It is the staff’s responsibility to explore eligibility for and explain the availability of PQ coverage to each participant.
The eligibility determination for PQ MO HealthNet coverage is separate from the eligibility determination for current MO HealthNet coverage. A participant does not have to be currently eligible for MO HealthNet 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 assistance sometime during the PQ, the date on which eligibility for MO HealthNet begins depends on whether the participant is eligible as a Non-Spend Down, Spend Down or Vendor case.
Individuals may apply or reapply for PQ for up to one year after the application. They may apply for PQ in person, by telephone, or in writing. If it is a reapplication, only request the previously unverified information from the application for PQ.
EXAMPLE: Sue returns in December and requests that PQ be explored again for April, May and June. Sue is provided with the IM-31A and given 10 days to provide the outstanding income information from May that was previously requested and not provided. Approve PQ months upon the receipt of the requested verification for the months the verification is provided.
Reasonable Opportunity is not allowed for PQ months. If citizenship is not provided at application and the individual goes into the 90 day Reasonable Opportunity period, send a rejection notice for PQ based on citizenship. Record the action taken in the eligibility system. If the individual provides citizenship verification within the 90 day Reasonable Opportunity period, approve the PQ months using worker initiated budget(s) (WIBCA).