The purpose of this eligibility is to give equitable treatment to children under age 18 and currently living with their parents, who would become eligible for Medicaid in an ICF/MR and allow them to remain in their parents home rather than entering an institution.  It also establishes a higher income level for all children receiving MOCDD waiver services.

INDIVIDUALS WHO DO NOT MEET THE FOLLOWING REQUIREMENTS MAY BE FOUND MEDICAID ELIGIBLE USING OTHER CRITERIA

ELIGIBILITY REQUIREMENTS

There are five general eligibility requirements for children to receive Title XIX under MOCDD waiver criteria.  A child must:

• Be under age 18
• Be determined by the Department of Mental Health (DMH) to 
1. Need an ICF/MR level of care; and
2. Be authorized to receive MOCDD Waiver Services;
• Have monthly income at or below $821.00; and
• Meet the available resource criteria; and
• Not otherwise be eligible for Medicaid without a spenddown.

When children living in their parents home meet these criteria, they are eligible for a "T" level of care under the Medical Assistance (MA) program.

A. AGE

The individual must be under age 18. Verify and record the age of the individual on the IM-36.  Refer to Chapter XI, Section I, pages 1-3 for acceptable verification of age.  Persons age 18 and over are not eligible under MOCDD waiver criteria.

B. MEDICAL NEED AND AUTHORIZATION FOR MOCDD WAIVERED SERVICES

MOCDD waiver services are extended to individuals who, in the absence of the waiver, would require ICF/MR care.  Therefore, the individual must require a level of care provided by an ICF/MR.

DMH determines if an individual requires a ICF/MR level of care and the need for MOCDD waiver services.  To be eligible for Medicaid, the MOCDD individual must be authorized by DMH to receive MOCDD waiver services.  The date of Medicaid eligibility under these criteria cannot be prior to the date of the DMH approval.

Central office will furnish the initial date of eligibility for ICF/MR level of care and eligibility for waiver services with the application packet.

C. INCOME

When the gross monthly income of the MOCDD waiver individual is at or below $821.00, he/she meets the income criteria for MOCDD eligibility.  Only the income of that individual is considered.  When determining gross monthly income, follow the regular MA policy outlined in Chapter VI, pages 6-8a.  DO NOT INCLUDE THE INCOME OF THE PARENTS OR ANY OTHER HOUSEHOLD MEMBER.

The $821.00 income standard is absolute.  Individuals cannot spenddown to become eligible under MOCDD waiver criteria.  Using the IM-30A, enter the gross income on line 5, compare this amount to $821.00.  Also record verification of income on the IM-30A.

For eligibility determinations prior to January 1, 1996 use $800.00 as the income standard.

NOTE: Persons with income above $821.00 can become eligible for Medicaid using regular MA procedures.

D. AVAILABLE RESOURCES

The resource maximum for this program is $999.99.  Determine as available resources anything that is considered available under the December 1973 eligibility requirements for PTD.  Refer to Chapter XI, Sections IV and V.

DO NOT INCLUDE THE RESOURCES OF THE PARENTS OR ANY OTHER HOUSEHOLD MEMBERS.

E. DISABILITY FACTOR

To be eligible for Medical Assistance, under the MOCDD waiver, the claimant must meet the December, 1973 eligibility requirements for Permanent and Total Disability.  These eligibility factors are thoroughly explained in Chapter XI.

The Medical Review Team (MRT) will make the final determination of medical eligibility.

F. MEDICAID ELIGIBILITY UNDER OTHER CATEGORIES

To qualify for Medicaid under the MOCDD waiver, a child must not otherwise be eligible for Medicaid without a spenddown.  DMH will gather income and resource information for the other household members.  It is not necessary to verify this information.  Record on 
the IM-2, on the basis of the claimant's statement, why the individual is otherwise ineligible for Medicaid or would have to meet a spenddown to be eligible.

G. TRANSFER OF PROPERTY

Follow the policy in Memorandum IM-42 dated June 23, 1994 for determining transfers of property.  Persons determined to have transferred property without receiving fair and valuable consideration are not eligible for Medicaid using MOCDD waiver criteria.

Eligibility for Title XIX using MOCDD waiver criteria cannot begin until the penalty period expires.

H. CITIZENSHIP, RESIDENCE, SOCIAL SECURITY NUMBER

Use the policy in Chapter XI to determine eligibility on the factors of citizenship, residence and Social Security number.

I. PRIOR QUARTER

Individuals found eligible under MOCDD waiver criteria may be approved for prior quarter coverage if the DMH ICF/MR level of care and need for waivered services determinations include the prior quarter.

Because the provisions were not effective until October 1, 1995, coverage using these guidelines cannot begin prior to October 1, 1995.

J. TIME LIMITS FOR APPLICATION PROCESSING

Process applications for MA using MOCDD waiver criteria within 90 days from date of application.

K. REINVESTIGATIONS

Reinvestigate MOCDD waiver cases on an annual basis, the same as any other MA case.

L. IMU5

Process MOCDD waiver cases in IMU5 in the same manner as any other non-spenddown MA case with the following exceptions:

1. Enter K or B in Field 23 (MA/NC).  The K or B identifies these cases as MOCDD waiver.  (This code will be furnished by central office on a case by case basis).

2. Enter $821.00 in field 33 (EXP/EIL).  The $821.00 is a mandatory amount when K or B is entered in field 23.

DMH field staff will interview the client and/or clients family, complete all forms and acquire appropriate documentation for the application process and submit the application packet to central office.

Central office staff will review all forms for completeness, retain medical information for MRT and forward the application packet to the appropriate county office with instructions for processing.  MRT will forward the disability determination to the county office.

The original approval, rejection or closing letter will be mailed to the client, with a copy to the IM POLICY UNIT in Central Office, as soon as possible after the appropriate action is completed.

All consumer inquiries regarding information or application requests for MOCDD waiver services must be referred to DMH at 314-751-8213.  DO NOT deny individuals the right to apply for these services if an application is requested, however, contact the IM Policy Unit immediately after the application interview is completed.

• Share this memorandum with all appropriate staff.
• Begin processing MOCDD applications immediately upon receipt.