Section 208.151 of the revised Statutes of Missouri, 1982 sets forth the legal basis for Title XIX coverage. Senate Bill 577 (2007) changed the name of Missouri Medicaid to MO HealthNet.
The participant's eligibility for MO HealthNet coverage begins with the first day of the month of application, provided the participant is subsequently found eligible, and was not obviously ineligible for the entire month of application and any subsequent month prior to approval. If the participant was obviously ineligible for the entire month of application and any subsequent months prior to approval, the MO HealthNet eligibility date begins with the first day of the month in which eligibility was met. MO HealthNet eligibility does not necessarily mean SNC coverage; please see example number two below.
EXAMPLE: The participant applies 06-18. Participant is ineligible on resources until 07-03. MO HealthNet eligibility begins 07-01.
EXAMPLE #2: The participant is currently receiving benefits under the MHABD spend down program. The participant enters an SNC facility on the 15th of the month. The participant’s eligibility would be as follows: From the 1st of the month through the 14th of the month the participant would receive spend down coverage. From the 15th of the month forward the participant would receive SNC coverage.
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:
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.
MO HealthNet coverage is not date-specific on SNC cash cases. When an SNC cash case is closed, MO HealthNet coverage continues through the last day of the month of the closing.
Participants of SNC cash payments are eligible for Buy-In. The State of Missouri pays the costs of the Supplementary Medical Insurance (SMI) Premium if the participant is eligible for and participating in Part B of Medicare.
NOTE: Enter the correct OASDI claim number in the FAMIS system on the Income (FMX0) screen, when applicable, as this number is required to “buy-in” the participant.