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Effective: February 1, 2008 |
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23.40.20ar2 - LTC Needs Allowance (Archive) |
Archived: October 1, 2008 |
There are four types of needs allowances which can be deducted from a client’s countable income in a LTC income calculation. Only one of the four is allowed on a client’s income calculation. This section provides policy requirements for using each type of allowance.
These allowances are only allowed in the LTC Income Calculation. See Beginning or Ending a LTC Income Calculation for more information on when to begin using these deductions.
Clothing and Personal Needs Allowance.
Clothing and Personal Needs Allowance
Allow a Clothing and Personal Needs Allowance for clients who are not allowed any other needs allowance.
The Clothing and Personal Needs Allowance is adjusted January 1 of each year. See LTC Allowances for exact figures.
Public Law 101-508 provides that certain veterans are entitled to a personal needs allowance of $90 per month. People who receive the improved pension include:
l Veterans who do not have a spouse or dependent children.
l The surviving spouse of a veteran who does not have dependent children.
Deduct $90 as the personal needs allowance for clients receiving the improved pension benefit.
Note: At no time may any portion of the improved pension be considered income and counted in the LTC income calculation.
l Adjust the LTC income calculation for clients who receive retroactive improved pension benefits.
l The retroactive amount must be applied based on the month for which it was intended.
l See LTC Spenddown for more information on steps to follow when a LTC spenddown decreases.
Example:
Charles is a long term care facility resident receiving MA using a LTC income calculation. In June he receives a Veterans improved pension retroactive payment of $450 to cover the months of February through June. This is an ongoing benefit.
Action:
Charles LTC income calculation for February through June includes the basic personal needs allowance. Redetermine the income calculation for each month, including future months, using the $90 Veterans Improved Pension deduction. This will decrease Charles’ LTC spenddown amount.
The home maintenance allowance is allowed for temporary LTCF residents and is equal to 100% FPG for a household size of one. It is only allowed for up to three consecutive calendar months at a time. See LTC Allowances for exact figures.
l If both spouses are residing in an LTCF and one spouse will return to the community within three months of admittance:
n Allow the home maintenance allowance if all conditions are met for the spouse who will be discharged within three months.
n Use the clothing and personal needs allowance or the Veterans Improved Pension for the other spouse.
If a client receiving EW while residing in a board and care facility, assisted living facility or GRH facility is admitted to an LTCF for a temporary stay and the bed in the non-LTC facility is being held for the client’s return, allow the home maintenance allowance if all conditions are met.
Example:
Marge was receiving SIS-EW and residing in a GRH facility when she broke her leg. She was admitted to an LTCF in February for a temporary stay of two months for rehabilitation. The GRH facility agreed to hold Marge’s bed at the GRH. Marge is responsible for the room and board costs at the GRH. Marge meets all of the home maintenance allowance conditions.
Action:
Change the SIS-EW maintenance needs allowance to the home maintenance allowance effective with the LTC income calculation for February. Switch back to the maintenance needs allowance if Marge again begins receiving waiver services the month after she returns to the GRH as long as the stay at the LTCF does not exceed three calendar months.
l The client must be discharged from the LTCF for one full calendar month before the allowance can be used again for three calendar months.
Example:
Stevanna entered the nursing home February 25. She meets all of the home maintenance allowance conditions.
Action:
The allowance will begin with the start of the LTC income calculation in March and continue through May if Stevanna remains in the LTCF.
Stevanna is discharged home on May 8 but reenters the LTCF on July 10.
Action:
Stevanna can use the home maintenance allowance again for three consecutive months beginning in August (the month the LTC income calculation will begin) because she was discharged for one full calendar month or more. She can continue to use the allowance for September and October if she remains in the LTCF.
Deduct the home maintenance allowance for people who meet all of the following conditions:
l Are residing in an LTCF.
Note: The home maintenance allowance can only be used for clients who move temporarily to an LTCF, not to other types of facilities such as board and care, assisted living or GRH facilities.
l Are expected to remain in the LTCF for three calendar months or less based on a physician's certification, and will live outside of an LTCF setting upon discharge.
n Begin counting the three calendar months with the month following the month of entry.
n Stop counting the three calendar months with the month before the month of discharge.
n The Physicians Certification Form (DHS-1503) provides length of stay information.
Note: If the physician initially indicates a short-term stay and then later indicates the client’s residence will be permanent or over three calendar months, discontinue the home maintenance allowance and begin the personal needs allowance effective the month after the updated DHS-1503 was signed.
The DHS-1503 gives the estimated length of stay in days (30 days or less, 31 to 90 days, 91 to 180 days, or over 180 days.) Contact the facility to find out the length of stay to determine if the three-month period is met.
l Have expenses to maintain or retain a residence in the community. These can include but are not limited to:
n A home the client owns.
n A rental apartment.
n A GRH.
n An assisted living facility.
l Were not living with any of the following at the time of entering the LTCF:
n Spouse.
Note: If both spouses enter a LTCF on the same day and one or both meet temporary placement criteria, allow the home maintenance allowance for the spouse who will be returning home and the personal needs allowance for the other spouse.
n Children under age 21.
n Children of the client or community spouse over age 21 who are claimed as tax dependents.
n Parents of the client or community spouse claimed as tax dependents.
n Siblings of the client or community spouse claimed as tax dependents.
Example:
Teresa has a hip replacement on October 13. She enters an LTCF for rehabilitation on October 15. The DHS-1503 indicates a 31-90 day stay in the LTCF. Discharge is anticipated for early January. Teresa was widowed in 1999 and has lived in her house for the past 30 years. She has a mortgage payment of $700 per month, and has to pay all of the utilities.
Action:
Teresa is allowed a home maintenance allowance beginning in November (the first month of the LTC income calculation) and continuing through January (three consecutive months). Teresa meets all of the conditions:
n She is residing in an LTCF.
n She has been certified for a temporary stay.
n She has costs to maintain and retain her residence.
n She did not live with a spouse, child, sibling or parent prior to admission to the LTCF.
On December 21 Teresa’s worker receives a new DHS-1503 indicating that Teresa’s stay has been extended and is anticipated to last an additional four months.
Action:
Teresa is no longer entitled to the home maintenance allowance because her stay no longer meets the temporary stay conditions. Update her LTC income calculation to begin using the personal needs allowance for January.
Example:
Clyde is a bachelor who entered the LTCF from his apartment on January 3. The DHS-1503 indicated he is anticipated to be in the facility for 91-180 days.
Action:
The worker contacts the facility and determines that Clyde is expected to be in the LTCF until early June. He does not meet the conditions for using the home maintenance allowance because his stay is expected to last more than three calendar months. He receives the clothing and personal needs allowance.
The worker is notified that Clyde was discharged home on March 3, three months early.
Action:
No adjustment is needed to the previous LTC income calculations which used the clothing and personal needs allowance rather than the home maintenance allowance because the worker acted on the certified information available.
Example:
Serina entered the LTCF on January 28 from her home, which she owned and lived in alone. Her cost of care was paid for by insurance until February 29. Serina applies for MA coverage to begin March 1. The DHS-1503 indicates Serina’s anticipated discharge is in April.
Action:
The home maintenance allowance is available to Serina because her anticipated stay is less than three calendar months. The length of stay determination is not affected by the fact that part of her stay was paid by insurance.
The Maintenance Needs Allowance is only available to Elderly Waiver (EW) clients whose income is less than or equal to the Special Income Standard (SIS).
l The other three needs allowances cannot be used in the SIS-EW income calculation.
l The Maintenance Needs Allowance is the total of the Minnesota Supplemental Aid (MSA) equivalent rate and the Clothing and Personal Needs Allowance amount. It is adjusted July 1 of each year. See LTC Allowances for exact figures.
l Allow the Maintenance Needs allowance as a deduction for both spouses if they are both SIS-EW.
For clients moving between a LTCF and SIS-EW follow these provisions for updating the needs allowance:
l LTCF to immediately beginning SIS-EW.
Update the income calculation to the Maintenance Allowance beginning the first of the month following the month they move to the community.
l SIS-EW to LTCF.
Update the income calculation to the Clothing and Personal Needs Allowance, Veterans Improved Pension or the Home Maintenance Allowance beginning the month following the month they enter the LTCF.