IM-#76 December 23, 2014, IM-#114 December 13, 2013, IM-97, November 7, 2013, IM-#100 December 7, 2012, IM-72 December 9, 2011, IM-104 December 3, 2008, IM-117 December 7, 2007, IM-109 December 8, 2006, IM-141 November 29, 2005, IM-126 December 2, 2004, IM-169 December 11, 2002, IM-75 December 26, 1995

The Missouri's Children with Developmental Disabilities (MOCDD) waiver program, also known as the Sarah Jian Lopez Waiver, provides eligibility for children who receive Home and Community Based (HCB) waiver services, as established in section 1915(c) of the Social Security Act. Under HCB waivers, a state may use Medicaid funding for home and community-based services provided only to a target group of people who have intellectual and developmental disabilities and whose care needs would otherwise require services in an institution. These HCB criteria were effective October 1, 1995.

The purpose of this waiver is to enable children with developmental disabilities to remain with their families rather than enter an institution, group home, or other out of home care. The MOCDD waiver allows the MO HealthNet eligibility requirements of deeming parental income and resources to the child to be waived so children targeted for participation may be determined MO HealthNet eligible. For children in this waiver program, financial eligibility for MO HealthNet is determined based solely on the income and resources of the child.

This waiver provides participants eligibility for all MO HealthNet services in addition to waiver services. It also establishes a higher income level for all children receiving MOCDD waiver services.

NOTE: Individuals who do not meet the following requirements may be eligible for MO HealthNet under another program.

0825.010.00 Overview of Eligibility Criteria

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

In addition, eligible individuals must meet the eligibility factors of disability, citizenship, residency, social security number and transfer of property.

When children living in their parents' home meet these criteria, they are eligible for MOCDD Waiver services under the MHABD program. The DMH will provide the MOCDD Waiver code entered on the Missouri Children with Developmental Disabilities Info screen (MOCDD/FMJ8) K, MOCDD CHILD - K WAIVER, or B, MOCDD CHILD - B WAIVER.

0825.020.00 Application Process

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All consumer inquiries regarding information or application requests for MOCDD waiver services must be referred to the participant’s DMH Regional Office. Addresses and contact information for all Regional Offices can be found at https://dmh.mo.gov/dd/facilities/. DO NOT deny individuals the right to apply for these services if an application is requested.

DMH field staff will interview the applicant and/or applicant's family, complete all forms and acquire appropriate documentation for the application process, and submit the application packet to the designated Processing Center.

Assigned FSD staff will review all forms for completeness, submit medical information to the Medical Review Team (MRT), and process the application packet. The MRT will forward the disability determination to the appropriate Processing Center.

0825.020.05 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 90 days.

0825.030.00 Eligibility Requirements

To be eligible for MHABD based on receipt of MOCDD waiver services, an individual must meet the eligibility requirements of the program.

0825.030.05 Age

The MOCDD individual must be under age 18. Refer to section 0110.010.00 AGE/RELATIONSHIP of the General Information manual for acceptable verification of age.

0825.030.10 Social Security Number

The MOCDD individual must furnish a Social Security Number. If s/he does not have a Social Security Number, s/he must apply for one. Refer to section 1005.010.00 SOCIAL SECURITY NUMBER (OAA, AB, PTD) of the December 1973 Eligibility Requirements Manual to determine eligibility on the factor of Social Security Number.

0825.030.15 Citizenship

The MOCDD individual must be a United States citizen or a qualified alien. Refer to section 1010.000.00 CITIZENSHIP AND ALIEN STATUS (OAA, PTD, and AB) December 1973 Eligibility Requirements Manual to determine eligibility on the factor of citizenship.

0825.030.20 Residence

The MOCDD individual must live in the State of Missouri and intend to remain in the state. Refer to section 1015.000.00 RESIDENCE (OAA, PTD, and AB) of the December 1973 Eligibility Requirements Manual to determine eligibility on the factor of residence.

0825.030.25 Disability

To be eligible for MO HealthNet, under the MOCDD waiver, the claimant must meet the December, 1973 eligibility requirements for Permanent and Total Disability.  Refer to section 1060.000.00 DISABILITY (PTD eligibility criteria) of the December 1973 Eligibility Requirements Manual.

The Medical Review Team (MRT) will make the final determination of eligibility based on disability.

0825.030.30 Medical Need and Authorization for MOCDD Waiver Services

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MOCDD waiver services are extended to individuals who, in the absence of the waiver, would require ICF/MR care.  Therefore, the individual must require a level of care provided by an ICF/MR.

The DMH determines if an individual requires an ICF/MR level of care and the need for MOCDD waiver services. To be eligible for MO HealthNet, the MOCDD individual must be authorized by the DMH to receive MOCDD waiver services. The date of MO HealthNet eligibility under these criteria cannot be prior to the date of the DMH approval.

The DMH will furnish the initial date of eligibility for ICF/MR level of care and eligibility for waiver services with the application packet.

Assigned FSD staff will make entries in FAMIS on the Missouri Children with Developmental Disabilities Info (MOCDD/FMJ8) screen. This screen is currently not accessed during the controlled flow, so staff will access this screen in maintenance mode upon completion of the controlled flow, by typing FMJ8 or MOCDD on the FAMIS command line. A user guide, Adding MOCDD Coverage, is available. Upon completion of the screen, staff will complete an eligibility resolution (EDRES), and review coverage recommendations.

0825.030.35 Income and Budgeting

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When determining gross monthly income, follow the policy outlined in Income Maintenance Manual section 0805.015.00 FINANCIAL NEED.

When the gross monthly income of the MOCDD waiver individual is at or below the HCB income standard listed in Appendix E, he/she meets the income criteria for MOCDD eligibility. Only the income of that individual is considered.  The HCB income standard is absolute. Individuals cannot spend down to become eligible under MOCDD waiver criteria. 

NOTE: The income and needs of parents and siblings are not included on the MOCDD budget; however, the income and needs of the parents and siblings must be evaluated to determine if the applying child should receive coverage as an MHDC non-spend down participant prior to the date found eligible for the MOCDD waiver.

A Qualifying Income Trust (QIT), also known as a Miller Trust, may be utilized to lower the budgeted income of an individual applying for HCB or MOCDD Waiver. A QIT may be established by the individual, their spouse, parent, grandparent, guardian, conservator, or a court. The purpose of the QIT is to decrease the income of the individual below the absolute HCB/MOCDD limit. All trust documents are to be sent through normal supervisory channels using the current Request for Interpretation (IM-14) process to determine availability of the income held in the trust to the applicant or participant. Include a copy of the entire original trust and any amendments.

NOTE: Persons with income above the HCB income standard may be eligible for MO HealthNet using regular MHDC procedures.

0825.030.40 Available Resources

The resource maximum for this program is $999.99.  Determine as available resources anything that is considered available under the December 1973 eligibility requirements for PTD.  Refer to Income Maintenance Manual section 1030.000.00 AVAILABLE RESOURCES (OAA and PTD).

NOTE: The resources of parents and siblings are not included as resources for MOCDD; however, the resources of the parents and siblings must be evaluated to determine if the applying child should actually receive coverage as an MHDC non-spend down participant prior to entering the MOCDD eligibility code.

0825.030.45 Transfer of Property

Because MOCDD 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 MOCDD waiver criteria cannot begin until the penalty period expires. Follow the policy in Income Maintenance Manual section 1040.000.00 TRANSFERS OF PROPERTY  for evaluating transfers of property and determining the penalty period.

Individuals who have transferred property without fair and valuable consideration may still be eligible for MHABD. Use the MHDC criteria for establishing eligibility for MO HealthNet for persons subject to transfer of property penalty.

0825.030.50 MO HealthNet Eligibility under Other Categories

To qualify for MO HealthNet under the MOCDD waiver, a child must not otherwise be eligible for MO HealthNet without a spend down. The DMH will gather income and resource information for the other household members. It is not necessary to verify this information. Comment on EUMEMROL, on the basis of the claimant's statement, why the individual is otherwise ineligible for MO HealthNet or would have to meet a spend own to be eligible.

0825.040.00 MO HealthNet Eligibility Date

Eligibility for MO HealthNet based on MOCDD criteria cannot be prior to the date of the DMH determination that the individual qualifies for MOCDD waiver services. Individuals found eligible under MOCDD waiver services criteria in the prior quarter may be approved for prior quarter coverage using those criteria if the DMH determination includes the prior quarter.

Individuals may qualify for MHDC spend down prior to the DMH determination.

EXAMPLE: James applies for MHABD on 8/15. He is age 15, receives Social Security of $900 per month. Due to a recent illness and hospitalization, James has medical expenses in May, June and July. He is referred to the DMH for a determination of eligibility for MOCDD waiver services. Neither he nor his parents have any countable available resources and he meets all other eligibility requirements for MHABD. On 09/01, the DMH determines that James is in need of ICF/MR level of care, and that he is in need of MOCDD waiver services.

0825.040.05 Reinvestigations

Reinvestigate MOCDD waiver cases on an annual basis.