0810.000.00 MO HealthNet Coverage

0810.035.15 Eligibility Determination (Division of Senior and Disability Services-DSDS)

IM-55 June 2, 2023

DSDS determines an individual’s medical need for the Personal Care Program. DSDS staff are responsible for the following:

  1. Making referrals to Family Support Division (FSD) for applications for Title XIX or verification of current Title XIX status
  2. Evaluating the need for Personal Care Services; this involves:
    • completing an In-Home Assessment of the participant’s current situation; and
    • working with the attending physician to obtain the Nursing Facility (NF) level of care information
  3. Developing a Personal Care Plan that:
    • obtains the participant’s signature
    • contains the attending physician’s evaluation of the necessary level of care and recommendation of Personal Care services
    • obtains the physician’s signature
    • establishes controls to reassess the Personal Care Plan every six months; and
    • notifies FSD staff, the participant, the provider, and the MO HealthNet Division (MHD) fiscal agent of the participant’s eligibility for Personal Care services
  4. Authorizing the delivery of necessary services
  5. Communicating with FSD staff regarding:
    • the joint application process; and
    • changes in circumstances affecting the participant’s eligibility, on an ongoing basis

If the initial request for Personal Care services is received through DSDS, DSDS staff will:

  1. Inform the claimant of the necessity for Title XIX eligibility
  2. Contact FSD staff, by using the Referral for Services form (IM-54), requesting an application for MO HealthNet or one of the cash programs.

Note: If the individual is found to be ineligible for Title XIX services, DSDS staff will explore other resources.

If Personal Care Services are not recommended, the DSDS staff will:

  • Assist the individual with other resources; and/or
  • Notify FSD staff (via the IM-54) if institutionalization is requested (the SNC or MHD vendor process must be followed).