It is the Eligibility Specialist’s responsibility to explore eligibility for and explain the availability of this coverage to each participant.
The eligibility determination for prior quarter 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 prior quarter coverage.
The prior quarter is the three month period prior to the month of application. Prior quarter 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 prior quarter. If the participant becomes eligible for assistance sometime during the prior quarter, 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.
The participant may apply or reapply for prior quarter for up to one year after the application date. If it is a reapplication, only request the previously unverified information from the application for prior quarter.
EXAMPLE: Sue returns in December and requests that prior quarter 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 the prior quarter months upon the receipt of the requested verification for the months the verification is provided.
Reasonable Opportunity is not allowed for prior quarter months. If citizenship is not provided at application and the individual goes into the 90 day Reasonable Opportunity period, send a rejection notice for prior quarter 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 prior quarter months using worker initiated budget(s) (WIBCA).