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5. Notify the a/b with the proper notice determined by the type of action taken. Refer to MA-2420, Notice and Hearings Process. F. Beneficiary In Nursing Home Level Moves To An Adult Care Home

1. The PML for the month of discharge is the nursing facility's Medicaid daily rate times the number of days at that level (exclude the day of discharge) up to the full PML.

2. Evaluate the a/b for Special Assistance. Refer to the Special Assistance Manual for policy requirements.

3. If the a/b is ineligible for Special Assistance, consider eligibility for other Medicaid covered services:

a. Budget like any other individual in a private living arrangement beginning the month following entry into adult care home.

b. Cost of room and board in an adult care home is not a medical expense; do not count towards the Medicaid deductible.

c. Cost of personal care services received in an adult care home is a medical expense. Verify with the provider the amount and count towards the Medicaid deductible. XII. PROCEDURES FOR OTHER MEDICAID COVERED SERVICES ONLY (STEP III) When an a/b’s PML (see V.C.7.b., above) exceeds the Medicaid reimbursement rate for the nursing facility they are ineligible for Medicaid to pay any of their cost of care. However, they may be eligible for Medicaid to pay other medical services. The section instructs you how to make this determination.

A. Use Step III procedures when: 1. Need (financial eligibility) was established in Step I; BUT

2. After all Step II deductions, the a/b’s income is equal to or greater than the facility's Medicaid rate for 31 days for the level of services being provided.

B. Subtract the following from the a/b’s gross monthly income to determine net countable income in Step III:

1. The monthly $20 general income exclusion;

2. Earned income exclusions (Refer to MA-2250, Income);

3. From net earned income, $65 earned income exclusion plus 1/2 of the remainder;

4. The facility's Medicaid rate for 31 days (FL-2 is required to establish level of care); and

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