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Chapter: 2000 Coverage Groups Program: MSSI, SFP 21 7. not be receiving Medicare, or 8. if receiving Medicare also be receiving institutional, hospice or home and community based services.

Individuals are considered to be receiving home and community based services (HCBS) when they are:

1. enrolled in and meet the level of care (LOC) as determined by the Department of Elder Affairs (DOEA), and Comprehensive Assessment and Review for Long-Term Care Services (CARES) or 2. enrolled in the Program of All-Inclusive Care for the Elderly (PACE). 2040.0813.04 Date of Entitlement for MEDS-AD (MSSI) The date of entitlement for Medicaid benefits begins the first day of the month in which the individual files an application and is determined to meet all factors of eligibility for the month of application and subsequent months. 2040.0813.05 Benefits Received through MEDS-AD (MSSI) Individuals who are eligible under this coverage group are eligible for all Medicaid benefits. An individual may also be eligible for institutional care, Hospice or HCBS services under this coverage group if the individual also meets the additional Title XIX criteria. 2040.0814.01 Hospice (MSSI) The Medicaid Hospice Program is a Medical Assistance Program. It provides special services to terminally ill individuals to maintain the individual at home for as long as possible, providing the best care available. (Hospice services are also available to an individual in a nursing home.)

If the individual is not already Medicaid eligible, he must meet all SSI-Related Medicaid technical criteria and have income and assets within the limits for ICP, MEDS-AD or MN. In addition, all individuals must meet additional criteria to receive Hospice services. 2040.0814.02 Additional Criteria for Hospice Eligibility (MSSI) The additional criteria for Hospice eligibility include:

1. prognosis that life expectancy is six months or less (if the illness runs its normal course), certified by medical statement of the physician’s or medical director’s judgment regarding the normal course of the individual’s illness. (This serves as certification of disability.) 2. a signed Hospice election statement stating that he selects Hospice to the exclusion of other regular Medicaid services. 3. individual must be served by a qualified Hospice provider. 2040.0814.03 Hospice for Institutionalized Individual (MSSI) If an individual requires Hospice care in a nursing home and has a spouse in the community, spousal impoverishment policies apply. (Refer to Chapters 1600 and 1800 for specific policy.) 2040.0814.04 Medically Needy Hospice (MSSI) If an individual has income and/or assets over the ICP income limit but within the Medically Needy limit, he can be eligible for Medicaid Hospice care when the share of cost has been met. 2040.0815.01 Home and Community Based Services (MSSI) Home and Community Based Services (HCBS) Programs is considered as the Medicaid Waiver Programs. Their purpose is to prevent institutionalization of the individual by providing care in the community with specific providers. Refer to 0240.0111 for a list of Medicaid Waiver Programs.