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Jefferson City, MO 65102
Phone: (573) 635-4128

Policy Memo Update

Jessica Kruseby Jessica L. Kruse, Springfield

Since the last newsletter there have been several new memorandums issued by the Department of Social Services. All memorandums mentioned below can be found online through the following link:  Specifically, the memorandums highlighted in this article include IM# 65, 68, 78, 97, 98, 100, 105 and 114 from 2012 and IM# 2 from 2013. 

Increase in the Average Private Pay Rate for the Purpose of Calculating Penalty Periods
On August 2, 2012, the Department of Social Services issued Memorandum IM-65 indicating that the manual section 1040.020.40 would be changed to reflect the increase in the private pay rate from $3960 to $4282.  This is commonly known as the penalty divisor and is used to calculate the penalty period that results from gifts or transfers for less than fair market value.  The manual was updated with examples of how to calculate this penalty period.  The memorandum and section 1040.020.40 indicate that this private pay rate is to be used on all cases in 2012 when calculating the penalty period.  As of the date of this publication, there have been no additional memorandums or updates to this section.

Transitions in the Eligibility Unit Offices
A new policy in effect now requires that all applications for vendor MO HealthNet benefits prepared by attorneys will be processed in one centralized office called the Vendor Processing Unit (VPU).  This, along with a few other changes, was announced in a memorandum at the beginning of August.

On August 6, 2012, the Missouri Department of Social Services, Family Support Division, issued its Memorandum IM-68 setting forth the “statewide vendor specialization plan,” which creates five offices statewide whose purpose is to maintain exclusively “any supercase,” including cases involving vendor MO HealthNet benefits.    This change became effective August 1, 2012.

Prior to August 1, 2012, there were approximately twelve offices statewide that would process vendor Medicaid benefit applications.  Other Medicaid benefit applications, including those for skilled nursing grants and Home and Community Based Services waiver (HCB) program, would be processed through each local county DFS office. 

Four of the new Eligibility Units are based on regions as follows:

North: Livingston County
Southwest and Southeast: Ozark County
Kansas City: Lafayette County
St. Louis: Madison County  

You can find the link to the color-coded map of these regions at the following address:

The fifth office, called the Vendor Processing Unit (VPU) is located in Miller County.  The Family Support Division has indicated that all applications will first be sent to one of the four regional offices (Livingston, Ozark, Lafayette, or Madison County).  Those four counties will screen the cases and if those cases meet one of five criteria, the application will be sent by the screening county to the VPU in Miller County.  The VPU processes the following applications:

  1. Applications involving a Division of Assets;
  2. Applications involving a trust;
  3. Applications involving an annuity;
  4. Applications involving transfers; and,
  5. Applications involving legal counsel representation.

The stated purpose of this change is to develop a more streamlined, uniform, and consistent approach when processing vendor Medicaid applications.

Although this memorandum notes an effective date of August 1, 2012, this program was launched in phases, with the first phase starting in June 2012.  Phase 2 activation of the Kansas City and St. Louis regions was not scheduled to occur until September 1, 2012 and phase 3 activation of the Kansas City and St. Louis regions was not scheduled to begin until October 1, 2012.  It appears from the outlined plan that HCB applications may also be processed in a similar way sometime in the near future, however the specific date has not yet been determined.  

Financial Exploitation of the Elderly Manual Addition
On August 29, 2012, the Missouri Department of Social Services, Family Support Division, issued its Memorandum IM-78 informing the staff of new provisions in the Missouri statute addressing financial exploitation of the elderly. 

RSMo. §570.145 is the Missouri criminal statute that defines financial exploitation of the elderly.  The Missouri legislature amended this statute effective August 28, 2012.  The amendment added “undue influence” to the definition of financial exploitation so that it is now a crime to knowingly permanently deprive an elderly or disabled person of their property by using undue influence, in addition to deception, intimidation, or force.  RSMo. §570.145.1(2012).  The statute goes on to define “undue influence” as “use of influence by someone who exercises authority over an elderly person or disabled person in order to take unfair advantage of that person’s vulnerable state of mind, neediness, pain, or agony.  Undue influence includes, but is not limited to, the improper or fraudulent use of a power of attorney, guardianship, conservatorship, or other fiduciary authority.”  RSMo. §570.145.2(5)(2012). 

Finally, the amended statute now provides that it is a crime for a person who is receiving or in possession of funds of a Medicaid eligible elderly or disabled person who is residing in a skilled nursing facility to fail to pay the facility all money that is owed to the facility from any source of income the disabled or elderly person may have.  RSMo. §570.145.7(1)(2012).  The section goes on to authorize the release of any records FSD may have concerning the resident’s income or assets to the prosecutor for the purpose of investigating violations of this statute.  Id.  Finally, this section provides that if a person is found guilty of withholding funds from the facility, restitution can be ordered to pay back the facility any amounts owed.  RSMo. §570.145.7(2)(2012). 

IM-78 was issued primarily to inform FSD staff of the changes to the financial exploitation statute as defined above.  In addition, the memo also drew attention to MOSAFE, which is a program launched by the Department of Health and Human Services for the purpose of bringing awareness to the issue of financial exploitation of elderly and disabled people.  If a person suspects elder abuse or neglect, including financial exploitation, he or she can call a hotline DHSS has dedicated to this issue: 1-800-392-0210.  For more information about MOSAFE, go to  At this web address one can find information, including brochures and articles, that can be provided to clients or used in a presentation about this issue.

Information Regarding How the Department of Social Services Reviews Irrevocable Trusts
Gerald L. Meyr with the Division of Legal Services in the Missouri Department of Social Services sent a letter to Reginald Turnball clarifying how the Department of Social Services reviews irrevocable trusts submitted by applicants for, or participants in, MO HealthNet.  He indicated that the first-party special needs trusts should be submitted directly to the Division of Legal Services for review.  Third-party special needs trusts and other trusts involving a MO HealthNet case or application can be submitted to the regional eligibility specialist with the Family Support Division or directly to the Division of Legal Services.  The address for the Division of Legal Services is: P.O. Box 1527, Broadway State Office Building, Jefferson City, MO 65102-1527.   

Increases in Certain Benefit Amount and Eligibility Standards
Effective December 8, 2012 there were several adjustments made to the benefit amounts and eligibility standards due to the 1.7% cost of living adjustment (COLA).  Memorandum IM-100 provides charts that detail all income increases.  This includes an increase in the SSI individual maximum, which is now $710.00 per month.  Another change that might affect the income for your clients is the change that was made to the Supplemental Medical Insurance Premium.  The Part B insurance premium was increased from $99.90 to $104.90 in 2013. 

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