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Effective: October 1, 2008 |
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23ar2 - MA Payment of Long-Term Care (LTC) Services (Archive) |
Archived: August 1, 2009 |
People who request MA payment of LTC services must meet specific eligibility requirements before MA can pay for their LTC services. People who meet the eligibility requirements for MA payment of LTC services may be obligated to contribute income toward the cost of the LTC services they receive. The amount of income that a person is obligated to contribute to the cost of LTC services is based on either an LTC income calculation or a community income calculation. From these calculations it is determined if a person has an LTC spenddown, a medical spenddown, a combination LTC/medical spenddown, or a waiver obligation.
Eligibility Requirements for MA Payment of LTC Services.
LTC services include:
l skilled nursing facility (SNF) care.
l nursing facility care in an inpatient medical hospital.
l intermediate care facility care (ICF, ICF/MR).
l services covered by home and community-based waiver programs (CAC, CADI, DD, EW, and TBI).
Eligibility Requirements for MA Payment of LTC Services
People who request request MA payment of LTC services must meet the following specific eligibility requirements in order for MA to pay for those services.
1. Meet all MA eligibility requirements, such as having countable assets within the asset limit, cooperating with third party liability requirements and documenting citizenship.
Note: Refer to Asset Assessments for special asset rules that apply to the treatment of assets of a married couple when one spouse resides in an LTCF or requests home and community-based services through the EW program and has a community spouse.
2. Have received a Long-Term Care Consultation (LTCC). The LTCC must be completed within the 60 days before the LTC services began and must resulting in a demonstrated need for LTC services that are anticipated to be received for at least 30 consecutive days.
Note: People requesting services through the Developmental Disability (DD) waiver must have a full team screening. The full team screening takes the place of the LTCC and meets this requirement.
3. Have home equity of $500,000 or less unless an exception applies.
4. Name DHS a preferred remainder beneficiary of certain annuities owned by the person or the person’s spouse.
5. Not be subject to a transfer penalty.
l Long-Term Care Consultation (LTCC).
Includes information on what an LTCC is, LTCC referrals and functions, and waiver program, Alternative Care (AC) and preadmission screening verifications.
l Determining Which Income Calculation to Use.
Provides information to determine if a community income calculation or an LTC income calculation is used to calculate how much income a person must contribute toward the cost of LTC services. An explanation of the Special Income Standard (SIS) for the EW program is also discussed.
Provides information to determine when to begin or end the LTC income calculation, what income is counted and what deductions are allowed in the LTC income calculation, and how to calculate community spouse and family allocations.
l LTC Spenddowns and Waiver Obligations.
Provides information about LTC spenddowns, combination LTC/Medical spenddowns, and waiver obligations.