0815.050.00 Claimant Not in Vendor Facility on the First Day of the Month of Application – DSS Manuals

IM-33 March 29, 2012 ; IM-07 January 26, 2011

If the participant was not in the nursing home or institution on the first day of the month of application, determine eligibility for MO HealthNet for the Aged, Blind, and Disabled spend down/non-spend down between the first day of the month of application and the date the participant entered the nursing home.

EXAMPLE: Mr. B. enters the hospital on 2/6. It is determined on 2/23 that he needs to be placed in a nursing facility. He signs the MHABD application on that date. On 3/11, he enters the nursing home. The attending physician completes the DA-124A/B and DA-124C on that date. On 3/15, COMRU completes the medical certification indicating that Mr. B. is eligible for NF level of care. No Level II screening is required. On 3/26, the eligibility specialist determines that Mr. B. was eligible on all December 1973 eligibility factors as of 3/11.

Mr. B. is eligible for vendor coverage as of 3/11, the date he entered the nursing facility.

Because the NF eligibility as of 3/11 does not cover Mr. B.’s hospital bills for 2/6 through 3/10, FAMIS determines his eligibility for MO HealthNet for the Aged, Blind, and Disabled spend down/non-spend down from 2/1 (the first day of the month of application) through 3/10, using the December 1973 eligibility requirements (spend down or non-spend down). Mr. B is determined to be eligible for MHABD spend down for 2/1 through 3/10. The Medicaid Category History (FM4L or MEDHIST) screen shows MHABD spend down coverage for 2/1/-3/10 and vendor coverage beginning 3/11.