Supplemental Nursing Care

0620.005.00 PRIOR QUARTER

IM-#7 January 26, 2011,  IM-#30 April 4, 2008

Eligibility determination for prior quarter MO HealthNet coverage is separate from the eligibility determination for current MO HealthNet coverage. A participant does not have to be currently eligible for MO HealthNet coverage to be eligible for prior quarter coverage and vise versa.

Prior quarter coverage can be no earlier than the first day of the third month prior to the month of the application and can extend up to but not including the first day of the month of application. To explore prior quarter in FAMIS enter a “Y” following the question, “Do you want us to explore Prior Quarter Eligibility?” on the MO HealthNet Application Detail (FM17) screen in FAMIS and enter an appropriate Y/N response to the subsequent questions regarding whether the participant had income in the three prior quarter months.

To be considered eligible for prior quarter MO HealthNet coverage, the participant must, during the prior quarter:

  1. meet all eligibility factors; and
  2. have unpaid medical expenses.

If the participant becomes eligible for assistance sometime during the prior quarter, eligibility for MO HealthNet begins on the first day of the month in which the participant became eligible for assistance.

EXAMPLE: Mr. Mill applied for benefits on 2/11 and had unpaid medical expenses for the months of November, December, and January. Mr. Mill had a checking account with resources exceeding $1000. During the month of December he spent the resources to under the allowable limit. Mr. Mill was determined eligible as of December 1. 2010.

In those cases where the participant has unpaid medical expenses in the prior quarter and is determined ineligible for MO HealthNet during that time, but is eligible for MO HealthNet in the current quarter, include an explanation of the date of eligibility for MO HealthNet benefits in the case record. Record a comment on the EU Unit Member Role (EUMEMROL or FM3Z) screen in FAMIS.

EXAMPLE: Ms. Smith applied for benefits on 3/11 and had unpaid medical expenses for the months of December, January, and February. Ms. Smith had excess resources until March and was ineligible for benefits in the prior quarter. Ms. Smith was not approved for benefits until March 1, 2010. Record a comment regarding the request for benefits for the prior quarter and rejection due to excess resources.

NOTE: If the participant is not eligible for prior quarter coverage because the participant was not in an SNC eligible facility, explore prior quarter coverage based on MHABD eligibility criteria. A separate application is not required.