To be eligible for MHABD based on receipt of HCB waiver services, an individual must meet the eligibility requirements of the program.
The HCB individual must be age 63 or older. Refer to section 0110.010.00 of the General Information manual for acceptable verification of age.
For individuals age 63 or 64, verify that PTD criteria are met. Refer to section 1060.000.00 of the December 1973 Eligibility Requirements Manual.
HCB waiver services are extended to individuals who, in the absence of the services, would:
The Department of Health and Senior Services, Division of Senior and Disability Services (DHSS/DSDS) determines whether the individual meets these requirements. Individuals who are applying for MHABD and who are considering placement in a long-term care facility, or who appear to be potentially eligible for HCB waiver services, must be referred to DHSS/DSDS for a determination.
Refer individuals to DHSS/DSDS using form IM-54A (Home and Community Based Referral). DHSS/DSDS will use the form to notify FSD of its decision, including the date the individual was authorized for HCB waiver services.
The referral process for authorization for HCB waiver services is as follows:
NOTE: The fax machine date stamp is verification that it has been faxed.
OR
NOTE: The case must be approved for MHABD non-spend down or spend down before faxing or scanning the request, if eligible.
The HCB application must not be approved until the IM-54A has been received from DSDS showing the participant was determined eligible for Aged and Disabled Waiver services. If the DSDS determines the claimant does not require NF Level of Care or Aged and Disabled Waiver services, reject the HCB application.
NOTE: Do not delay approving the application for MHABD non-spend down or spend down while waiting for the HCB determination to be completed.
Eligibility for HCB is based on adjusted gross income. When the adjusted gross monthly income of the HCB individual is at or below the HCB income maximum, the individual is eligible on the factor of income. Only the income of the individual is considered. Do not include the income of the spouse or any other household member.
Adjusted gross earned income is income remaining after the following deductions:
Adjusted gross non-earned income is the income remaining after:
The total of adjusted gross earned income and adjusted gross unearned income is compared to the HCB income maximum. The $20 personal income exemption does not apply to HCB income determinations.
Enter all sources and the gross amount of earned and non-earned income in FAMIS from the Select Income (SELINC, FMX2) using F14=ADDINC. When determining adjusted gross monthly income, follow the regular policy outlined in the following sections of the MHABD manual:
NOTE: If the individual is participating in a valid Qualified Income Trust (QIT)/Miller Trust under 42 U.S.C. 1396p(d)(4)(B), the amount of income being deposited into the trust is excluded from income consideration for the HCB participant’s determinations. It is not excluded from consideration for any programs other than the QIT.
The HCB income standard is absolute. Individuals cannot spend down to become eligible under HCB criteria. If the individual's income is greater than the HCB income maximum, determine eligibility for MHABD spenddown, using regular MHABD procedures.
NOTE: If there have been changes in income, complete a separate computation for each month.
When the spouse of an HCB individual also applies for or receives MO HealthNet, certain income and budgeting issues may arise.
If the non-HCB spouse applies for MO HealthNet, do not consider the income of the HCB spouse in that determination.
If the non-HCB spouse is MHABD spenddown, only the expenses of the non-HCB spouse can be used to meet the spenddown. Do not apply the medical expenses of the HCB spouse toward the spenddown.
Consider as available resources anything that is considered under the December 1973 eligibility requirements for OAA or PTD. Refer to section 1030.000.00 of the December 1973 Eligibility Requirements Manual.
The available resource maximum for eligibility based on receipt of HCB waiver services is:
EXAMPLE: Mr. and Mrs. Barrett both apply for MHABD on July 15, 2018. Mr. Barrett is authorized by DHSS/DSDS for HCB waiver services. When determining eligibility for MHABD based on HCB criteria, Mr. Barrett's resource limit is $3000.00. When determining eligibility for regular MHABD, Mrs. Barrett's resource limit is also $3000.00.
EXAMPLE: Mr. and Mrs. Jones both apply for MHABD on August 1, 2018. Both are authorized by DHSS/DSDS for HCB waiver services. When determining eligibility for MHABD based on HCB criteria, use the couple resource limit of $6000.00.
A married couple is eligible for an assessment and division of assets when one member of the couple is HCB. Follow the policy outlined in section 1030.035.00 of the December 1973 Eligibility Requirements Manual.
If both members of a married couple are HCB, the couple is not eligible for an assessment and division of assets.
NOTE: When the HCB individual's income is greater than the HCB income maximum, the couple is not eligible for a division of assets under HCB waiver criteria. In these instances, regular MHABD resource criteria for couples in their own homes and regular MHABD spenddown budgeting procedures apply.
HCB waiver individuals are considered to be institutionalized. The month of institutionalization is the month that DHSS/DSDS determines that the individual needs NF level of care and needs HCB waiver services.
As noted in section 1030.035.10 of the December 1973 Eligibility Requirements Manual, an assessment of assets is completed for the month in which the first continuous period of institutionalization begins. If the HCB spouse enters a MO HealthNet certified bed after the assessment of assets has been completed, a new assessment is not required. The month of assessment would be the EARLIER of:
A new assessment of assets is also not required if the non-HCB spouse enters a MO HealthNet certified bed. In these cases, the non-HCB waiver spouse becomes the institutionalized spouse, and the HCB waiver spouse becomes the community spouse.
Because HCB individuals are considered to be institutionalized, persons determined to have transferred property without fair and valuable consideration are subject to transfer of property penalties. Eligibility for MHABD using HCB waiver criteria cannot begin until the penalty period expires. Follow the policy in section 1040.000.00 of the December 1973 Eligibility Requirements Manual for evaluating transfers of property and determining the penalty period.
Couples who have transferred property without fair and valuable consideration are eligible for an assessment of assets. However, as above, eligibility for MHABD using HCB waiver criteria cannot begin until the penalty period expires.
Individuals who have transferred property without fair and valuable consideration may still be eligible for MHABD. Use the spenddown or non-spenddown criteria for establishing eligibility for MO HealthNet for persons subject to transfer of property penalty.
The HCB individual must furnish a Social Security Number. If s/he does not have a Social Security Number, s/he must apply for one. Use the policy in section 1005.010.00 of the December 1973 Eligibility Requirements Manual to determine eligibility on the factor of Social Security Number.
The HCB individual must be a United States citizen or a qualified alien. Use the policy in section 1010.000.00 of the December 1973 Eligibility Requirements Manual to determine eligibility on the factor of citizenship.
The HCB individual must live in the State of Missouri and intend to remain in the state. Use the policy in section 1015.000.00 of the December 1973 Eligibility Requirements Manual to determine eligibility on the factor of residence.