Under 42 CFR 435.1009 and RSMo 208.151, an applicant or participant between the ages of 21 and 65 in a state mental hospital does not qualify for MO HealthNet for the Aged, Blind or Disabled (MHABD) coverage on the basis of age.
EXCEPTION: Individuals who enter a Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) facility when they are under the age of 21 or are certified for Mental Health Care (MHC) level of care when they are under the age of 21, may continue to receive vendor services until they reach their 22nd birthday.
Individuals of ANY age residing in a state mental hospital may receive Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiaries (SLMB) coverage, if they are otherwise eligible, under RSMo 208.151 and 13 CSR 40-2.120.
When an individual applies for, is found otherwise eligible, and ages out of or into MHABD coverage, the coverage ending or beginning date is the date of the participant’s birth.
EXAMPLE: Joan, age 64, applies for MHABD vendor coverage prior to her 65th birthday in the following month of March. Joan is found eligible for vendor coverage and her coverage begin date is her 65th birthday on March 5th.