7534 Continuing Financial Medical Eligibility

When circumstances change, adjustments will be made as necessary depending on the category of medical coverage. For persons eligible based on receipt of SSI, changes of circumstances may affect the basis of eligibility . For the Medicaid Poverty Level and CHIP programs for children and pregnant women, changes in income will not impact eligibility based on continuous eligibility provisions. Changes in the amount of earned income do not impact eligibility for TransMed. All other changes must be evaluated to determine if eligibility criteria continue to be met; see 8111.1 (3) for information relating to minors.

For non-SSI cases, if a person goes from independent living (including a non-Medicaid approved institution or specialized living arrangement) to long term care in a Medicaid approved institution or to an HCBS arrangement or vice versa, the eligibility base will be adjusted beginning with the month of the living arrangement change. When an individual goes from independent living to long term care in a Medicaid approved institution, financial eligibility shall be recomputed for the actual time in independent living. A one month eligibility base period shall be established for all institutional months, including the month of entry and the month of discharge. When an eligible individual goes from independent living to an HCBS arrangement, financial eligibility shall be computed in accordance with 8272 .

When an eligible individual goes from long term care in a Medicaid approved institution or from an HCBS arrangement to independent living, a new 1 or 6-months eligibility base period shall be established beginning with the month following the month the care arrangement ends for institutionalized spouses for whom the provisions of 8144.2 have been applied or the month the care arrangement ends for all others. In the latter situations for Medically Needy, the amount of the previously established client obligation or the cost of care incurred by the individual in the month of discharge or service termination, whichever is less, shall be applied towards the spenddown for the new base. A new Medically Needy base period would not, however, be required for an individual subject to the provisions of 8172.2(2) and who goes from the adult care home to independent living. The 6-months base previously established in such cases would continue in these instances.