DDCS LTC and Specialty Programs Unit (LTCSPU) financial - changes

Reporting requirements

Effective date of changes

WAC 182-504-0120 (subsection 11): When institutional medical assistance participation changes, we calculate the new participation amount beginning with the month income or allowable expense changes.

Effect of changes on medical program eligibility

The financial worker has 10 days to act on changes reported. Issue the appropriate award letter if there is a participation change or change of benefit.

Excess resources . The LTC financial worker reviews the individual's resources as of the first moment of the first day of the month. If the resources exceed the $2,000 resource limit but are below the state cost of care for the month, a new award letter to update the individual's responsibility toward the cost of care for that month. The resources are indicated on the appropriate screens in ACES for the month. Make sure the resource screens in ACES are updated for the ACES ongoing month to account for the application of excess resources being applied toward the cost of care.

Lump sums and long-term care . The financial worker: Determines the type/source of the lump sum payment. If the lump sum is a retroactive SSDI/SSI payment, exclude the income as a resource for 9 months. Set a barcode tickler to review case and request resource verification in the 9th month. If the payment is an unanticipated lump sum from another source, request a resource statement from the RHC and individual/guardian as of the first of the month following the receipt of the lump sum. If the lump sum amount plus the individual's available income exceeds the monthly projected cost of care, send a notice of termination (giving 10 days advance notice) for LTC and medical benefits. If the financial worker determines there is an overpayment and the individual no longer has the available funds to pay the adjustment, an overpayment needs to be established by the financial worker and sent to OFR.