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State of Maryland Medical Assistance Manual Revised April 2014

g. Redetermination Procedures for SSI Recipients Entering Long-Term Care (Policy Alert 10-08) When it is anticipated that an individual receiving Supplemental Security Income (SSI) will remain in a long-term care facility (LTCF) for more than thirty days, the CM must confirm with the individual, or his or her representative, that the change of address and living arrangement have been reported to the Social Security Administration (SSA). Upon admission to the LTCF, SSA will reduce the SSI- only individual’s monthly income to the $30.00 SSI Personal Needs Allowance. Any other income received by an SSI recipient must be verified. The form DHMH 257, which either requests a begin date for Medicare co-payment or satisfies Utilization Control Agent (UCA) authorization for nursing facility services, is required. Non- SSI individuals admitted to LTCFs who are eligible for community Medical Assistance, must file an application for long-term care Medical Assistance. This requirement is non-mandatory for the SSI individual. However, it is strongly recommended that a Medical Assistance long-term care (LTC) application is completed to satisfy administrative and post-eligibility requirements and to establish eligibility for Medical Assistance cost of care payments. The application ensures that: • A representative is identified if necessary; • Home property is evaluated for continued excludability and applicability of a lien; • Disposals of resources for less than fair market value are identified and properly treated; and • Any additional income is evaluated for availability toward the cost of care, spousal or family allowance, residential maintenance allowance, or dependent allowance. Please refer to Policy Alert 10-7 for procedures concerning the appropriate action to take when MCO- enrolled recipients move from community Medical Assistance to long-term care and when recipients enter one of the Institutions for Mental Diseases (IMDs). Failure To File A Long-Term Care Application Failure to file a long-term care application does not result in termination of eligibility, since an SSI recipient is categorically needy. However, if the long-term care application is not filed, and the information necessary to make an eligibility determination is not available to the CM, the long-term care case cannot be completed. Return the form DHMH 257 to the LTCF if an application has not be filed, since the applicant’s eligibility determination for long-term care cannot be made without the application and necessary verifications. Excess Resources If resources are found to be overscale, delay LTC certification until SSA has verified that SSI eligibility will continue. Send a manual notice indicating the reason for delay in processing the application as: awaiting response from SSA regarding continued SSI eligibility. If notified by SSA that the individual remains eligible for SSI, certify in the appropriate long-term care category. If notified by SSA that the individual is no longer eligible for SSI, enter the resource amount onto the appropriate CARES asset screen. Allow the system to determine eligibility. If resources exceed the $2000 SSI resource standard, but are within the $2500 MA medically needy resource standard, the person may be certified as LTC medically needy (L98). Include in the narrative the case action taken, including information received from the SSA.