MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual

0815.005.00 Eligibility for Vendor Payments

IM-136, September 1, 2020; IM-#33, March 29, 2012

Vendor payments may only be made on behalf of MO HealthNet for the Aged, Blind, and Disabled (MHABD) participants who meet the following requirements:

  • Have received an initial assessment (DA-124 A/B) and
    • have been medically certified for NF or 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).

NOTE: Review the DA-124 Inquiry Report screen in FAMIS from the Facility and Placement Information Details screen (F14=I124). See the FAMIS User Guide FACILITY AND PLACEMENT INFORMATION DETAILS.

  • Qualify for MHABD based on December 1973 eligibility requirements, or as a child under age 18 based on MHF (See 1810.000.00 MO HealthNet for Families (MHF)) or MHK criteria for poverty level children (See 1830.000.00 MO HealthNet for Kids (MHK) Non-Chip Coverage). 
    • 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-enrolled 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 to determine the portion of an eligible participant’s income that is available to pay toward the cost of his/her care.