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C. Effective date of LTC Budgeting

Long Term Care Budgeting begins:

1. The month after the CPI begins when placed in a Medicaid certified nursing facility or swing bed or inappropriate level of care bed in a general hospital.

2. The month after the CPI begins when the a/b is admitted to a general/acute care hospital, psychiatric unit of a state mental hospital, or PRTF and their inpatient stay (of any length) ends with a direct move to one of the medical facilities listed in II.A.1.a. or 1.b. above.

3. The month following the month of the 30th continuous inpatient day when placed in a general/acute care hospital, psychiatric unit of a state mental hospital, or PRTF.

For example, an a/b enters a general/acute care hospital on March 18th. The 30th continuous inpatient day is April 16th. Long-term care budgeting begins May 1st.

III. EXCEPTIONS TO LTC BUDGETING

Do not use LTC budgeting procedure when:

A. The case is under a transfer of resource sanction; or

B. The FL-2/MR-2 has not been received in the agency, if required; or

C. The FL-2/MR-2 recommends adult care home level of care; or

D. Individual resides in a facility which is not certified for Medicaid participation; or

E. The individual is under VA contract for payment of cost of care; or

F. The individual is not in a Medicaid bed. When any of these conditions occur, proceed to XIII. in this section for other instructions.

IV. DETERMINING ELIGIBILITY FOR THE MONTHS PRIOR TO LONG-TERM CARE BUDGETING

A. Individuals Under Age 21

If the institutionalized a/b is under 21, has not been determined disabled or blind (not receiving SSI/SSA or MAD), and is expected to remain institutionalized for over 12 full months, evaluate for long-term care eligibility under Family and Children's coverage groups.(See Family and Children’s Medicaid Manual, MA-3325, Long Term Care Budgeting.)

Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493