0820.040.00 MO HealthNet Eligibility Date – DSS Manuals

Eligibility for MO HealthNet based on HCB criteria cannot be prior to the date of the DHSS/DSDS determination that the individual qualifies for HCB waiver services. Individuals may qualify for MHABD spend down prior to the DHSS/DSDS determination.

EXAMPLE : Mr. and Mrs. Bledsoe apply for MHABD on 8/15/07. Mr. Bledsoe, age 68, receives Social Security of $900 per month. Mrs. Bledsoe, age 65, receives Social Security of $500 per month, and a private pension of $300 per month. Due to a recent illness and hospitalization, Mr. Bledsoe has medical expenses in May, June and July. Mr. Bledsoe is referred to DHSS/DSDS for a determination of eligibility for HCB waiver services. Neither Mr. nor Mrs. Bledsoe has any countable available resources. Both meet all other eligibility requirements for MHABD. On 09/01/07, DHSS/DSDS determines that Mr. Bledsoe is in need of NF level of care, and that he is in need of HCB waiver services.

For the prior quarter (May-July), complete a budget including both Mr. and Mrs. Bledsoe’s income to determine their spend down amount.

Approve Mr. and Mrs. Bledsoe for MHABD spend down for the prior quarter (May-July).

For the month of application, (beginning 8/1/07), complete a budget including both Mr. and Mrs. Bledsoe’s income to determine their spend down amount.

Mr. Bledsoe qualifies for MHABD based on HCB waiver services effective 9/1/07. Complete a budget for 9/07 which includes only his income. Compare his income to the HCB standard of $1088.

Mrs. Bledsoe will continue to qualify for MHABD spend down. To determine her spend down amount, complete a budget for 9/07 which includes only her income. Compare her income to the single person non-spend down income limit to determine her spend down amount.

Individuals found eligible under HCB criteria in the prior quarter may be approved for prior quarter coverage using those criteria IF the DHSS/DSDS determination includes the prior quarter.