This section describes eligibility requirements for persons applying for or participating in the MO HealthNet for the Aged, Blind, and Disabled (MHABD), Supplemental Nursing Care (SNC) programs or Supplemental Payment (SP) programs (conversion cases.)
These programs were designed to address specialized needs that were not met by the Supplemental Security Income (SSI) program, which became effective January 1, 1974.
The law required any State that wished to establish a Medicaid program and that had to establish a Supplemental Payments (SP) program could use eligibility criteria no more restrictive than the criteria in effect for all its adult programs as of January, 1972. The January 1972 eligibility criteria for Old Age Assistance (OAA), Aid to the Permanently and Totally Disabled (PTD), and Aid to the Blind (AB) had not changed in Missouri by December 1973 when transition to the SSI program occurred. Therefore, in Missouri, the eligibility requirements for the MHABD, SNC, and the mandatory SP programs are referred to as the December 1973 OAA, PTD, and AB eligibility factors.
The law prohibits States from imposing eligibility requirements more restrictive than those in effect in January 1972; however, States can establish less restrictive requirements within the scope of existing SSI criteria.
Federal Regulation 42 CFR-435.608 stipulates that applicants for and recipients of MO HealthNet for Aged, Blind, and Disabled (MHABD), Supplemental Nursing Care (SNC), and Supplemental Pension (SP) must take all necessary actions to acquire annuities, pensions, retirement, and disability benefits to which they may be entitled, unless they can show good cause for not doing so. Examples of these benefits include, but are not limited to, Veteran's benefits, Social Security Disability or Retirement, Railroad Disability or Retirement, Workman's Compensation, Supplemental Security Income, Qualified Medicare Beneficiary and Specified Low Income Beneficiary programs, and union, association, company, or government employee benefit programs. Do not approve an application for MHABD, SNC, or SP without verification that an applicant has applied for other benefits for which they are potentially eligible.
If the applicant answers yes to the MO HealthNet Declaration question in the FAMIS interview, "Do you agree to apply for other benefits (Annuities, Pensions, Retirements and Disability)?" and is potentially eligible for other benefits, the MHABD, SNC, or SP application cannot be approved until verification of the application for other benefits is received.
Eligibility specialists (ES) must complete the following steps to pend applications for required verification.
Do not approve the case until all verification is received.
EXAMPLE: Verification of citizenship has been provided. Please provide documentation showing you have applied for a pension from XYZ Company (specify which benefits such as Annuities, Pensions, Retirement, Disability, and/or Supplemental Security Income).
Do not approve the case until all verification is received.
The day after the appropriate FA-325 has expired; the eligibility specialist must update the case based on the participant's response.
If the participant has provided the requested verification of application for other benefits and the verification field was left blank on the Citizenship Verification (CITVERF/FM8X) screen for only this reason, update the screen with the appropriate code and authorize the actions.
If the applicant has not provided the requested verification of application for other benefits, generate an Appointment Letter/Request for Contact, FA-331, to the applicant to determine if good cause exists.
The ES must enter comments on the Eligibility Unit Member Role (EUMEMROL/FM3Z) screen which should include interim contacts, explanation of screen updates, and reasons for actions taken.
To be eligible for OAA, an applicant must be 65 years of age or older. It is not necessary to determine exact age when it is satisfactorily established that the applicant is more than 65 years of age.
To be eligible for AB, an applicant must be age 18 or older. When documentary verification is not readily available and the applicant is obviously over the age of 18, the applicant's statement and the eligibility specialist's judgment are acceptable proof of age.
For PTD, individuals under age 18 are subject to deeming of their parents' income and resources. Verification of age is needed for PTD only if it is not clear whether the applicant is age 18 or over.
Section 1902(a) of the Social Security Act asserts 'the State shall require, as a condition of eligibility for (Medicaid) benefits..., that each applicant for or recipient of (such) benefits furnish to the State his social security account number (or numbers, if he has more than one such number) ...'
Every applicant or participant must have a social security number (SSN) and provide the number to Family Support Division (FSD).
This requirement does not apply to:
Applicants who do not already have an SSN must apply for one as a condition of program eligibility. Ensure the participant understands:
Procedures for obtaining and verifying the Social Security number are the same as for MO HealthNet for Families (MHF). Refer to Sections 1805.015.00 and 1805.015.05.
The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 changed eligibility for individuals who are not citizens of the United States. MO HealthNet eligibility for aliens is based on whether the alien is qualified or non- qualified, and the alien's date of entry into the United States. For MHABD, SNC, and SP the requirement is the same as for MO HealthNet for Families. See 1805.020.00.
Section 6036 of the Deficit Reduction Act of 2005 amended section 1903 of the Social Security Act requiring states to obtain satisfactory documentation of citizenship and identity prior to approving Medicaid benefits, effective July 1, 2006.
Certain individuals are exempt from having to provide documentation of citizenship and identity. Refer to Section 0110.020.00 for more information. Current or former receipt of SSI, Medicare, Social Security Disability Insurance (SSDI), and Old Age Survivors Disability Insurance (OASDI) benefits based upon their own disability meets citizenship requirements, as the Social Security Administration determined them to be either citizens or qualified immigrants meeting the requirements prior to approving for benefits.
Refer to Section 0110.020.01 for a complete list of acceptable documents to use as verification of citizenship.
Section 211 of the Children's Health Insurance Program Reauthorization Act (CHIPRA) signed February 4, 2009, amended section 1903(x) of the Social Security Act. The law allows an individual declaring to be a citizen or national of the United States who is required to present documentary evidence of citizenship or nationality a reasonable opportunity to present the documentation. A reasonable opportunity is defined as 90 days from the date of approval. Refer to Section 0110.020.02 for more information on reasonable opportunity.
An individual may be approved only one time while allowing the 90 day period of reasonable opportunity to provide documentary evidence of citizenship. If the case or individual closes for failure to provide documentary evidence of citizenship and the individual for whom the verification was pending requests MHABD, SNC, or SP following the closing, complete FAMIS entries to generate one FA-325 requesting verification of citizenship and allow FAMIS to take action to close the case or reject the individual if the documentary evidence of citizenship is not provided. See Section 0110.020.03.