standard
    • 0865.010.10.15 Income Considered
    • 0865.010.10.20 Income Exemptions/Deductions
    • 0865.010.10.25 Completion of the QMB Budget
  • 0865.010.15 Resources (QMB)
  • 0865.010.20 Citizenship/Alien Status
  • 0865.010.25 Residency
  • 0865.010.30 Social Security Number
• 0865.015.00 Benefits Available to QMB Recipients
  • 0865.015.05 Buy-In for QMB
  • 0865.015.10 Payment of Medicare Coinsurance and Deductibles
  • 0865.015.15 Services Not Covered Under QMB
• 0865.020.00 Application Processing (QMB)
  • 0865.020.05 Begin Date for QMB Eligibility
  • 0865.020.10 Filing a QMB Application
  • 0865.020.15 Application Procedures
    • 0865.020.15.05 QMB-Only Approvals
    • 0865.020.15.10 Approval of QMB and Another Type of Assistance
    • 0865.020.15.15 Requests for QMB Coverage on Active Cases
    • 0865.020.15.20 Exploration for QMB Eligibility With Other Types of Assistance
• 0865.025.00 Annual Renewal
• 0865.030.00 Special Procedures for System Opening and Closing of QMB Cases
  • 0865.030.05 QMB-Only Is Approved for Another TOA
  • 0865.030.10 QMB-Only Is Approved for Another TOA and Is No Longer Eligible for QMB
  • 0865.030.15 QMB Eligibility Continues When Another TOA Stops
  • 0865.030.20 Both QMB and Another TOA Are Closed
• 0865.035.00 QMB in Conjunction With Spend Down
  • 0865.035.05 Non-Spend Down May Become Spend Down When Adding QMB
  • 0865.035.10 Special Procedures For QMB/Spend Down Combination Approvals
  • 0865.035.15 Budgeting Procedure When MA and QMB Applications Are Approved in the Same Month
  • 0865.035.20 Medical Expenses Allowed In QMB/Spend Down Budgeting
  • 0865.035.25 QMB Benefits Guide

0870.000.00 Specified Low-Income Medicare Beneficiaries (SLMB) and Qualifying Individuals (QI)

• 0870.005.00 Legal Basis
• 0870.010.00 Eligibility Requirements
  • 0870.010.05 SLMB Income Standard
  • 0870.010.10 Budgeting Procedures (SLMB)
  • 0870.010.15 Buy-In Eligibility for Persons in Alternative Care
• 0870.015.00 Benefits Available to SLMB Recipients
• 0870.020.00 Application Processing (SLMB)
  • 0870.020.05 Beginning Date of SLMB Coverage
  • 0870.020.10 Processing SLMB Applications
    • 0870.020.10.05 SLMB Only
    • 0870.020.10.10 Approvals of SLMB in Combination With Other Type of Assistance
  • 0870.020.15 IMU5 Completion
• 0870.025.00 Annual Renewal
• 0870.030.00 System Approvals and Closings of SLMB Cases
  • 0870.030.05 SLMB Group 1 Is Approved for Another Type of Assistance
  • 0870.030.10 SLMB Recipient Is Determined Ineligible at Approval of Another Type of Assistance
  • 0870.030.15 QMB Recipient Is Determined SLMB Eligible at Approval for Another Type of Assistance
  • 0870.030.20 SLMB Eligibility Continues, Other Type of Assistance Closes
  • 0870.030.25 Both SLMB and Another Type of Assistance Close
• 0870.035.00 SLMB in Combination With Spend Down Cases
• 0870.040.00 QMB to SLMB Cases
• 0870.045.00 Effect of COLA Increases on SLMB Cases

0875.000.00 Former Foster Care Youth

0880.000.00 Cost Recovery

• 0880.005.00 Estate Recovery
• 0880.010.00 TEFRA Liens
• 0880.015.00 Voluntary Repayment
• 0880.020.00 Third Party Liability (TPL)

0890.000.00 Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE)

• 0890.005.00 Unwinding the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE)
• 0890.010.00 Transition Period