Page 35

35

5. The PLA medically needy full maintenance for 1 (or 2 for spouses in the same LTC room). Do not deduct for the spouse or dependents at home.

C. Multiply the remaining income by the number of months in the prospective or retroactive certification period to determine the deductible amount. 1. The result, rounded to the nearest whole dollar (50 cents-up; 49 cents- down), is the amount of the deductible which must be met.

a. Do not apply the cost of care toward the deductible because it has already been deducted from net countable income in XII.B.4., above. Refer to MA- 2360, Medicaid Deductible, for allowable charges to count toward the deductible.

b. Eligibility for all other Medicaid covered services begins no earlier than the day the deductible is met.

2. There is no financial responsibility for spouses not living together. Therefore, do not apply the medical expenses of the spouse at home to the a/b's deductible.

D. When all eligibility criteria are verified, including documentation that the a/b can reasonably be expected to meet the deductible: 1. At application: a. Send the DHB-5099/5099s, Your Application for Medicaid is Pending for a Deductible, notifying the applicant and/or representative of the deductible amount. b. Send a manual DHB-5016, Notification of Eligibility for Medicaid/Amount and Effective Date of Patient's Liability to the facility notifying it of the applicant's patient monthly liability (PML). The PML is the facility's reimbursement rate for a 31 day month. c. When the deductible is met, approve the application and authorize the case. The automated DHB-5016 will be issued by NC FAST. 2. At the end of the first (and any subsequent) certification period: a. If the deductible was met,

(1) Notify the applicant and/or representative of the new deductible amount and recertify for an additional 6 months.

(2) Send a manual DHB-5016 to the facility notifying it of the PML. See XII.D.l.b., above. b. If the deductible has not been met, propose termination. c. When the deductible is met, authorize the case. NC FAST will issue the DHB-5016.

E. Whenever a Step III deductible is met, whether at approval of the application or when a certified case is authorized and the PML is keyed, Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493