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Effective: December 1, 2006 |
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23.55ar1 - LTC, EW and Transfers (Archive) |
Archived: October 1, 2008 |
Clients who have made an improper transfer of income or assets are ineligible for payment of long-term care (LTC) or elderly waiver (EW) services for the months of penalty.
Note: Clients continue to be eligible for all other MA services.
Continue to use the LTC income calculation for clients with a transfer penalty period who meet the conditions for using an LTC income calculation even if the LTC/EW services will not be paid for by MA.
For months in which the entire month is penalized:
l LTCF residents and EW clients with a community spouse and income over the Special Income Standard (SIS) follow these steps:
1. Use a combination LTC/medical spenddown to determine the medical spenddown amount. Be sure to recalculate the LTC income calculation making any changes in deductions and allocations as appropriate.
2. Apply the client’s monthly LTC/EW cost of care to the medical portion of the spenddown.
n This amount will vary based on the cost of care and the number of days in a month.
n The client will be responsible for the cost of any LTC services.
3. Enter the spenddown and recipient amounts based on the calculations in MMIS.
l SIS-EW : These clients do not have a medical spenddown. MA eligibility will continue and LTC services will be denied. The client will be responsible for the cost of any LTC services.
l EW clients without a community spouse, and income over the SIS: These clients use the MA Method B community income calculation and transfer provisions.
For partial penalty months:
l LTCF residents and EW clients with a community spouse and income over the Special Income Standard (SIS) follow these steps:
1. Total the partial month penalty amount and the medical portion spenddown amount for clients using a Combination LTC/EW Spenddown.
2. Enter the amount as the client’s spenddown amount and recipient amount in MMIS.
l SIS-EW: These clients do not have a medical spenddown. Enter the partial penalty amount as the client’s spenddown amount and recipient amount in MMIS.
l EW clients without a community spouse, and income over the SIS: These clients follow MA Method B community income calculation and transfer provisions.