0810.020.00  MO HEALTHNET COVERAGE END DATE ON CLOSINGS

IM-#8, January 24, 2012, IM-119, December 19, 1996

MO HealthNet coverage is date-specific for MHABD non-spend down cases and vendor cases (level of care N, D or K) at the time of the closing.  A date-specific closing can take effect in the future, up to the last day of the month following the month the closing action is entered in FAMIS.

For MHABD spend down cases MO HealthNet eligibility and coverage is not date-specific at the time of the closing. When a MHABD spend down case is closed, MO HealthNet eligibility continues through the last day of the month of the closing.  If MO HealthNet coverage had been authorized by pay-in or due to incurred expenses, it will continue through the last day of the month of the closing.

0810.025.00 ELIGIBILITY FOR BUY-IN (SMI PREMIUM) FOR MEDICARE

Under certain conditions, the State of Missouri will pay the cost of an MA recipient's Supplementary Medical Insurance (SMI) Part B premium.  This is called Buy-In.

To be eligible for this coverage, an MA recipient must (1) be eligible for and enrolled in Part B of Medicare, and (2) receive an SSI cash payment.

NOTE: Enter the correct OASDI claim number in the IMU5 system, when applicable, as this number is required to “buy-in” the recipient.

0810.030.00  EARLY PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT)

Medical Assistance recipients under the age of 21 are eligible for Healthy Children and Youth (HCY) services.  These services were formerly known as Early Periodic Screening, Diagnosis and Treatment (EPSDST) services.  Refer questions about these services the Division of Medical Services Recipient Services unit.