0815.070.00 Participant Leaves the Vendor Facility – DSS Manuals

IM-22 April 11, 2024

When a participant leaves a vendor facility for a non-vendor living arrangement, the action taken will depend on the new living arrangements and whether or not the participant has a spouse. Staff must establish the new living arrangement.

When a single individual leaves a vendor facility the individual will remain eligible for Medicaid either on a Non-Spend Down or Spend Down basis. A married participant may be ineligible based on assets of the spouse, unless:

the participant returns to the spouse’s home and is receiving HCB waiver services; OR

the spouse is receiving Medicaid.

For a married participant (not receiving HCB waiver services) whose spouse is not on Medicaid, complete an Annual Renewal to determine if the participant remains eligible based on the couples’ assets. Continue the participant’s eligibility as MO HealthNet Non-Spend Down until the reinvestigation is complete.

Note: If the participant leaves the vendor facility and goes to a hospital (other than an institution in which Medicaid may not be continued), record the information and take no further action for 30 days . If, after 30 days, the participant remains in the hospital, determine if the participant would continue to be eligible for MO HealthNet Non-Spend Down or Spend Down.

Note: Continuous Eligibility for Children (CEC) must be applied to all eligible participants under the age of 19. Refer to section 1805.070.00 Continuous Eligibility for Children (CEC) located in the MAGI Manual.