Supplemental Nursing Care (SNC) Manual

0605.000.00 ELIGIBILITY

IM-#30 April 4, 2008

Process SNC applications on an individual basis, for persons age 21 and over who are in a licensed:

  1. Residential Care Facility;
  2. Residential Care Facility II (RCF-II);
  3. Assisted Living Facility (ALF); or
  4. Intermediate or a Skilled Nursing Facility when the participant does not qualify for vendor payments.

A person may not receive any other category of assistance and SNC. However, a conversion participant (SSI-SP) who enters or is in a licensed nursing facility may request that the conversion case be closed and an SNC application taken and processed, IF SNC is more beneficial to the participant and the participant meets the SNC eligibility requirements. The closing of the SSI-SP or SP case does not terminate the participant’s right to regain conversion status if the participant’s circumstances change.

If the participant dies after eligibility has been established but before the approval process has been completed, approve the participant eligible for Title XIX coverage from the date of application. Title XIX begins with the first day of the month of application, if eligible, and ends with the date of death.

In most instances, an SNC application is taken in conjunction with or subsequent to a MO HealthNet for the Aged, Blind, and Disabled (MHABD) eligibility determination. To receive Title XIX coverage under the SNC program, the participant must meet all the requirements for SNC. One of those requirements is that the participant resides in a licensed RCF, ALF, or nursing facility. If the participant was not residing in the licensed RCF, ALF, or nursing facility during the month of application or the prior quarter, the participant cannot be approved for SNC payment for this period. The participant must be eligible for MHABD to have Title XIX coverage for this period.

EXAMPLE 1: Ms. Jones requests assistance on June 22, while in a hospital. On July 29, she enters a licensed Assisted Living Facility. If Ms. Jones is subsequently determined eligible for SNC, her Title XIX coverage based on SNC criteria cannot precede the first of the month in which she entered the Assisted Living Facility. A person cannot be eligible for SNC payment, if the person is not in a RCF, Assisted Living Facility, or nursing facility. Therefore, Ms. Jones’ eligibility for Title XIX for the month of June must be based on MHABD.

EXAMPLE 2: Ms. Jones enters a non-Medicaid certified Intermediate Care home and requests assistance within the same month, but she also wants prior quarter Title XIX coverage for the three-month period that preceded her application and entry into the home. The only way to do this is to establish MHABD eligibility for this prior quarter.

The only time an SNC application stands by itself is when the participant was in a licensed Intermediate, Skilled, Residential Care or Assisted Living Facility during the month of application and:

  1. was in the facility during the three months prior to the month of application, or
  2. did not want prior quarter coverage.