Eligibility for MO HealthNet based on MOCDD criteria cannot be prior to the date of the DMH determination that the individual qualifies for MOCDD waiver services. Individuals found eligible under MOCDD waiver services criteria in the prior quarter may be approved for prior quarter coverage using those criteria if the DMH determination includes the prior quarter.
Individuals may qualify for MHDC spend down prior to the DMH determination.
EXAMPLE: James applies for MHABD on 8/15. He is age 15, receives Social Security of $900 per month. Due to a recent illness and hospitalization, James has medical expenses in May, June and July. He is referred to the DMH for a determination of eligibility for MOCDD waiver services. Neither he nor his parents have any countable available resources and he meets all other eligibility requirements for MHABD. On 09/01, the DMH determines that James is in need of ICF/MR level of care, and that he is in need of MOCDD waiver services.
- For the prior quarter (May-July), complete a MHDC budget including the income of James’ parents to determine his spenddown amount.
- Approve James for MHDC spend down for the prior quarter (May-July).
- For the month of application, (beginning 8/1), complete a MHDC budget including the income of James’ parents to determine his spenddown amount.
- James qualifies based on MOCDD waiver services effective 9/1. Complete a budget for September which includes only his income. Compare his income to the MOCDD standard.
- If James loses eligibility for MOCDD waiver services during the month, then he would be eligible for MHDC non-spend down coverage until the last day of the month.
Note: Continuous Eligibility for Children (CEC) must be applied to eligible participants under the age of 19. Refer to section 1805.070.00 Continuous Eligibility for Children (CEC) located in the MAGI Manual.