Process SNC applications on an individual basis, for persons age 21 and over who are in a licensed:
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:
The participant must be 21 years of age or older to receive a grant at the licensed Residential Care Facility (RCF) level; Assisted Living Facility (ALF) level; and Intermediate or Skilled level, when the participant does not qualify for vendor payments. For applicants under 21, explore eligibility for MHABD or SAB.
To be eligible for SNC, the participant must meet the December 1973 eligibility requirements for Old Age Assistance (OAA), Permanent and Total Disability (PTD), or Aid to the Blind (AB). The determination of eligibility is always based on whichever eligibility factors in effect in December 1973 (for either OAA, PTD, or AB) best meet the situation of the participant. These eligibility factors are explained in Manual Section 1000.000.00: December 1973 Eligibility Requirements. If the participant is ineligible on any of these factors, reject the SNC application and explore eligibility for BP.
To be eligible for Intermediate or Skilled SNC, in addition to meeting the December 1973 eligibility requirements, the participant must be certified as medically in need of the Intermediate or Skilled level of nursing facility (NF) care.
The eligibility specialist is to do the following:
If the participant is medically certified, Department of Health and Senior Services, Division of Senior and Disability Services returns the Initial Assessment Report (DA-124), indicating the participant has been approved.
If Department of Health and Senior Services, Division of Senior and Disability Services returns the Initial Assessment and indicates the participant is NOT medically certified: