MO HealthNet for the Aged, Blind, and Disabled

0815.050.05 Applicant or Participant Not in Vendor Facility in the Prior Quarter Has Medical Expenses in the Prior Quarter

IM-#33, March 29, 2012, IM-#7 January 26, 2011

If the applicant or participant had medical expenses in the three months prior to application, determine eligibility for MHABD during the prior quarter.

EXAMPLE: Mr. B. (from the previous situation) had medical bills in November, December and January, prior to entering the hospital on 2/6. On the Application Detail (FM17) screen in FAMIS enter a “Y” in response to the question, “Do you want us to explore Prior Quarter Eligibility? “.  Based on the data entered, FAMIS will explore eligibility for the prior quarter for Mr. B under MHABD spend down/non-spend down guidelines since he was not in the facility during this time period.

NOTE: Always review the Budget Summary screen prior to authorizing a case action in FAMIS. From the MHABD Action Authorization (FMD9) screen, use F16= MHABD to view the MHABD Assistance Group Summary screen. Select the coverage type and use F16= AGBUDSUMM to view the Adult MO HealthNet Budget Summary screen; press F17=INCSUM to view the Income Summary Detail screen to ensure all countable income is included in the budget. If the income is incorrect, return to the appropriate Income (FMX0) screen and Income Amount (FMX3) screens and make any necessary correction to inaccurate information.