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Jessica Kruse
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The Missouri Bar
326 Monroe
Jefferson City, MO 65102
Phone: (573) 635-4128

Jessica Kruse Update on Memoranda

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 #14, 22, 25, and 43.

Applicants and Participants in Certain MO HealthNet Programs Must Seek Other Available Benefits

On January 31, 2013 the Department of Social Services issued Memorandum IM#14, which instructs the eligibility specialists to refer all MHABD applicants and participants to the Social Security Administration to apply for SSI if their income is below the SSI income maximum (currently $710) plus $20. The exception to this is an applicant or participant for vendor coverage because generally, a person must have income of less than $30 per month to be eligible for SSI when they have vendor coverage.

Along the same lines, on March 8, 2013 the Department of Social Services issued Memorandum IM #25, which revised Section 1000.005.00. This memorandum instructs the Eligibility Specialists not to approve any applications for MHABD, Supplemental Nursing Care (SNC), and Supplemental Pension (SP) unless the applicant can verify that they took all actions necessary to acquire any annuities, pensions, retirement and disability benefits to which they are entitled. If the applicant did not take these necessary actions, including showing that they applied for other potential available benefits, the applicant must show good cause for not doing this.

Based on the above memorandums, a good practice tip will be to include some questions on your intake form, or in the intake session with a client, to help identify other potential benefits that may be available so that the processing of the Medicaid application is not delayed while trying to apply for other potential benefits.

Institutionalized Spouses Must Elect to Take Against Their Spouse’s Will

On February 28, 2013 the Department of Social Services issued Memorandum IM#22, which revises Section 1040.20.25. It is now the department’s policy that if a community spouse precludes any inheritance for the institutionalized spouse and the institutionalized spouse fails to elect to take against the will at the death of the community spouse, the failure to elect will be considered a transfer of assets valued at the portion of his or her estate to which the institutionalized person would be entitled. The prior language was not as strong and simply stated that if the institutionalized person did not contest the spouse’s will, the inaction may be considered a transfer of assets. Now the language regarding the spousal election is mandatory.

This will be a good memorandum to include in any newsletters that go out to former clients so that the families of the institutionalized spouse will know what to do if the community spouse passes away.

Increase in the Average Private Pay Nursing Care Rate (Penalty Divisor)

On April 18, 2013 Memorandum IM #43 was issued by the Department of Social Services, which revised Section 1040.020.40. The rate increased from $4,282 to $4,563. The rate increase is effective for applications taken on or after January 1, 2013. This rate is used when calculating the penalty period that results from transfers for less than fair market value or gifts that were made within the five years prior to the vendor Medicaid application date. The total value of gifts or transfers for less than fair market value is divided by this penalty divisor, which generates the penalty period. The rate increases periodically and is meant to represent the average rate of nursing home care in the state of Missouri.

Please note that since this rate is effective on all applications submitted on or after January 1, 2013, this may affect penalty periods that are currently in place for your clients.

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