Federal regulation 42 CFR 435.733 requires the reduction of the MO HealthNet Division (MHD) payment to a vendor facility by the amount that the FSD determines the participant can contribute to the cost of their institutional care. This is referred to as a surplus computation. This computation is completed in FAMIS:
- Review and enter sources of gross income for the participant and members of the Eligibility Unit in FAMIS (see 0815.030.05 Determining Adjusted Gross Income).
- Enter allowable deductions from gross income in the appropriate FAMIS screens (see 0815.030.10 Determining Total Allowable Deductions).
- FAMIS determines a surplus amount based on the data entered by the eligibility specialist.
NOTE: For months that have been approved in FAMIS for Spenddown or Non-spenddown coverage prior to authorizing vendor benefits, Worker Initiated Budget Calculation Area (WIBCA) must be completed. Comments must include verification of the income, expenses and the date of facility placement or payment start date, for each month of vendor coverage needed.
If a participant enters the vendor home after the first day of the month or leaves the vendor home before the last day of the month, multiple WIBCAs will need to be completed. The WIBCAs must be done to show the appropriate coverage type for the days when the participant was eligible for VENDOR NURSING CARE (VEND), and for the days either prior to entering and/or after leaving the facility when the participant would be eligible for another coverage type such as MA SPENDDOWN/NON-SPENDDOWN (SPNDN). Review the Medicaid Category History screen (MEDHIST) to determine if WIBCAs were authorized appropriately to provide coverage to the participant for the entire month.