0815.010.00 Applications for Claimants Not Currently Receiving Medicaid
IM-#33, March 29, 2012
If an institutionalized individual or their spouse with whom they are residing, or were residing prior to institutionalization, is not currently receiving MHABD, a MHABD application request must be entered in FAMIS:
- Obtain a signed application form (FA-100 or IM-1MA). Refer to Application Processing manual, Section 0105.010.00 for more information on who may sign the application.
- Have the applicant or their representative complete the eligibility statement (IM-1MA), or have the applicant or their representative complete a FAMIS interview with an Eligibility Specialist.
- If the applicant is entering or has entered a MO HealthNet (MHN) certified bed in a nursing facility, verify that the preadmission screening (DA-124 C) has been completed and that the applicant is medically certified for the appropriate level of care.
NOTE: Review the DA-124 Inquiry Report screen in FAMIS from the Facility and Placement Information Details screen accessed from (FACPLACE or FMJ4). See the FAMIS User Guide FACILITY AND PLACEMENT INFORMATION DETAILS.
- Determine if the applicant meets December 1973 eligibility requirements for PTD, AB or OAA. For children under age 18 who do not qualify as MADC determine eligibility based on MHF or MHK for poverty level children criteria.
0815.010.05 Application Processing Time Frames
IM-#33, March 29, 2012
Processing time frames for MHABD vendor are the same as other MHABD applications. Complete the eligibility determination so that an applicant will receive notification of eligibility or notice of ineligibility:
- within 45 days from the date of request if eligibility is based on OAA criteria, or
- within 90 days from the date of request if eligibility is based on PTD or AB criteria.
FAMIS determines the due date for applications. From the individual's Application Request screen (REQUEST or FM0G), select the current MA request and press F14= APPDETL to view the Application Details screen. From the Application Details screen press F15 = DUEDATES to view the MO HealthNet Application Due Dates screen.
Delinquent applications must be explained with comments on Eligibility Member Unit Role screen (EUMEMROL or FM3Z).