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State of Maryland Medical Assistance Manual Revised April 2014

Evaluation of SSI Recipient’s Income The income of SSI-only recipients certified for LTC MA (L01) is reduced to the SSI Personal Needs Allowance of $30.00 per month. These individuals will never have income to contribute toward the cost of care in the LTCF. Also, there will never be income available for spousal, family, dependent, or residential maintenance allowances. However, any “other income” (e.g., Social Security benefit, pension, etc.) will be considered beginning the second month of institutionalization. These individuals will be in the L98 coverage group, and will receive a $40.00 per month Personal Needs Allowance and any other applicable deductions. Any remaining income will be contributed toward the monthly cost of care. Penalty Period Imposed Individuals who are eligible for coverage in the L01 or L98 coverage groups, except that a current penalty period exists due to the disposal of assets for less than fair market value, are not eligible for Program payment toward cost of care in the LTCF. Normally, CARES transmits the resource information to MMIS Screen 4, and a long-term care span is created that allows providers to bill for services rendered. In the case of a penalty being imposed, the MMIS Screen 1 will reflect eligibility in the L01 or L98 coverage group. However, Screen 4 will not reflect the long-term care span that is necessary for provider billing. When the asset- disposal information is entered onto the CARES “TRANS” Screen, a system edit precludes Cares from transmitting the resource information necessary to create a long-term care span onto the MMIS Screen 4. These individuals are however, entitled to receive the Medical Care Program card to cover medical expenses. Under these circumstances, after the penalty period has been calculated and entered onto CARES: • Send a manual Notice of Ineligibility for Medical Assistance long-term care due to the transfer or disposal of assets for less than fair market value. Include the amount of the transfer or disposal and the duration of the penalty period. • Include in the Notice that he or she is ineligible for Program assistance with payment toward the cost of care in the LTCF, however, he or she is eligible and will receive the Medical Care Program card to cover medical expenses. • Include COMAR citations and appeal rights. Please note: The CM must set an Alert to ensure that the case is reviewed and Program payment toward the cost of care begins when the penalty period is ended if the individual’s eligibility continues beyond the penalty period. Scheduled Redeterminations Redetermination packets will be automatically sent out every year for recipients in the L98 coverage group. For recipients in the L01 category, the CM should set an Alert at least once a year to review the case for any changes, e.g., change of nursing facility residence, sale of home property if a lien has been placed, change of representative, new assets, death, etc.. When the alert is received, take the following action: