1850.030.00 Prior Quarter (PQ) and Month of Application Eligibility – DSS Manuals

IM-105 December 22, 2023 ; IM-117 November 15, 2021 ; IM-67 June 29, 2021

Title 42 Subsection 435.915, states that eligibility for PQ coverage may be effective on the first day of a month that an individual received medical services and was eligible at any time during that month. The eligibility for PQ months should be treated as if the person had applied in that month. Individuals may apply or reapply for PQ for up to one year after the application. They may apply for PQ in person, by telephone, or in writing.

A participant who requests PQ coverage for MO HealthNet for Pregnant Women (MPW) must meet all eligibility factors including pregnancy. Coverage begins on the first day of the first month in which she is determined to be eligible and continues through the end of the 12 month postpartum period.

MPW coverage continues into application/ongoing months

Once determined eligible, MPW coverage will continue through the postpartum period regardless of changes in income.

MPW in PQ; SMHB in application month

Once approved for MPW in a PQ month, coverage cannot switch to SMHB in the application month or in any ongoing month, through postpartum months.

Use the level of care in the most recent PQ month to determine the level of care in the application month and ongoing.