Assignment of excess resources when Medicare pays 100 percent

An individual is not eligible if they have excess resources that must be assigned toward cost of care (medical institution) when there is no obligation to pay the facility for that month because Medicare or another TPL source is covering 100% of the cost. Deny eligibility for that month as there isn't a cost of care the individual is obligated to pay. Consider eligibility for the following month.

This is only for issues where the individual has excess resources and other coverage. If the individual doesn't have excess resources, Medicare or other TPL coverage does not affect eligibility.

For months where there is other coverage for only a part of a month, eligibility with excess resources will be based on the cost for the number of days the individual is obligated to pay, similar to a partial month with excess resources:

If the assigned excess plus income is greater than the cost for the number of days of individual's obligation, the individual isn't eligible.

If the assigned excess plus income is no greater than the cost for the number of days of individual's obligation, the individual is eligible and must pay the excess toward care.

Code the date the client starts having an obligation to pay as the payment authorization date.

Example #1: Excess, not eligible

Arlo is single and his monthly income is $2,000. On 2/1 his resources were $2500 after reducing for out-of-pocket medical expenses. He admits to the nursing home under Medicare on 2/19 and applies for Medicaid. Medicare is paying the cost at $100%. Because he has no obligation toward his cost of care, his excess resources cannot be assigned to an actual medical obligation. He is not resource eligible. Deny February for being over resources and consider eligibility for March.

Example #2: Excess, is eligible

Milly is single and her monthly income is $2,000. On 2/1 her resources were $2,000 after reducing for out-of-pocket medical expenses. She enters the nursing home under Medicare on 2/19 and applies for Medicaid. Medicare is paying the cost at 100%. She is eligible because her resources do not need to be assigned toward the cost of care.