0810.035.15 Eligibility Determination (Division of Senior and Disability Services-DSDS) – DSS Manuals

IM-55 June 2, 2023

DSDS determines an individual’s medical need for the Personal Care Program. DSDS staff are responsible for the following:

Making referrals to Family Support Division (FSD) for applications for Title XIX or verification of current Title XIX status

Evaluating the need for Personal Care Services; this involves: completing an In-Home Assessment of the participant’s current situation; and working with the attending physician to obtain the Nursing Facility (NF) level of care information

Developing a Personal Care Plan that: obtains the participant’s signature contains the attending physician’s evaluation of the necessary level of care and recommendation of Personal Care services obtains the physician’s signature establishes controls to reassess the Personal Care Plan every six months; and notifies FSD staff, the participant, the provider, and the MO HealthNet Division (MHD) fiscal agent of the participant’s eligibility for Personal Care services

Authorizing the delivery of necessary services

Communicating with FSD staff regarding: the joint application process; and changes in circumstances affecting the participant’s eligibility, on an ongoing basis

If the initial request for Personal Care services is received through DSDS, DSDS staff will:

Inform the claimant of the necessity for Title XIX eligibility

Contact FSD staff, by using the Referral for Services form ( IM-54 ), requesting an application for MO HealthNet or one of the cash programs.

Note: If the individual is found to be ineligible for Title XIX services, DSDS staff will explore other resources.

If Personal Care Services are not recommended, the DSDS staff will:

Assist the individual with other resources; and/or

Notify FSD staff (via the IM-54 ) if institutionalization is requested (the SNC or MHD vendor process must be followed).