|
Effective: December 1, 2006 |
|
|
23.25ar1 - Choosing Appropriate Income Calculation (Archive) |
Archived: December 1, 2007 |
Clients receiving long-term care (LTC) or elderly waiver (EW) services may use either a community income calculation or an LTC income calculation. Which calculation to use is dependent on several factors which include:
l Whether the client has a community spouse.
l The length of stay or receipt of services.
This section provides information on which income calculation to use for LTC and EW clients. For information on when to begin or end the LTC income calculation, see Begining or Ending LTC Income Calculation.
Use the LTC income calculation for clients in the following situations:
l Reside in a long-term care facility (LTCF) and have established a Continuous LTC/EW Period.
l Reside in an LTCF, have a community spouse and anticipate establishing a Continuous LTC/EW Period.
l Reside in a medical hospital and have established a Continuous LTC/EW Period.
l Receive SIS-EW.
l Receive EW with income greater than the Special Income Standard (SIS) and have a community spouse.
l Receive EW with income greater than the SIS, but do not have a community spouse, and they are admitted to and reside in a hospital for 30 calendar days or more.
Note: These clients must have the community income calculation updated to an LTC income calculation after the client has been in the hospital for one full calendar month.
l Reside in a regional treatment center (RTC), MA is paying the cost of care and the client is either:
n Under the age of 21.
n Age 65 or older.
l Reside in an RTC - inpatient psychiatric hospital and are less than 22 years old and meet both of the following conditions:
n Received inpatient psychiatric hospital services continuously since before their 21st birthdays.
n Were eligible for MA on their 21st birthday while living in inpatient psychiatric hospital.
l Reside in a private inpatient psychiatric hospital, are less than 22 years old, have established a Continuous LTC/EW Period and meet both of the following conditions:
n Received inpatient psychiatric hospital services continuously since before their 21st birthdays.
n Were eligible for MA on their 21st birthday while living in inpatient psychiatric hospital.
l Reside in an inpatient psychiatric hospital, MA is paying for treatment, have established a Continuous LTC/EW Period and are either:
n Under the age of 21.
n Age 65 or older.
l Live in an Intermediate Care Facility for People with Mental Retardation or Related Conditions (ICF-MR).
Note: Minnesota Extended Treatment Option (METO) clients residing at the Cambridge State Operated Services (SOS) facility may be ICF-MR or Rule 36-IMD. Only those in the ICF-MR certified beds may use LTC budgets.
l Live in a State Operated Services (SOS) nursing home facility.
Note: As of February 2006, there are two SOS nursing home facilities in Minnesota. They are:
m Ah-Gwah-Ching.
m Woodhaven.
Example:
Dorothy enters the hospital on February 25. She is discharged home on March 6 and EW services start immediately. On April 25 Dorothy enters a nursing home.
Action:
Dorothy has established a Continuous LTC/EW Period. The 30 consecutive days began on February 25 and continued throughout receipt of EW services and entry into the LTCF. Dorothy will use an LTC Income Calculation. When that calculation begins is dependent on whether or not she has a community spouse.
Example:
Paulette (age 65) enters a medical hospital on February 14. On February 20 she is discharged to an inpatient psychiatric hospital. She is expected to be discharged on March 30 to an LTCF.
Action:
Paulette has established a Continuous LTC/EW Period beginning February 14. She will use the LTC income calculation for eligibility. The begin date of that calculation is dependent on whether or not she has a community spouse.
Note: If Paulette were between 21 and 65 years of age and did not qualify for MA, she would have IMD eligibility during the inpatient psychiatric hospital stay. Her Continuous LTC/EW Period would restart on April 1.
Use a community income calculation for clients in the following EW and LTC situations:
l Reside in an LTCF for less than a Continuous LTC/EW Period.
l Receive services through EW with income greater than the Special Income Standard (SIS) and who do not have a community spouse.
l Live in a non-Medicaid medical or nursing facility, such as a veterans hospital or a nursing home.
l Reside in decertified beds under Minnesota Extended Treatment Option (METO).
l Live in an LTCF but are receiving only QMB or SLMB.
l Receive services through one of the following waiver programs:
n Community Alternatives for the Disabled (CADI).
n Developmental Disabilities (DD).
n Community Alternative Care (CAC).
n Traumatic Brain Injury (TBI).
l Receive home and community-based services through the Alternative Care (AC) program.
Example:
Glenda receives Alternative Care services at home before she permanently enters the nursing home in June. She applies for MA in June requesting three months of retroactive coverage.
Action:
A community income calculation will be used for the retroactive months. Glenda is anticipated to establish a Continuous LTC/EW Period due to her permanent LTCF placement. Begin using a LTC income calculation according to begin/end date policy.