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E. From LTC To A Private Living Arrangement When a/b returns to PLA, review financial eligibility based on PLA rules. The transition to PLA budgeting is different depending upon how long an a/b has been in LTC.
1. Do not recompute the PML for the month of discharge if:
a. The a/b has a spouse or dependents at home; or
b. They were budgeted to return home in six months and is now returning.
2. For a/b, with no spouse or dependents, who was not budgeted to return to PLA within six months and returns to PLA within six months refer to V.D.3., above.
3. For a/b with no spouse or dependents who return home after six months, recompute the PML for the month of discharge.
From the patient monthly liability:
a. Deduct any reported UMN; and
b. Deduct PLA full medically needy income limit for one.
(1) If there is no excess income, report $0 PML for month of discharge.
(2) If there is excess income, round up or down to the nearest whole dollar and report the PML as the lesser of the following:
(a)Medicaid per diem times the number of days the a/b was…#
(a) Medicaid per diem times the number of days the a/b was in the facility (do not count the day of discharge).
(b)The amount of excess income#
(b) The amount of excess income
4. For the remainder of the c.p. determine eligibility using PLA procedures in MA- 2260, Financial Eligibility Regulations – PLA, for all M-AABD Coverage Groups.
a. If the a/b had a spouse or dependents at home, determine the new b.u., and include their income and needs in the determination of eligibility.
b. If the predicted medical expenses of the b.u. are expected to meet the deductible, continue the case in deductible status and authorize when the deductible is met.
c. If the predicted expenses will not meet the PLA deductible, terminate the case.
Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493