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Effective: January 1, 2007 |
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23.50ar2 - LTC, EW and Assets (Archive) |
Archived: October 1, 2008 |
LTC and EW programs have additional asset policy to follow.
LTC/EW Clients with a Community Spouse.
Lump Sums and Periodic Payments.
Follow MA Method B asset policy when determining if a client’s asset total is within the appropriate asset limit.
Note: If both spouses are residing in an LTCF or receiving EW services, and one spouse is above the asset limit and the other below, then the spouse with the greater assets may transfer assets to the other spouse without penalty.
Long-term care (LTC) residents and Elderly Waiver (EW) clients who have a community spouse must complete an asset assessment when the LTC/EW spouse anticipates or has had a continuous LTC/EW Period.
Certain applicants and enrollees receiving MA payment of long-term care (LTC) services have a limit on the amount of equity they have in their home.
See Home Equity Limit for more verification information and the steps to determining if this requirement is met.
Lump Sums and Periodic Payments
LTC clients receiving a lump sum or periodic payment in a month must have assets reviewed for the month following receipt of the payment to determine if the client has excess assets.
Note: Excess assets should be reduced by the end of the month following the month the lump sum or periodic payment was received.
Example:
John resides in a LTC Facility. He has a LTC spenddown of $1300 per month. He currently has $2800 in his bank account. His cost of care is $3300 each month. In December of each year John receives a land rental payment of $3000.
Action:
The land rental payment must be included in the LTC income calculation for December, whether the payment can be anticipated or must be updated retroactively.
John’s total income for December is increased by $3300. He now has a LTC spenddown of $4300. His cost of care is less than his spenddown amount. John must have his income calculation recalculated because John now must have a Combination LTC/Medical Spenddown.
The income is recalculated resulting in a LTC spenddown portion of $3300 which is the cost of care amount and a medical spenddown portion is $700. He must meet the medical portion of the spenddown with additional medical expenses. John retains the remaining $300 of the rental payment into January.
Action:
John now has $3100 total assets for January. He is $100 over his asset limit. John must reduce assets to the asset limit to continue eligibility.
Review a client’s asset total when a refund from the LTCF is received to determine if the client remains within the asset limit.
l See LTC Spenddown for more information on LTCF refunds due to Medicare payment.
l See Excess Assets for more information on how a client may reduce assets to remain eligible.