|
Effective: December 1, 2012 | |
|
19.55.05 - Home Equity Limit Analysis |
Follow this analysis for clients requesting or receiving MA payment of LTC services. For more information about each step in the process, see LTC Home Equity Limit, Steps to Applying the Home Equity Limit.
1. Does the client own or have an ownership interest in a home that was occupied as a primary dwelling The living structure in which an applicant or enrollee, requesting MA payment of LTC services, currently lives in or lived in immediately prior to receiving LTC services. A primary dwelling can be real or personal property, fixed or mobile and can be located on land or water. before the start of LTC services?
l Yes. Go to Step 2.
l No. Client is eligible for MA payment of LTC services if all other eligibility requirements are met. Send a manual notice or update worker comments as directed.
2. Has the client received MA payment of LTC services without a break in services A gap of one calendar month or more in receiving MA payment of LTC services because the individual either: 1. Became ineligible for MA payment of LTC services; or 2. Stopped residing in a LTC facility or receiving services through a home and community-based waiver program. based on a request filed before January 1, 2006?
l Yes. Client is eligible for MA payment of LTC services if all other eligibility requirements are met. Send a manual notice or update worker comments as directed.
l No. Go to Step 3.
3. Is the client's spouse, child under 21 or child of any age who is blind or permanently and totally disabled living in the home?
l Yes. Client is eligible for MA payment of LTC services if all other eligibility requirements are met. Send a manual notice or update worker comments as directed.
l No. Go to Step 4.
4. Is the client's home equity interest less than the applicable home equity limit?
l Yes. Client is eligible for MA payment of LTC services if all other eligibility requirements are met. Send a manual notice or update worker comments as directed.
l No. Go to Step 5.
5. Does the home meet the requirements of an agricultural homestead? See the Agricultural Homestead Analysis to determine if the home meets this requirement.
l Yes. Go to Step 6.
l No. The client is not eligible for MA payment of LTC services. Code MMIS to prohibit MA payment of LTC services. Send a manual notice or update worker comments as directed.
6. Is the client's verified equity interest in the agricultural homestead less than $536,000?
l Yes. Client is eligible for MA payment of LTC services if all other eligibility requirements are met. Send a manual notice or update worker comments as directed.
l No. The client is not eligible for MA payment of LTC services. Code MMIS to prohibit MA payment of LTC services. Send a Notice of Action for Payment of Long-Term Care Services (DHS-4915) or update worker comments as needed.