IM-#33, March 29, 2012, IM-117 October 24, 1997

If an applicant had medical expenses while in the vendor facility in the three months prior to the month of application, s/he may be eligible to have MO HealthNet vendor benefits as of the first day of the third month prior to the month of application. This is prior quarter coverage.

Explore eligibility for and explain the availability of prior quarter coverage to each vendor applicant.

The eligibility determination for prior quarter coverage is separate from the eligibility determination of current vendor coverage. An applicant does not have to be currently eligible for vendor coverage to be approved for prior quarter vendor coverage.

The effective date of prior quarter coverage can be no earlier than the first day of the third month prior to the month of application, and may extend up to but not including the first day of the month of application. When the applicant has unpaid medical expenses in the prior quarter and is determined to be ineligible for MO HealthNet during the prior quarter, the eligibility specialist should record an explanation of the eligibility begin date on Eligibility Unit Member Role (EUMEMROL or FM3Z) screen in FAMIS.

To determine the applicant's MO HealthNet eligibility for the prior quarter, use: