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UPDATED: JUNE 2011

471

OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

community based long-term care services. SSI-related Medicaid applicants who are not seeking coverage of long-term care services may attest to the amount of their resources rather than provide proof. (See RESOURCES DOCUMENTATION REQUIREMENTS) 2. Community Coverage with Community-Based Long-Term Care which includes all Medicaid covered care and services except nursing facility services. (See RESOURCES DOCUMENTATION REQUIREMENTS) SSI-related Medicaid applicants electing to apply for this coverage must provide proof of their current resources. 3. Medicaid coverage of all covered care and services which includes nursing facility services. SSI-related Medicaid applicants electing to apply for this coverage must provide documentation of resources for the past 60 months in accordance with transfer of resource policies. (See RESOURCES TRANSFER OF ASSETS )

Local districts must inform SSI-related Medicaid applicants of the available coverage options and may require the applicant to sign a “Request for Medicaid Coverage” or an approved local equivalent, indicating the coverage choice an applicant made.

It is important that the applicant understand the eligibility determination process, including the effect that the documentation of resources options have on the services the SSI-related individual may receive. The applicant must also understand that it is his/her responsibility to keep the district informed of any change in his/her income and/or resources and the need for a service which s/he does not have coverage.

If a recipient has active community coverage (with or without long term care) and subsequently is admitted to a nursing facility, Supplement A must be completed and resource and trust documentation submitted for the appropriate time period(s).

If an SSI-related recipient who attested to his/her resources subsequently requests coverage for long-term care services, the date of the request shall be treated as the date of the new application for purposes of establishing the effective date and the three-month retroactive period for increased coverage. Districts must send the recipient a “Long-Term Care Change in Need Resource Checklist” and inform the recipient of the additional documentation that is needed to determine eligibility for long-term care.

(MRG)