Page 188

UPDATED: JUNE 2010

285

INCOME PERSONS IN MEDICAL FACILITIES

CHRONIC CARE BUDGETING METHODOLOGY FOR INDIVIDUALS

Policy: Chronic care budgeting procedures are used for institutionalized individuals in permanent absence status. References: SSL- Sect. 366

366-ee

Dept. Reg. 360-1.4(c), (k) and (p)

360-4.9

ADMs 10 OHIP/ADM-01

89 ADM-47

GIS

09 MA/027

08 MA/022 Interpretation: For chronic care budgeting purposes, an institutionalized individual is a person in permanent absence status who does not have a community spouse. (See the GLOSSARY for the definition of community spouse and the definition of permanent absence)

NOTE: When both members of a couple are in permanent absence status, they are each budgeted as individuals.

When an A/R enters a medical facility on a permanent basis, the first month or partial month of permanent absence, the A/R and any persons residing in his/her former household are budgeted as a community household. Appropriate disregards are used to determine monthly net income. The monthly income of the A/R and his/her household (if any) is compared to the Medically Needy Income level or Medicaid Standard (and MBL Living Arrangement Chart, as appropriate) whichever is most beneficial.

Unmarried ADC and S/CC-related recipients who are temporarily placed in a nursing home and subsequently become “permanently absent” will be budgeted using community budgeting rules until a disability determination is completed. Any excess income for the ADC-related recipient is the individual’s liability toward his/her nursing home care pending the disability determination.

(MRG)