30.01 Definitions

Accounting period. The one-month or six-month span of time used to budget the income of an individual requesting Medicaid. Community living arrangement A community living arrangement includes any residence, such as a house, apartment, residential care home, assisted living facility, boarding house, or rooming house. In a community living arrangement, the individual requesting Medicaid obtains and pays for basic maintenance items, such as food, shelter, clothing, personal needs, separately from medical care. The individual requesting Medicaid may live alone, as a member of a family, or with non-relatives. An individual requesting Medicaid coverage of long-term care services and supports is not considered to be in a community living arrangement. [Reserved] Long-term care living arrangement. An individual requesting Medicaid coverage of long-term care services and supports, including services and supports in a home and community-based setting, is considered to be in a long-term care living arrangement. Medicaid eligibility is determined according to the applicable long-term care Medicaid eligibility rules. Financial Methodologies Part 5 – Page 56 (Sec.30.00, Sub.30.02) An individual receiving hospice services is considered to be in a long-term care living arrangement.32 An individual receiving hospice services is: Terminally ill; Would be eligible for Medicaid coverage of long-term care services and supports if they lived in a medical institution; and Needs additional interdisciplinary medical care and support services to enable them and their families to maintain personal involvement and quality of life in their choice of care setting and site of death. Income spenddown. The amount of qualifying medical expenses an individual must incur to reduce their excess income to the maximum applicable to their Medicaid coverage category. Resource spenddown. The amount an individual must spend to reduce their excess resources to the resource standard applicable to the appropriate Medicaid coverage category.