Prior Quarter Healthcare Coverage

ONLINE RESOURCE:

• Prior Quarter Income Entry
• Prior Quarter Income Chart

REQUIREMENT:

Explore healthcare eligibility for the three months prior to the month of application on the MO HealthNet Application Detail screen, if requested by the applicant. If eligible on all program requirements, the healthcare coverage can be backdated to as early as the first day of the third month prior to the month of application. This period is referred to as the ‘prior quarter’.

Prior quarter eligibility occurs only when the applicant met all eligibility requirements during the three months prior to application. In order to make that determination, FAMIS must evaluate all factors for those months.

Non-spend down coverage begins on the first day of the month in which the claimant became eligible for assistance.

Spend down eligibility begins the first day of the first month of the prior quarter in which the claimant was eligible on all factors except meeting spend down. MHABD coverage begins on the first day in which spend down is met in each of the prior quarter months.

PROCEDURE:

A ‘Y/N’ question appears on the MO HealthNet Application Details screen asking whether prior quarter coverage is requested. If prior quarter is requested, the next three questions ask whether the EU had income during the three month period prior to the month of application. If the individual requests prior quarter coverage and states that the EU did have income, FAMIS will request prior quarter income information during the controlled flow. If prior quarter coverage is requested and the EU did not have income during those months, FAMIS assumes there was NO income.

When gathering details of income, resources and other factors, the eligibility specialist must ask for prior quarter information and verification. Capture information and amounts for each prior quarter month separately when necessary, such as varying bank balances. If prior quarter months values are not captured, FAMIS cannot make an accurate determination of prior quarter eligibility. FAMIS will present a Prior Quarter Resource confirmation screen in the controlled flow to confirm that all information has been gathered.