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Effective: December 1, 2006 |
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23.40ar1 - LTC Income Calculation (Archive) |
Archived: December 1, 2007 |
The purpose of the long-term care income calculation is to determine a person’s long-term care spenddown or waiver obligation. For help determining whether a client should use an LTC income calculation, see Choosing the Appropriate Income Calculation.
Requirements for Use of LTC Income Calculation.
LTC Income Calculation and Hospice.
Requirements for Use of LTC Income Calculation
Clients who are living in a long-term care facility (LTCF) or receive Elderly Waiver (EW) services use a LTC income calculation if they meet the following criteria:
l They have established a continuous LTC/EW period.
l Live in an LTCF or receive EW services.
l Have a long-term care consultation (LTCC).
In addition:
l Clients with a transfer penalty period who meet the conditions for using a LTC income calculation must continue to do so even if the LTC/EW services will not be paid for. See LTC, EW and Transfers for more information.
l If both spouses of a married couple are residing in an LTCF or receiving EW Services, use separate LTC income calculations for each.
Example:
Julie and John are a married couple who both receive EW services.
Action:
Both Julie and John will use a LTC income calculation to determine EW eligibility. Each is a household size of one.
LTC Income Calculation and Hospice
Clients residing in an LTCF or are SIS-EW or EW with a community spouse will continue to using the LTC Income Calculation when receiving care through hospice.
l Update the designated provider from the LTCF to the hospice provider, even if the client participates in Minnesota Senior Health Options (MSHO).
l Update MMIS according to system instructions.
Income calculation steps for LTC are:
1. Determine the gross earned and unearned monthly income for the client only. Do not average income. See LTC Income for further instructions on calculating the total monthly income.
2. Deduct allowances and deductions in the order listed to arrive at the LTC spenddown or waiver obligation.
b. Special Personal Allowance.
See LTC Income for details on this allowance.
c. LTC Medicare Premium Deduction.
d. LTC Needs Allowance.
There are four types of allowance that may be used as a deduction which are dependent on the client’s program and/or living situation.
f. LTC Community Spouse Allocation.
Note: Do not allow this allocation when the spouse living in the community is receiving EW.
g. LTC Court-Ordered Child Support.
h. Family Allocation.
Note: Do not allow this allocation for clients who are using an LTC income calculation for all Elderly Waiver (EW).
j. Medical Expenses.
Note: Do not allow this allocation for clients who are using an LTC income calculation for Elderly Waiver (EW). Allow it for SIS-EW clients.
3. Results greater than $0 indicate the client has an LTC Spenddown and Waiver Obligation.
Note: Clients with $0 income remaining after calculating income do not have a cost obligation for eligibility.