Procedures

Follow the steps below to determine ABD Medicaid eligibility under the ICWP class of assistance.

Step 1 Accept the A/R’s ABD Medicaid application. Step 2 Obtain information necessary to process application. Step 3 Verify that the A/R is receiving ICWP services through receipt of an ICWP Communicator from the case manager. The ICWP Communicator should indicate the beginning date of case management and the slot date. Step 4 Determine basic eligibility, including Length of Stay (LOS) and Level of Care (LOC). Refer to Chapter 2200, Basic Eligibility Criteria. Step 5 Determine financial eligibility. Consider the A/R to be in LA-D. See Chapter 2500, ABD Financial Responsibility and Budgeting, for procedures on whose resources to consider and the resource limit used in determining resource eligibility. Complete a Medicaid Cap budget to determine income eligibility. See Medicaid CAP Budgeting in Chapter 2510. If client’s income exceeds the Medicaid CAP, then client must establish a QIT in order to be determined eligible. If the A/Rs income includes SSI, STOP, deny application. SSI ICWP claims are directly billed to DCH through ICWP. Step 6 Determine the A/R’s cost share using the Community Spouse Maintenance Need Standard (CSMNS) as the personal needs allowance (PNA) and all other policies applicable to patient liability/cost share budgeting. If AR is over the Medicaid CAP and has a QIT please remember that there is the potential of a cost share with these cases. Step 7 Notify the A/R of eligibility/cost share. Do not approve Medicaid under the ICWP class of assistance for any month prior to the month of the slot date. Do not approve Medicaid under the ICWP COA if the A/R is under age 21 or age 65 or older. Step 8 Notify the ICWP Case manager by: Entering the Case Manager’s name and address in the system as an Authorized Representative. The Case Manager will then receive information concerning dates of eligibility and cost share. OR Completing Section II of the ICWP Communicator. Enter the Medicaid number on the top of the form. Send one copy to the Case Manager and scan the other into the document imaging system.