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5. For a Medicaid member who was or could have been certified through a deductible before entering the institution, there is no cost of care until the deductible period ends. Note 503, DAC, Widow or Widower, and COLA disregards that are used in eligibility determinations for Special Status Medicaid are not used in Patient Liability Calculations. If the cost of care amount is equal to or more than the medical institution’s Medicaid rate, the individual is responsible for the entire cost of his or her institutional care. He or she would be entitled to keep any overage without restriction. He or she would remain eligible for the Medicaid program and have no further financial obligation to the Medicaid program for that month. 27.7.2 Hospitalized People Effective December 1, 2008, hospitalized people will be responsible for paying a patient liability. See SECTION 27.7.4 TRANSFERS BETWEEN INSTITUTIONS for information about patient liability calculations when a person transfers between a hospital and nursing home(s). 27.7.3 Partial Months If a member is residing in an institution (see SECTION 27.1 INSTITUTIONS) and not Medicaid-eligible as of the first of the month, there is no patient liability for that month. If a member was not institutionalized as of the first of the month or was discharged to the community prior to and including the last day of the month, there is no patient liability. However, if the member is enrolled in Family Care, Family Care Partnership, or PACE, he or she may owe a cost share to the MCO if a cost share is determined following the change in living arrangement. Exceptions: • There is a patient liability if the reason the person did not reside in the institution for the entire month was due to death or being on therapeutic leave. • There is a patient liability if the reason the person was not eligible for long-term care services for the entire month is because a divestment penalty period ended in that month. Members who are institutionalized for the entire month in which their divestment penalty period ends must pay the full patient liability for that month. 27.7.3.1 Death If the patient liability amount in the month of death is greater than the nursing home’s cost of care for that month and the nursing home or entity responsible for collecting the patient liability requests it, the patient liability can be adjusted to be equal to the nursing home charges for that month (see Process Help Section 12.18.1.2.3 Death). 27.7.3.2 Community and Nursing Home There is no patient liability in a month in which a member moves from one of the following: • The community into a nursing home after the first of the month. • From a nursing home to the community before the end of the month. This includes members moving from the nursing home to the community on the last day of the month.