IM-18 March 20, 2025; IM-136 September 1, 2020; IM-33 March 29, 2012
Vendor payments may only be made on behalf of MO HealthNet participants who meet the following requirements:
- Have received an initial assessment (DA-124 A/B) (see 0815.020.00 Initial Assessment and Medical Certification) and:
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- have been medically certified for NFor IMR level of care, or
- are age 65 or older or under age 21 and medically certified for MHC level of care
Note: An individual who is certified for MHC level of care when s/he is under the age of 21 may continue to qualify for vendor payments until age 22.
- If certified for NF level of care and entering a nursing facility, have received a preadmission screening (DA-124C) (see 0815.025.00 Preadmission Screening for Entry Into Nursing Facilities).
NOTE: Review the DA-124 Inquiry Report screen in FAMIS from the Facility and Placement Information Details screen (F14=I124). See the Facility and Placement Information Details user guide.
- Qualify for MHABD based on December 1973 eligibility requirements, or for a MAGI level of care with the exception of Uninsured Women’s Health Services (UWHS).
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- Note: A child in acute care called inpatient on a temporary stay for less than 30 days, is left on whatever level of care he/she is currently receiving. MHD will dis-enroll the (MHF) or (MHK) Poverty Level child from the managed care plan. These children are anticipated to have a short stay at this level of care and will either be discharged, or transitioned into residential care.
- Reside in a MHN certified bed (T19) if in a Missouri nursing facility, or a MHN certified bed if (T19) if in a facility out of state.
A surplus determination must be made for Non-MAGI participants. This is required to determine the portion of an eligible participant’s income that is available to pay toward the cost of his/her care.