MEMORANDUM

DISCUSSION:

Eligibility for applicants of vendor or SNC coverage, who are not in a vendor facility or not in a Supplemental Nursing Care facility on the first day of the month of application, is determined under the MO HealthNet for the Aged, Blind, and Disabled Spenddown/Non-Spenddown program. When a participant leaves a vendor facility eligibility is re-determined based upon the participant’s living arrangement. In both these situations partial month eligibility may be determined. This is not a change in policy. The limitations of the Legacy system did not allow partial month eligibility to be entered whereas FAMIS can determine partial month eligibility provided that the correct application date is entered and the dates the participant entered and left the facility (if applicable) are entered correctly on the Facility Placement Information Details (FMJ5) screen. This memorandum provides examples which clarify the process in FAMIS for participants who enter a vendor or SNC facility on any day except for the first day of the month and who leave a vendor facility for another living arrangement.

EXAMPLE #1: Mr. B enters a nursing facility on 2-8-10. Mr. B had an active MHABD Spenddown case in FAMIS. The eligibility for Mr. B would appear as follows: Spenddown (MHSD) from 2-01-10 thru 2-07-10, Vendor (VENDOR) from 2-8-10 ongoing.

EXAMPLE #2: Mr. C enters an SNC on 3-5-10 and leaves the facility on 3-15-10. Mr. C had an active MHABD Spenddown case in FAMIS. The eligibility for Mr. C would appear as follows: Spenddown (MHSD) from 3-01-10 thru 3-04-10, Vendor (SNC) from 3-05-10 thru 3-15-10, and Non-Spenddown (MHNS) from 3-16-10 thru 3-31-10. A new determination is run and ongoing eligibility is determined based on the information in the system. In this case Mr. C will change back to a Spenddown (MHSD) beginning 4-1-10.

EXAMPLE #3: Mr. D enters a nursing facility on 2-9-10 and leaves the facility on 2-27-10. Mr. D had an active MHABD Spenddown case in FAMIS. The eligibility for Mr. D would appear as follows: Spenddown (MHSD) from 2-1-10 thru 2-8-10, Vendor (VENDOR) from 2-9-10 thru 2-27-10, Non-Spenddown (MHNS) from 2-28-10 thru 3-31-10. The reason the Non-Spenddown eligibility is extended through 3-31-10 is that the adverse action “spilled over” to the month of March so the system cannot adversely affect the participant until the month of April.

EXAMPLE #4: Mr. E enters a nursing facility on 12-8-10. He applies for Vendor coverage on 12-15-10. Upon approval the eligibility for Mr. E would appear as follows: Spenddown/Non-Spenddown from 12-1-10 to 12-7-10, Vendor from 12-8-10 forward.

Income Maintenance Manual Sections 0620.000.00, 0620.005.00, 0620.010.00, 0620.015.00, 0815.050.00, and 0815.050.05 have been updated to include FAMIS processes.  Manual section 0620.010.00 has also been updated to remove reference to SNC cases receiving Title XIX only, as FAMIS approves these cases under MHABD spenddown/non-spenddown level of care.

NECESSARY ACTION:

• Review this memorandum with all appropriate staff.

SS