No Previous Policy

A. To be eligible for the CTW, individuals must meet all the following criteria

1 . No age requirement

2. Meet eligibility criteria for a Medicaid coverage group; and

o Individuals may qualify under a community Medicaid group for aged, blind or disabled persons, under a Special Income group, or under the Spenddown Waiver group ( 384-2) .

3. Meets the level of care criteria as determined by the Division of Services for People with Disabilities (DSPD) ( 380-1 ).

Note - Individuals referred for the waiver who are not already on Medicaid or who have not already applied must file an application for Medicaid

B . Other Waiver Specific Rules for the CTW

1. Resources and Spousal Impoverishment (Assessment of Assets)

a. Married individuals applying for the Community Transitions Waiver, except those who will be on the MWI coverage group, need to have an assessment of assets completed, unless the individual's spouse does not meet the criteria of being a community spouse. Follow the rules in 573 for the assessment. Apply the spousal resource assessment to determine resource eligibility.

For individuals who were not in a nursing home or intermediate care facility prior to entering the CTW, set the assessment date as follows.

i. For individuals entering the waiver from a hospital, use the date of entry to the hospital as the assessment date. Ask the individual if he wants Medicaid coverage to pay for the hospital stay.

ii. Individuals entering the waiver from an assisted living facility, use the level of care date on the original 927 as the assessment date.

b. Single individuals must meet the aged, blind or disabled one-person asset test.

c. For any individual in the MWI group, see 384-1 MWI coverage group policy. Individuals eligible under the Community Transitions Waiver MWI category will not need an assessment of assets.

2. What does the individual pay?

a. Members who qualify in the SSI, SSI Protected, 100% FPL, and Special Income groups will not have a contribution to the cost of care.

b. MWI members will have to pay an MWI premium.

c. Members who qualify in the Special Income group receive certain deductions from their total income to determine their cost-of-care. See section 431-16 for post-eligibility deductions.

d. Members with income over the special income limit (spenddown group) will receive the regular aged, blind or disabled deductions to determine their spenddown.

3. The PMV rule applies to CTW members if someone else pays some or all of the member's shelter and/or food costs. See section 415-10 .

· Does not apply to the Special Income Group

4. Transfer of Assets rules ( 575 ) apply only to the Special Income group, do not apply transfer of asset policies to any of the Community Medicaid Coverage groups or to the Spenddown Waiver group.

a. If a penalty period for a transfer of assets was in place while the individual was in a nursing home or intermediate care facility, the penalty period would not apply after the individual leaves the institution.

b. A penalty period that began while someone was in a medical institution continues to run. If the individual returns to an institution while the penalty period is still in effect, Medicaid will not cover the institutional costs.

c. If a member eligible under the Special Income group transfers assets for less than fair market value resulting in a penalty period, that penalty period will carry over to eligibility under the Community Transitions Waiver until the end of the applicable penalty period. The member would not be eligible for waiver services until the penalty period ends, but may qualify for regular Medicaid services.