0820.030.00 Eligibility Requirements

0820.030.10.05 Referrals to DHSS/DSDS

IM-22 March 23, 2021; IM-25 April 8, 2015

The referral process for authorization for Home and Community Based (HCB) waiver services is as follows:

  1. Within two business days of the approval of spend down coverage, or the decision that a division of assets will be required prior to approval, fax or scan and email the completed IM-54A (Home and Community Based Referral) to the DHSS/DSDS Call Center for registration and distribution.
    • Fax to 573-526-2915 (A cover sheet is not necessary).

      NOTE: The fax machine date stamp is verification that it has been faxed.


    • Scan the IM-54A and email to hcbscallcenter@health.mo.gov
  2. DHSS will return the IM-54A with their decision to Family Support Division (FSD) staff by email.
    • If the form is not returned within four weeks after faxing or emailing, call local DSDS staff to discuss the delay.

NOTE: The case must be approved for MHABD spend down, or SLMB2 before faxing or scanning the request, if eligible.

The HCB application must not be approved until the IM-54A has been received from DSDS showing the participant was determined eligible for Aged and Disabled Waiver services. If the DSDS determines the claimant does not require NF Level of Care or Aged and Disabled Waiver services, reject the HCB application.

NOTE: Do not delay approving the application for MHABD spend down while waiting for the HCB determination to be completed.

NOTE: MHABD non-spend down is the same level of care as HCB. An HCB referral is not needed.  Do not send an IM-54A referral to DHSS/DSDS if the participant is eligible for MHABD non-spend down.