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s/he is institutionalized (see Section 2.5: MA Income Eligibility Determination and Section 2.15: Determining Total Countable Income for P/A Calculation in this Chapter).

SSI Recipients 2.4.4

If an individual is a recipient of MA as a community-assistance unit and is also a recipient of SSI, s/he or his/her authorized representative is responsible for notifying the SSA of his/her plans to enter a LTC facility.

The SSI payment will be reduced to $70 (or less in some instances) if the individual has no other income. SSI will be terminated if the individual has other income that totals $45 or more. If SSI is terminated, then categorical eligibility (see Chapter 12: Categorical Eligibility in Part IV) is also terminated. If the individual's categorical eligibility is terminated, the SSR must advise him/her or the authorized representative to submit a new application for MA to the LTC Eligibility Unit.

MA INCOME ELIGIBILITY DETERMINATION 2.5

If an individual or couple is about to enter or has entered a LTC facility and is seeking assistance for the costs of LTC, s/he must first establish eligibility for MA (in many cases, individuals will already be MA- eligible; if this is the case, this section does not apply). An individual or couple over-income for MA but otherwise eligible for MA, may be eligible for LTC placement. LTC eligibility or payability is determined after MA eligibility is established (see Section 2.14: Patient Pay Amount (PPA) in this Chapter).

If the individual applies while residing in the community, the SSR should follow the policies detailed in Chapters 4-8 in Part VI for the appropriate MA category. If, however, an individual applies while residing in the LTC facility, then the LTC Eligibility Unit processes the application and not a service center. After a child has remained in the institution for 30 days, the parent's income is disregarded when determining MA eligibility and LTC payability.

Example 1 Mr. Goldman is divorced and lives in the community. He currently does not receive MA. Mr. Goldman learns that he may have to enter a LTC facility in the next few weeks following his scheduled surgery. He applies for MA. Since he is living in the community at the time of his MA application, the policies in Chapter 4 - 8 in Part VI apply, and an SSR in the appropriate service center determines his eligibility. Example 2 Ms. Raikes is widowed and unexpectedly enters a LTC facility. She applies for MA after her admittance to the LTC facility. Because she is residing in the LTC facility at the time of her MA application, the LTC Eligibility Unit processes her application.

Impoverished Spouse: If an individual with a community spouse is about to enter or has entered a LTC facility and is seeking assistance for the costs of LTC, s/he must first establish income eligibility for MA (in many cases, individuals will already be MA-eligible; if this is the case, this section does not apply). LTC eligibility (payability) is determined after MA eligibility (see Section 2.14: Patient Pay Amount (PPA) in this Chapter). If, however, the individual is over income for MA but has income of less than the cost of care in the LTC facility, the individual is eligible for LTC coverage.

If s/he applies while residing in the LTC facility, then his/her income is treated differently than it would be if s/he applied while residing in the community. In addition, if an individual applies while residing in the LTC facility, then the LTC Eligibility Unit processes the application and not a service center.