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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page ii Chapter 24 Long Term Care

24.4.3 SPECIAL PROCEDURES RELATED TO APPLICATION AND REDETERMINATION PROCESSING ......................................................................................................................12 24.4.3.A Authorized Representative Resides in Another State .......................................13 24.4.3.B Authorized Representative Resides in Another County ....................................13 24.4.3.C Correct County of Residence for Nursing Facility Applicants ............................13 24.5 COMMON ELIGIBILITY REQUIREMENTS ................................................................15 24.5.1 EXPRESSION OF INTENT TO LIVE IN WEST VIRGINIA .......................................15 24.5.2 MINORS ..................................................................................................................15 24.5.3 PLACEMENT BY OUT OF STATE AGENCY ..........................................................16 24.6 ELIGIBILTY DETERMINATION GROUPS .................................................................17 24.6.1 THE ASSISTANCE GROUP (AG) ...........................................................................17 24.6.2 THE INCOME GROUP (IG) .....................................................................................17 24.6.3 THE NEEDS GROUP (NG) .....................................................................................17 24.6.4 CASE COMPOSITION ............................................................................................17 24.7 INCOME FOR ELIGIBILITY DETERMINATION .........................................................18 24.7.1 BUDGETING METHOD ...........................................................................................18 24.7.2 FINANCIAL ELIGIBILITY PROCESS ......................................................................18 24.7.2.A QMB Clients .....................................................................................................18 24.7.2.B Full Coverage Medicaid Clients ........................................................................19 24.7.2.C Nursing Facility Coverage Group, Gross Income Test ......................................20 24.7.2.D SSI-Related / Monthly Spenddown ...................................................................20 24.7.2.D.1 Spenddown Calculation ..............................................................................20 24.7.3 POST-ELIGIBILITY PROCESS ...............................................................................21 24.7.3.A Income Disregards and Deductions ..................................................................22 24.7.3.A.1 Client’s Personal Needs Allowance (PNA) ..................................................22 24.7.3.A.2 Community Spouse Maintenance Allowance (CSMA) ................................22 24.7.3.A.3 Family Maintenance Allowance (FMA)........................................................23 24.7.3.A.4 Outside Living Expenses (OLE) ..................................................................24 24.7.3.A.5 Non-Reimbursable Medical Expenses (NRME) ..........................................24 24.7.4 FIRST AND LAST MONTH CALCULATIONS .........................................................28