Explore eligibility for each PQ request.
The eligibility determination for PQ MO HealthNet (MHN) coverage is separate from the eligibility determination for current MHN coverage. A participant does not have to be currently eligible for MHN coverage to be eligible for PQ coverage.
The PQ is the three month period prior to the month of application. PQ coverage can begin 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.
The participant must meet all eligibility factors including spend down/non-spend down or vendor, during the PQ. If the participant becomes eligible for MHN sometime during the PQ, the date on which eligibility for MHN begins depends on whether the participant is eligible as a non-spend down, spend down, or vendor case.
The participant may apply or reapply for PQ for up to one year after the application date. If it is a reapplication, only request the previously unverified information from the application for PQ.
EXAMPLE: Sue applied in July and was approved in August, but PQ was denied because she failed to provide income verification. In December she requests again that PQ be explored for April, May and June. Sue is provided with the Request for Information and given 10 days to provide the previously requested income information. Approve the PQ months upon the receipt of the requested verification for the months the verification is provided.
Allow reasonable opportunity for PQ months. If the citizenship or qualified immigration status is not verified at application, approve the PQ with reasonable opportunity when the ongoing benefit is approved.