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LTC APPLICATION PROCESS 2.4

Transfer of Case Record 2.4.1

Determining eligibility for LTC coverage (payability) is the responsibility of the LTC Eligibility Unit. An individual who is already a recipient of MA as a community-assistance unit (AR, AX, SR, or QM (must be Medicaid eligible)) must have his/her eligibility for LTC coverage re-determined by the LTC Eligibility Unit at the time of admission to a LTC facility (see Section 2.4.3: Assistance Unit Requirements in this Chapter). The SSR should transfer the recipient's MA case record to the appropriate LTC SSR (see Chapter 2: Case Transfers Between Service Centers in Part VIII).

Time Standards 2.4.2

See Section 2.3: Time Standards in Part III. In addition, if the Patient Start of Care Notice has not been received from the facility by the 45th day of pending disposition, the application for MA must be processed as if it was for a community-assistance unit (i.e., no eligibility for LTC coverage).

If the start of care date falls within the 45 days of pending disposition but not within the month of application, eligibility for the first month, or first and second months, must be established as a community- assistance unit. If the start of care date falls within the three months prior to the month of application, then the LTC SSR should determine if the LTC resident is eligible for retroactive LTC coverage.

Assistance Unit Requirements 2.4.3

The individual or couple entering a LTC facility must establish eligibility as either an AR, AX, SR, or QM (must also be Medicaid-eligible)) unit (see Section 2.5: MA Income Eligibility Determination and Section 2.9: MA Asset Eligibility Determination in this Chapter and Part IV: Non-Financial Eligibility). Once the individual or couple has been certified by the MAA (see Section 2.3: Medical Certification for LTC), then s/he is considered an SR unit, regardless if s/he was initially considered as an AR, AX, or QM unit.

If the individual or couple is residing in a LTC facility and has not yet established MA eligibility, then s/he must establish eligibility as an SR unit. Because s/he is establishing eligibility while residing in a LTC facility, his/her income and assets are treated differently (see Section 2.5: MA Income Eligibility Determination in this Chapter and Section 2.9: MA Asset Eligibility Determination in this Chapter).

If an individual who is residing in or entering a LTC facility has an eligible spouse who is residing in or entering the same LTC facility, include both spouses in the same assistance unit whether or not they share a room.

If the individual in LTC has an eligible spouse who is residing in a different LTC facility, each spouse is considered to be financially responsible for the other for the month of their physical separation. During this one-month period, both spouses are included in the same assistance unit.

See Exhibit VII-3: Provisions for Pre-October 1989 Institutionalization for additional policy for LTC residents institutionalized before October 1, 1989 who have a community spouse.

Impoverished Spouse: See above. However, if the individual in LTC is eligible for the Impoverished Spouse provisions (i.e., has a community spouse and was institutionalized after September 30, 1989), then no income from the community spouse should be deemed to the institutionalized spouse for any month in which