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Effective: December 1, 2006 |
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23.45.10ar1 - Waiver Obligations (Archive) |
Archived: October 1, 2008 |
Special Income Standard (SIS) Elderly Waiver (SIS-EW) clients whose income is greater than $0 after the LTC income calculation have a waiver obligation.
Cost of Care Less than Waiver Obligation.
Waiver Obligation Adjustments.
SIS-EW clients with a waiver obligation are responsible to pay for EW services up to the cost of EW services.
l SIS-EW clients may use the designated provider option.
l SIS-EW clients cannot use the client option spenddown .
l SIS-EW clients participating in Minnesota Senior Health Options (MSHO) must pay the provider for services up to the waiver obligation amount.
Note: MSHO enrollees with a waiver obligation who pay the provider are not using the designated provider option and should not be coded in the system as such.
Clients whose EW cost of care is less than the waiver obligation are still eligible for SIS-EW. They may keep the income in excess of the cost of care.
Waiver obligations are allowed to be adjusted retroactively without providing advance notice.
Note: If a client’s waiver obligation increases retroactively, the system is currently not able to reprocess claims for those months. A request to the client may be made for voluntary repayment.
SIS-EW clients may move between a waiver obligation and a LTC spenddown or medical spenddown within a certification period if they have varying income.
l SIS-EW clients with a community spouse must be considered an EW client when income is estimated to be above the SIS.
n Continue to use an LTC income calculation but recalculate using deductions and allocations as appropriate.
n Change the waiver obligation to a LTC spenddown.
l SIS-EW clients who do not have a community spouse must use the MA Method B community income calculation and may have a medical spenddown for months in which income is estimated to be above the SIS.
Note: A ten-day notice is required to change the cost obligation from a waiver obligation to a medical spenddown.
Clients receiving a periodic income payment or a lump sum as an income increase, and which causes excess assets for the month following the receipt of the payment, must reduce assets. See the following manual sections for more information:
Example:
Tony is single, lives in the community and is eligible for EW. Tony is eligible for SIS-EW because his income is below the SIS. His LTC income calculation determines a waiver obligation of $332. His monthly cost of EW services is $400.
Action:
Tony is responsible to pay his waiver obligation of $332 because his cost of care is greater than his obligation.
Tony’s EW services change and his cost of care is now $250 a month.
Action:
Tony’s cost of care is now less than his waiver obligation. Tony only has to pay $250 and may retain the extra $82 of income.