*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: October 1, 2008 |
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23.15 - LTC Income Calculation |
Archived: June 1, 2016 (Previous Versions) |
Use the long-term care (LTC) income calculation to determine the amount of LTC spenddown or waiver obligation.
Include only the income of the person requesting LTC services in the LTC income calculation.
After determining when to begin the LTC income calculation, determine the person’s countable gross income and deductions from gross income to arrive at the LTC spenddown or waiver obligation.
When to Begin the LTC Income Calculation.
When to End the LTC Income Calculation.
Retroactive Eligibility Prior to Receipt of LTC Services.
When to Begin the LTC Income Calculation
The LTC income calculation begins in the month that a person begins receiving LTC services or in the month following the month LTC services begin, depending on whether the person has a community spouse.
Person with a community spouse:
l Start the LTC income calculation in the month that LTC services begin.
Person without a community spouse:
l Start the LTC income calculation in the month following the month that LTC services begin.
Calculate a shortened spenddown for MA enrollees who were eligible with a six-month spenddown prior to the start of the LTC income calculation.
When to End the LTC Income Calculation
The LTC income calculation ends in the month that a person stops receiving LTC services or in the month before the month that LTC services stop, depending on whether the person has a community spouse.
Person with a community spouse:
l End the LTC income calculation in the month that LTC services end.
Person without a community spouse:
l End the LTC income calculation in the month before the month that LTC services end.
Exception: Continue the LTC income calculation through the month in which a person who resides in a long-term care facility (LTCF) or receives Elderly Waiver (EW) dies.
Calculate eligibility using a community income calculation for the remaining months of the certification period after the month the LTC income calculation ends. The client must be able to meet a monthly spenddown. Close eligibility with timely notice if the client cannot meet a monthly spenddown.
Retroactive Eligibility Prior to Receipt of LTC Services
Use a community income calculation for any months the person requests coverage prior to the month in which the LTC income calculation begins.
Example:
Paula is admitted to a LTCF on June 7. On June 9, she applies for MA and requests MA payment of LTC services. She also requests retroactive coverage back to April 1. Paula has a community spouse.
Action:
Begin the LTC income calculation in June because Paula has a community spouse and was admitted to the LTCF in June. Use a community income calculation for a household size of two for April and May.