Page 12

MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL D-540.2 Division of Welfare and Supportive Services CHANGES Medical Assistance Manual CONVERTING TO HOME BASED WAIVER ELIGIBILITY 24 Jan 25 MTL 02/24 i. Notify the customer and authorized representative of the change in benefits. Allow adverse action for any reduction in benefits, including QMB. Add free form text to ensure a notice is generated.

j. Evaluate for parental financial obligation for children under 18 if there is no deeming of parental income/resources in determining eligibility.

Note: When a customer is converting from Institutional to a Home and Community Based Waiver in the middle of a month, post the HBW aid code for the waiver approval month. The GRIN screen must be completed with the date they leave the facility to allow Medicaid to pay the facility bills as well as provide Home based services in the same month. Complete Form 2817, Partial Month, to advise DHCFP of the partial institutional month.

D-540.3 Other MAGI Groups to SSI Case

a. Verify SSI eligibility. Create a sub-case if SSI recipient is not head of household, or if others in household have Medicaid.

b. Terminate eligibility under current category prior to cut-off and approve SSI eligibility for the following month. View and post a correct version to update the aid code, eligibility code and notify the customer of the change in benefits.

c. Evaluate for parental financial obligation for children under 18 if there is no deeming of parental income/resources in determining eligibility.

D-540.4 SSI Eligibility Terminating

a. When SSI eligibility terminates, evaluate each Public Law category. Update the appropriate information/STAT screens in NOMADS, view and post a correct version to update the aid code, eligibility code, and to notify the customer of the change in benefits.

b. Evaluate eligibility for Medicare beneficiary programs.

c. If Public Law criteria are not met and the recipient is a disabled child under age 18, terminate eligibility allowing 13 days adverse action time. Evaluate eligibility under the Child group and Nevada Check Up; if not eligible, advise the customer of possible Medicaid eligibility under the Katie Beckett program. (1902(e)(3) of the Social Security Act)

D-540.5 QMB/SLMB/QI1 Only to Medicaid with QMB/SLMB

a. Establish eligibility for the appropriate Medicaid category, e.g., SSI, State Institutional, etc.

b. Evaluate income and resources if applicable for Medicaid category.

c. Determine Patient Liability (P/L).