0810.000.00 MO HealthNet Coverage

0810.035.15 Eligibility Determination (Division of Senior Services)

The Division of Senior Services determines the client’s medical need for the Personal Care Services program.  The Division of Senior Services workers are responsible for the following:

  1. Making referrals to 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 client’s current situation; and
    • working with the attending physician to obtain the NF level of care information.
  3. Developing a Personal Care Service Plan that:
    • obtains the claimant’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 Care Plan every six months; and
    • notifies the IM Worker, claimant, provider, and the DMS fiscal agent of claimant’s eligibility for Personal Care Services.
  4. Authorizing the delivery of necessary services.
  5. Communicating with the FSD worker regarding:
    • the joint application process; and
    • changes in circumstances affecting the claimant’s eligibility, on an ongoing basis.

If the initial request for personal care services is received through the Division of Senior Services, the Division of Senior Services worker will:

  1. Inform the claimant of the necessity for Title XIX eligibility.
  2. Contact the FSD worker, by using the (IM-54) Referral for Services form, requesting an application for Medical Assistance or one of the cash programs. Note:  If the claimant is found to be ineligible for Title XIX services, the Division of Senior Services worker will explore other resources.

If Personal Care Services are not recommended, the Division of Senior Services worker will:

  • Assist the claimant with other resources; and/or
  • Notify the IM worker (via the IM-54), if institutionalization is requested.  (The SNC or MA vendor process must then be followed.)