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State of Maryland Medical Assistance Manual Revised April 2014

month after ineligibility due to “spend-down”, the individual is responsible for the full cost of care in the LTCF. If an individual reapplies after the “spend-down” period expires, a new period under consideration is established. Any income that has been retained from the prior period under consideration is considered as a resource in the new period under consideration. G. Change in Deductions When the CM is informed of a change in a recipient’s deductions, this affects the recipient’s available income for the cost of care. A change is presumed to continue until the local department is otherwise notified. The CM recalculates the available income. A notice about the change in the recipient’s contribution towards the cost of care must be mailed to the recipient, any representative, and the LTCF at least 10 days before the effective date of the action. • A decrease in the recipient’s contribution towards the cost of care may take effect retroactively, in order to benefit the recipient. • An increase in the recipient’s contribution towards the cost of care may not take effect retroactively, only prospectively after timely and adequate notice of this adverse action.

H. Change in Level of Care An increase in level of care will not affect MA eligibility or available income. If a person’s level of care is reduced to less than intermediate, the person no longer has a medical need for LTC. The LDSS may not cancel payment to the facility based solely on the reduced level of care until the facility notifies the LDSS that the patient has been discharged, or the LDSS determines that the patient is otherwise ineligible. Medicaid will continue to make payments to the LTCF at the facility’s lowest rate as long as the facility documents, to the satisfaction of the UCA, that it is looking for suitable placement for the patient. Eligibility may be continued as long as this condition is met. I. Medicare Coverage A person receiving Medicare may be eligible to have Medicare pay all or part of the LTC expenses. Medicare will only pay LTC expenses for a person who requires skilled or chronic care and only for a limited period of time. Medicare will pay a portion of the daily rate, and the remainder is the “co-pay” rate (the amount to be paid by the person, the Program or other insurance). There is no action required by the LDSS when a LTC MA recipient begins or ends Medicare coverage. However, if an applicant is determined eligible for MA long-term care and needs coverage of Medicare co-pays or the cost of the Medicare deductible, the LTCF must send a 257 to the LDSS. The 257 does not require UCA approval since Medicare’s UCA has already determined the person’s level of care as either skilled or chronic. Upon receipt of the 257 request to begin Medicare co-payment, the CM must enter the following onto the “INST” screen: