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Job Aid Member Coverage Desciptions Version 1.0

3 © 2024 Gainwell Technologies. All rights reserved. Coverage Coverage Description Coverage Level 13 - Nursing Home, would be SSI if at Home Long Term Care - Eligible as SSI at-home. These are residents of a Nursing Facility, Hospital, ICF/IID or PRTF Facility who, based on income only, would be eligible for SSI if not institutionalized. Aged, blind, and disabled Individuals Individuals in long term care must pay toward the cost of care. The amount of the recipient's liability is referred to as Medicaid Income, which is total income less allowable deductions. Individuals with income over the limit can qualify under the terms of an Income Trust which obligates all of their income toward the cost of care and/or to Medicaid. If income exceeds the private pay rate for the facility in which the individual resides, the individual cannot qualify for Medicaid. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 014 - Long Term Hospitalization, would be SSI if at Home These are residents of a Nursing Facility, Hospital, ICF/IID or PRTF Facility who, based on income only, would be eligible for SSI if not institutionalized. Aged, blind, and disabled Individuals Individuals in long term care must pay toward the cost of care. The amount of the recipient's liability is referred to as Medicaid Income, which is total income less allowable deductions. Individuals with income over the limit can qualify under the terms of an Income Trust which obligates all of their income toward the cost of care and/or to Medicaid. If income exceeds the private pay rate for the facility in which the individual resides, the individual cannot qualify for Medicaid. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 015 - Swing Bed, would be SSI if at Home Long Term Care - Eligible as SSI at-home. These are residents of a Nursing Facility, Hospital, ICF/IID or PRTF Facility who, based on income only, would be eligible for SSI if not institutionalized. Aged, blind, and disabled Individuals. Individuals in long term care must pay toward the cost of care. The amount of the recipient's liability is referred to as Medicaid Income, which is total income less allowable deductions. Individuals with income over the limit can qualify under the terms of an Income Trust which obligates all of their income toward the cost of care and/or to Medicaid. If income exceeds the private pay rate for the facility in which the individual resides, the individual cannot qualify for Medicaid. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefit