Procedures

Follow the steps below to determine ABD Medicaid eligibility under the Nursing Home COA.

Step 1 Accept the A/R’s Medicaid application. Step 2 Verify from the receipt of a Form DMA-59 from the nursing home that the A/R resides in a nursing home or TCU. Verify from the receipt of an approved LOC instrument that the A/R resides in a swing bed or that the A/R is in a facility for the mentally retarded (may be a NH). Step 3 Conduct an interview. A telephone interview is acceptable. Step 4 Determine basic eligibility, including Length of Stay (LOS) and Level of Care (LOC). LOC verification may vary depending on whether A/R is in NH, TCU, swing bed or has a LOC of IC-MR. Refer to Chapter 2200, Basic Eligibility Criteria. Step 5 Determine financial eligibility. Refer to Chapter 2500, ABD Financial Responsibility and Budgeting for procedures on whose resources to consider and the resource limit to use in determining resource eligibility. Complete a Medicaid CAP budget to determine income eligibility. Refer to Section 2510, Medicaid CAP Budgeting Step 6 Approve Medicaid using the Nursing home COA if the A/R meets all the above eligibility criteria. The system will determine the A/R’s patient liability based on information entered. Do not approve Medicaid under the Nursing Home COA for any month in which the A/R was not confined to a nursing home for at least one day of the month. Step 7 Notify the A/R and/or PR and the nursing home of the case disposition and patient liability.

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Procedures

Official source

Follow the steps below to determine ABD Medicaid eligibility under the Nursing Home COA.

Step 1 Accept the A/R’s Medicaid application. Step 2 Verify from the receipt of a Form DMA-59 from the nursing home that the A/R resides in a nursing home or TCU. Verify from the receipt of an approved LOC instrument that the A/R resides in a swing bed or that the A/R is in a facility for the mentally retarded (may be a NH). Step 3 Conduct an interview. A telephone interview is acceptable. Step 4 Determine basic eligibility, including Length of Stay (LOS) and Level of Care (LOC). LOC verification may vary depending on whether A/R is in NH, TCU, swing bed or has a LOC of IC-MR. Refer to Chapter 2200, Basic Eligibility Criteria. Step 5 Determine financial eligibility. Refer to Chapter 2500, ABD Financial Responsibility and Budgeting for procedures on whose resources to consider and the resource limit to use in determining resource eligibility. Complete a Medicaid CAP budget to determine income eligibility. Refer to Section 2510, Medicaid CAP Budgeting Step 6 Approve Medicaid using the Nursing home COA if the A/R meets all the above eligibility criteria. The system will determine the A/R’s patient liability based on information entered. Do not approve Medicaid under the Nursing Home COA for any month in which the A/R was not confined to a nursing home for at least one day of the month. Step 7 Notify the A/R and/or PR and the nursing home of the case disposition and patient liability.