0820.000.00  ELIGIBILITY BASED ON RECEIPT OF HCB WAIVER SERVICES

The Home and Community Based Services (HCB) waiver is part of Missouri's nursing home diversion program (Missouri Care Options). Missouri Care Options is administered by the Department of Health and Senior Services, Division of Senior and Disability Services (DHSS/DSDS). The program offers information to Missouri citizens about the variety of long-term care options available to individuals considering nursing home placement. Through the HCB waivers, individuals are offered in-home services that may allow them to remain in their own homes, rather than going to a nursing home.

Effective January 1, 1993, individuals who receive HCB waiver services are subject to separate eligibility criteria when determining eligibility for MO HealthNet for the Aged, Blind, and Disabled (MHABD). The intent of these special criteria is to:

• Give equitable treatment of resources for married couples, by allowing an assessment and division of assets to persons choosing to remain in their own homes rather than entering a nursing facility, and
• Encourage people to remain in their own homes by establishing a higher MHABD income limit for individuals receiving HCB waiver services.

0820.010.00  Overview of Eligibility Criteria

In order to be eligible for MO HealthNet for the Aged, Blind, and Disabled (MHABD) based on HCB criteria, an individual must meet the following requirements:

• Be age 65 or older, OR
• Be at least age 63 and meet Permanent and Total Disability (PTD) requirements.
• Be determined by the Department of Health and Senior Services, Division of Senior and Disability Services (DHSS/DSDS) to:
  • Need a nursing facility (NF) level of care; AND
  • Be authorized to receive HCB waiver services.
• Have income equal to or less than the HCB income limit.
• Meet the December 1973 eligibility requirements of:
  • Available Resources
  • Citizenship
  • Residency
  • Social Security Number, and
  • Transfer of Property

0820.020.00  Application Process

If the individual is not currently receiving MO HealthNet benefits, an application for MHABD must be taken:

1. Obtain a signed application form (IM-1MA or IM-1). Refer to Application Processing manual, Section 0105.010.00 for more information on who may sign the application.

   NOTE: As with any MHABD application, determine eligibility for QMB/SLMB

2. Have the individual or his/her representative complete the eligibility statement (IM-1MA or IM-2) or complete a FAMIS interview and sign the interview summary.
3. Determine that the individual is age 63 or older.
4. If the individual is at least age 63 but is under age 65, determine that the individual meets PTD requirements.
5. Determine that the individual's gross income is at or below the HCB maximum. Complete the application flow in FAMIS.
6. Approve the MHABD application if individual is eligible for MHABD spend down or nonspend down.
7. If applicant cannot be approved for MHABD due to excess resources, but has a spouse with whom they live and the individual is not obviously ineligible for HCB, begin the division of assets.
8. Using the Home and Community Based Referral (IM-54A) form, refer the individual to DHSS/DSDS to determine medical need and authorization for HCB services within 2 days of approval for MHABD coverage or decision that a division of assets will be required.

0820.020.05 Application Processing Timeframes

Applications must be processed without delay unless there are unusual or extreme circumstances. Complete the eligibility determination so that an applicant will receive notification of eligibility or ineligibility:

• Within 45 days if the applicant is age 65 or older.
• Within 90 days if the applicant is age 63 or 64.