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

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

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 – Medicaid Coverage

• 0810.005.00 – Medicaid Non-Spend Down Coverage
• 0810.010.00 – Medicaid 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 Spenddown
    • 0810.010.15.10 – Authorizing Spenddown Coverage Based on Incurred Expenses
    • 0810.010.15.15 – Preventing Medicaid Payment of Expenses Used to Meet Spenddown
      • 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
      • 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 Coverage
  • 0810.015.05 – Prior Quarter Non-Spend Down
  • 0810.015.10 – Prior Quarter Spend Down

• 0810.020.00 – Medicaid Coverage End Date on Closings
• 0810.025.00 – Eligibility For Buy-In (SMI Premium) for Medicare
• 0810.030.00 – Early Periodic Screening, Diagnosis, and Treatment (EPSDT)
• 0810.035.00 – Personal Care Services 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 Services)
  • 0810.035.20 – Family Support Division Responsibilities
  • 0810.035.25 – Division of Medical Services 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 Services)
  • 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 – Medicaid Certified Beds in Nursing Facilities
• 0815.010.00 – Applications for Claimants Not Currently Receiving Medicaid
  • 0815.010.05 – Application Processing Time Frames
• 0815.015.00 – Claimants Currently Receiving Medical Assistance or SNC to Vendor
  • 0815.015.05 – Claimant Returns to Vendor Facility
  • 0815.015.10 – Tracking MA and SNC 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 Re-certifications (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 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 Claimants in a Nursing Facility When No Level II Screening Is Required
  • 0815.035.10 – Effective Date of Vendor Coverage for Claimants in a Nursing Facility When Level II Screening Is Required and Claimant Is Not found to be MR, MI or DD
  • 0815.035.15 – Effective Date of Vendor Coverage for Claimants in a Nursing Facility When Level II Screening is Required and the Claimant 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 – Claimant Not in Vendor Facility in the Prior Quarter Has Medical Expenses in the Prior Quarter
• 0815.055.00 – Inpatient Psychiatric Services for Individuals Under Age 21
  • 0815.055.05 – Claimants Under Age 18 Receiving Inpatient Psychiatric Services
  • 0815.055.10 – Claimants Ages 18 to 21 Receiving Inpatient Psychiatric Services
• 0815.060.00 – Claimants 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 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
• 0820.050.00 – 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 – Reinvestigations

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

• 0835.010.00 Canceling a Rejection

0840.000.00 – Reviews and Interim Activities

• 0840.005.00 – Annual Reinvestigation
  • 0840.005.00.05 –  Application for Other Benefits at Annual Review
  • 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
  • 0840.010.20 – Change to MA-WD Premium
  • 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 – Reviews (Section 1619 Status Cases)
• 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
  • 0855.010.05 – Approval Notice
• 0855.015.00 – Reviews and Interim Changes
  • 0855.015.05 – Medicaid 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 Tpes of Assistance
• 0865.025.00 – Reinvestigations (QMB)
• 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 Spenddown
  • 0865.035.05 – Non-spenddown May Become Spenddown When Adding QMB
  • 0865.035.10 – Special Procedures For QMB/Spenddown 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/Spenddown 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 – Reinvestigations (SLMB)
• 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)