0815.005.00 Eligibility for Vendor Payments – DSS Manuals

IM-18 March 20, 2025 ; IM-136 September 1, 2020 ; IM-33 March 29, 2012

Vendor payments may only be made on behalf of MO HealthNet participants who meet the following requirements:

Have received an initial assessment (DA-124 A/B) (see 0815.020.00 Initial Assessment and Medical Certification ) and:

have been medically certified for NF or IMR level of care, or are age 65 or older or under age 21 and medically certified for MHC level of care

Note: An individual who is certified for MHC level of care when s/he is under the age of 21 may continue to qualify for vendor payments until age 22.

If certified for NF level of care and entering a nursing facility, have received a preadmission screening (DA-124C) (see 0815.025.00 Preadmission Screening for Entry Into Nursing Facilities ).

NOTE : Review the DA-124 Inquiry Report screen in FAMIS from the Facility and Placement Information Details screen ( F14=I124 ). See the Facility and Placement Information Details user guide.

Qualify for MHABD based on December 1973 eligibility requirements, or for a MAGI level of care with the exception of Uninsured Women’s Health Services (UWHS).

Note : A child in acute care called inpatient on a temporary stay for less than 30 days, is left on whatever level of care he/she is currently receiving. MHD will dis-enroll the (MHF) or (MHK) Poverty Level child from the managed care plan. These children are anticipated to have a short stay at this level of care and will either be discharged, or transitioned into residential care.

Reside in a MHN certified bed ( T19 ) if in a Missouri nursing facility, or a MHN certified bed if ( T19 ) if in a facility out of state.

A surplus determination must be made for Non-MAGI participants. This is required to determine the portion of an eligible participant’s income that is available to pay toward the cost of his/her care.