0800.000.00 Medical Assistance for the Aged, Blind, and Disabled
0800.000.05 Related Special Eligibility Groups
0800.005.00 Legal Basis
0805.000.00 Eligibility
0805.005.00 December 1973 Eligibility Requirements
0805.010.00 MA/GR Dual Eligibility
0805.015.00 Financial Need
0805.015.05 Persons Whose Income And Needs Are Considered
0805.015.05.05 Couple Cases In The IMU5 System
0805.015.10 Income Exclusions
0805.015.10.05 Social Security Cost of Living Adjustment (COLA) Disregard
0805.015.15 Overhead Expense Of Producing Income
0805.015.20 Determination Of Gross Earned Income
0805.015.25 Standard Deductions From Gross Earned Income
0805.015.30 Non-Earned Income
0805.015.35 Income Exemptions/Deductions
0805.015.40 Types Of Need Determination
0805.015.45 Income Maximum
0805.020.00 Medical Assistance For Disabled Children (MADC)
0805.020.05 Definition Of Living With A Parent
0805.020.10 Deeming Parental Resources
0805.020.15 Deeming Parental Income
0810.000.00 Medicaid Coverage
0810.005.00 Medicaid Non-Spenddown Coverage
0810.010.00 Medicaid Spenddown Coverage
0810.010.05 Processing Spenddown Medicaid Cases
0810.010.10 Notification Of Spenddown Amount
0810.010.10.05 Notification Of Spenddown On New Approvals
0810.010.15 Meeting Spenddown With Incurred Expenses
0810.010.15.01 Documentation of Incurred Medical Expenses
0810.010.15.02 Determining Patient Responsibility After Third Party Liability
0810.010.15.05 Countable Medical Expenses For Spenddown
0810.010.15.10 Authorizing Spenddown Coverage Based On Incurred Expenses
0810.010.15.15 Preventing Medicaid Payment Of Expenses Used To Meet Spenddown
0810. Allowable Third Party Payment from State Funded Programs
0810. Identifying DMH Medical Services Allowable For Spend Down
0810. Identifying DHSS NME CDS Participants
0810. Verification of DMH Medical Expenses
0810. Verification of DHSS Medical Expenses
0810.010.20 Spenddown Pay-In Option
0810.010.20.05 Pay-in option for new approvals
0810.010.20.10 Pay-in by automatic withdrawal
0810.010.20.15 Pay-in by other agencies
0810.010.20.17 Combination of Incurred Medical Expenses and Pay-In
0810.010.20.20 Out-of-Pocket Expenses for Spenddown Cases
0810.015.00 Prior Quarter Coverage
0810.015.05 Prior Quarter Non-Spenddown
0810.015.10 Prior Quarter Spenddown
0810.020.00 Medicaid Coverage End Date On Closings
0810.025.00 Eligibility For Buy-In (SMI Premium) For Medicare
0810.030.00 Early Periodic Screening, Diagnosis, And Treatment (EPSDT)
0810.035.00 Personal Care Services Program
0810.035.05 Legal Reference (Personal Care Services)
0810.035.10 Basic Eligibility Guidelines For Personal Care Services
0810.035.15 Eligibility Determination (Division Of Senior Services)
0810.035.20 Family Support Division Responsibilities
0810.035.25 Division Of Medical Services Responsibilities
0810.035.30 Personal Care Service Provider Responsibilities
0810.040.00 The Respite Care Program (In-Home And Institutional)
0810.040.05 In-Home Respite Care
0810.040.10 Institutional Respite Care
0810.040.15 Basic Eligibility Guidelines For Respite Care
0810.040.20 Eligibility Determination (Division Of Senior Services)
0810.040.25 Family Support Division Responsibilities
0810.040.30 Respite Care Provider Responsibilities
0815.000.00 Vendor Eligibility
0815.000.05 Missouri Care Options
0815.000.10 Definitions for Vendor Coverage
0815.005.00 Eligibility for Vendor Payments
0815.005.05 December 1973 Eligibility Requirements
0815.005.10 Medicaid Certified Beds in Nursing Facilities
0815.010.00 Applications for Claimants Not Currently Receiving Medicaid
0815.010.05 Application Processing Time Frames
0815.015.00 Claimants Currently Receiving Medical Assistance or SNC to Vendor
0815.015.05 Claimant Returns to Vendor Facility
0815.015.10 Tracking MA and SNC to Vendor Requests
0815.020.00 Initial Assessment and Medical Certification
0815.020.05 Verification of Medical Certification
0815.020.10 Claimant Not Medically Certified
0815.020.15 Medical Re-certifications (Utilization Reviews)
0815.025.00 Preadmission Screening for Entry into Nursing Facilities
0815.025.05 Preadmission Screening Process
0815.025.10 Verification of Preadmission Screening
0815.030.00 Vendor Surplus Computation
0815.030.05 Determining Adjusted Gross Income
0815.030.10 Determining Total Allowable Deductions
0815.030.10.05 Personal Needs Allowance
0815. Increasing the Personal Needs Allowance Due to Child Support Payments
0815.030.10.10 Allotments
0815. Maintenance Standards for Allotments
0815. Determining the Allotment to the Community Spouse
0815. Hearing Officer or Court of Law Sets Allotment Amount
0815. Allotments for Minors and Dependents Living with the Community Spouse
0815. Allotments for Minors Not Living With Community Spouse
0815.030.10.15 Medical Deductions (Health Insurance Premiums)
0815.030.10.20 Other Deductions
0815.030.15 Effective Date of Surplus
0815.030.20 Changes in Surplus Amount
0815.035.00 Effective Date of Vendor Coverage for Claimants in a Nursing Facility
0815.035.05 Effective Date of Vendor Coverage for Claimants in a Nursing Facility When No Level II Screening is Required
0815.035.10 Effective Date of Vendor Coverage for Claimants in a Nursing Facility When Level II Screening is Required and Claimant is not found to be MR, MI or DD
0815.035.15 Effective Date of Vendor Coverage for Claimants in a Nursing Facility When Level II Screening is Required and the Claimant is found to be MR, MI or DD
0815.040.00 Effective Date of Vendor Coverage for MHC or IMR Level of Care
0815.045.00 Prior Quarter Vendor
0815.050.00 Claimant Not in Vendor Facility on the First Day of the Month of Application
0815.050.05 Claimant Not in Vendor Facility in the Prior Quarter Has Medical Expenses in the Prior Quarter
0815.055.00 Inpatient Psychiatric Services for Individuals Under Age 21
0815.055.05 Claimants Under Age 18 Receiving Inpatient Psychiatric Services
0815.055.10 Claimants Ages 18 to 21 Receiving Inpatient Psychiatric Services
0815.060.00 Claimants Between the Ages of 21 and 65 in State Mental Hospital
0815.065.00 Individuals Under Age 18 in an Institution for the Intellectually Disabled or Nursing Facility
0815.070.00 Claimant Leaves the Vendor Facility
0815.070.05 Vendor Facility to SNC Facility
0815.070.10 Vendor Facility to Private Home, not receiving HCB
0815.070.15 Vendor Facility to Private Home, receiving HCB
0815.075.00 Claimant Moves from One Type of Vendor Facility to Another
0815.075.05 Claimant Moves to a Nursing Facility from Another Type of Vendor Facility
0815.075.10 Nursing Facility or Institution for the Intellectually Disabled to Mental Hospital
0815.075.10.05 Claimant Age 22 to 65 Goes from NF or IMR to State Mental Hospital
0815.075.10.10 Claimant Age 65 or Older Goes from NF or IMR to State Mental Hospital
0815.075.15 Nursing Facility or Mental Hospital to Institution for the Intellectually Disabled
0815.080.00 Entering a Vendor Case Into IMU5
Appendix A Accessing Vendor Numbers for Licensed Nursing Homes
Appendix B Maintenance Standards For Allotments
Appendix C JCAHO Facilities
Appendix D July 1996 Percentage Of Need Standard
0820.000.00 Eligibility Based On Receipt Of HCB Waiver Services
0820.010.00 Overview of Eligibility Criteria
0820.020.00 Application Process
0820.020.05 Application Processing Timeframes
0820.030.00 Eligibility Requirements
0820.030.05 Age
0820.030.05.05 Permanent and Total Disability
0820.030.10 Medical Need and Authorization for HCB Waiver Services
0820.030.10.05 Referrals to DHSS/DSDS
0820.030.15 Income and Budgeting
0820.030.15.05 HCB with Non-HCB Spouse
0820. Income of HCB Spouse When Non-HCB Spouse Applies for MO HealthNet
0820. Spouse of HCB is MHABD Spenddown
0820.030.20 Available Resources
0820.030.20.05 Division of Assets
0820. Month of Institutionalization
0820. Entry Into a MO HealthNet Certified Bed
0820.030.25.00 Transfer of Property
0820.030.30.00 Social Security Number
0820.030.35.00 Citizenship
0820.030.40.00 Residence
0820.035.00 HCB and QMB
0820.040.00 MO HealthNet Eligibility Date
0820.050.00 Entering an HCB Case into IMU5
Appendix E HCB Income Maximums
0825.000.00 Eligibility Based on Receipt of Missouri's Children with Developmenta Disabilities (MOCDD) Waiver Services
0825.010.00 Overview of Eligibility Criteria
0825.020.00 Application Process
0825.020.05 Application Processing Timeframes
0825.030.00 Eligibility Requirements
0825.030.05 Age
0825.030.10 Social Security Number
0825.030.15 Citizenship
0825.030.20 Residence
0825.030.25 Disability
0825.030.30 Medical Need and Authorization for MOCDD Waiver Services
0825.030.35 Income and Budgeting
0825.030.40 Available Resources
0825.030.45 Transfer of Property
0825.030.50 MO HealthNet Eligibility under Other Categories
0825.040.00 MO HealthNet Eligibility Date
0825.040.05 Reinvestigations
0830.000.00 Program of All-Inclusive Care for the Elderly (PACE)
0835.000.00 Prompt Disposition
0840.000.00 Reviews And Interim Activities
0840.005.00 Annual Reinvestigation
0840.010.00 Changes In Circumstances
0840.010.05 Adding A Spouse
0840.010.10 Non-Spenddown To Spenddown
0840.010.15 Spenddown To Non-Spenddown Or MA-WD Non-Premium
0840.010.20 Change To MA-WD Premium
0840.010.25 Increase In Spenddown Amount
0840.010.30 Decrease In Spenddown Amount
0840.015.00 Closing Of Cases
0840.015.05 Pre-Closing Ex-Parte Review
0845.000.00 Location Of Case Records
0845.005.00 Separation Of Spouse Cases
0850.000.00 Individuals Qualifying Under Section 1619 Of The Social Security Act
0850.005.00 Eligibility Requirements For MA Based On Section 1619 Status
0850.005.05 SSA 1619 Status
0850.005.10 Title XIX Eligibility In The Month Prior To Attaining SSA 1619 Status
0850.005.15 Resources
0850.005.20 Financial Need
0850.010.00 Case Processing Procedures Section 1619 Status Cases
0850.015.00 Reviews (Section 1619 Status Cases)
0850.020.00 Individuals Losing SSA 1619 Status
0855.000.00 Ticket to Work Health Assurance (TWHA) Program
0855.005.00 Eligibility Requirements for Ticket to Work Health Assurance (TWHA) Program
0855.005.05 Age
0855.005.10 Citizenship/Alien Status
0855.005.15 Social Security Number
0855.005.20 Residence
0855.005.25 Disability
0855.005.30 Employment
0855.005.35 Available Resources
0855.005.40 Income Limit
0855.005.40.01 Social Security Cost of Living Adjustment (COLA) Disregard
0855.005.40.05 Gross Income Limit
0855.005.40.10 Net Income Limit
0855.005.45 Premium Payment
0855.005.45.05 Premium Collection Process
0855.010.00 Case Processing Procedures
0855.010.05 Approval Notice
0855.015.00 Reviews and Interim Changes
0855.015.05 Medicaid Coverage End Dates On Closings
0855.020.00 TWHA Couple Cases
0855.025.00 HIPP
0860.000.00 Qualified Disabled Working Individuals (QDWI)
0860.005.00 Eligibility Requirements
0860.005.05 SSA QDWI Status
0860.005.10 Enrollment in Part A Medicare (Hospital Insurance)
0860.005.15 Need
0860.005.15.05 QDWI Income Standard
0860.005.15.10 Budgeting Procedures (QDWI)
0860.005.20 Resources
0860.005.25 Eligibility for Other Assistance
0860.005.30 Citizenship
0860.005.35 Residency
0860.005.40 Social Security Number
0860.010.00 Application Processing (QDWI)
0865.000.00 Qualified Medicare Beneficiaries (QMB)
0865.005.00 Legal Basis
0865.010.00 Eligibility Requirements
0865.010.05 Enrollment In Part A Medicare
0865.010.05.05 Verification of Part A
0865.010.05.10 Part A Eligibility and Enrollment Process
0865.010.05.15 Part A Conditional Enrollment
0865.010.05.20 Buy-In eligibility for persons in Alternative Care
0865.010.10 Financial Need (QMB)
0865.010.10.05 Assistance Group
0865.010.10.10 QMB Income Standard
0865.010.10.15 Income Considered
0865.010.10.20 Income Exemptions/Deductions
0865.010.10.25 Completion of the QMB budget
0865.010.15 Resources (QMB)
0865.010.20 Citizenship/Alien Status
0865.010.25 Residency
0865.010.30 Social Security Number
0865.015.00 Benefits Available To QMB Recipients
0865.015.05 Buy-in for QMB
0865.015.10 Payment of Medicare Coinsurance and Deductibles
0865.015.15 Services not covered under QMB
0865.020.00 Application Processing (QMB)
0865.020.05 Begin Date for QMB Eligibility
0865.020.10 Filing a QMB Application
0865.020.15 Application Procedures
0865.020.15.05 QMB-only Approvals
0865.020.15.10 Approval of QMB and another type of assistance
0865.020.15.15 Requests for QMB Coverage on Active Cases
0865.020.15.20 Exploration for QMB eligibility with other types of assistance
0865.025.00 Reinvestigations (QMB)
0865.030.00 Special Procedures For System Opening And Closing Of QMB Cases
0865.030.05 “QMB-only” Is Approved For Another TOA
0865.030.10 “QMB-only” Is Approved For Another TOA, And Is No Longer Eligible For QMB
0865.030.15 QMB Eligibility Continues When Another TOA Stops
0865.030.20 Both QMB And Another TOA Are Closed
0865.035.00 QMB In Conjunction With Spenddown
0865.035.05 Non-spenddown May Become Spenddown When Adding QMB
0865.035.10 Special Procedures For QMB/Spenddown Combination approvals
0865.035.15 Budgeting Procedure When MA and QMB Applications
Are Approved In The Same Month
0865.035.20 Medical Expenses Allowed In QMB/Spenddown Budgeting
0865.035.25 QMB Benefits Guide
0870.000.00 Specified Low-Income Medicare Beneficiaries (SLMB) And Qualifying Individuals (QI)
0870.005.00 Legal Basis
0870.010.00 Eligibility Requirements
0870.010.05 SLMB Income Standard
0870.010.10 Budgeting Procedures (SLMB)
0870.010.15 Buy-In eligibility for persons in Alternative Care
0870.015.00 Benefits Available to SLMB Recipients
0870.020.00 Application Processing (SLMB)
0870.020.05 Beginning Date Of SLMB Coverage
0870.020.10 Processing SLMB Applications
0870.020.10.05 SLMB Only
0870.020.10.10 Approvals of SLMB in Combination With Other Type of Assistance
0870.020.15 IMU5 Completion
0870.025.00 Reinvestigations (SLMB)
0870.030.00 System Approvals And Closings Of SLMB Cases
0870.030.05 SLMB Group 1 Is Approved for Another Type of Assistance
0870.030.10 SLMB Recipient is Determined Ineligible at Approval of Another Type of Assistance
0870.030.15 QMB Recipient is Determined SLMB Eligible at Approval for Another Type of Assistance
0870.030.20 SLMB Eligibility Continues, Other Type of Assistance Closes
0870.030.25 Both SLMB and Another Type of Assistance Close
0870.035.00 SLMB In Combination With Spenddown Cases
0870.040.00 QMB To SLMB Cases
0870.045.00 Effect of COLA Increases On SLMB Cases
0875.000.00 Former Foster Care Youth
Appendix A Changing a Facility Address
Appendix G Spend Down Calculator
Appendix H Spend Down Calculator and Expense Log Instructions
Appendix I Setting Up a New Calculator