0815.050.05 Applicant or Participant Not in Vendor Facility in the Prior Quarter (PQ) Has Medical Expenses in the PQ – DSS Manuals

IM-117 November 15, 2021 ; IM-33 March 29, 2012 ; IM-07 January 26, 2011

If the applicant or participant had medical expenses in the three months prior to application, determine eligibility for MHABD during the PQ. 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.

EXAMPLE: Mr. B. (from the previous situation) had medical bills in November, December and January, prior to entering the hospital on February 6th. On the Application Detail (FM17) screen in the eligibility system, enter a “Y” in response to the question, “Do you want us to explore Prior Quarter Eligibility?”. Based on the data entered, the eligibility system will explore eligibility for the PQ for Mr. B under MHABD Spend Down/Non-Spend Down guidelines since he was not in the facility during this time period.

NOTE: Always review the Budget Summary screen prior to authorizing a case action in the eligibility system. From the MHABD Action Authorization (FMD9) screen, use F16= MHABD to view the MHABD Assistance Group Summary screen. Select the coverage type and use F16= AGBUDSUMM to view the Adult MO HealthNet Budget Summary screen; press F17=INCSUM to view the Income Summary Detail screen to ensure all countable income is included in the budget. If the income is incorrect, return to the appropriate Income (FMX0) screen and Income Amount (FMX3) screens and make any necessary correction to inaccurate information.