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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 5 Chapter 24 Long Term Care

NURSING FACILITY SERVICES 24.4 APPLICATION/REDETERMINATION Payment for nursing facility care is a service available to eligible Medicaid clients. Eligibility for payment for nursing facility services is determined in any of the following four ways, in priority order; also see Section 24.7.2. 1. Qualified Medicare Beneficiary (QMB) clients, when Medicare is participating in the nursing facility payment, or will participate when the client enters the nursing facility. 2. Full coverage Medicaid clients. 3. Nursing Facility coverage group – nursing facility residents who meet a special income test. 4. Supplemental Security Income (SSI)-Related/Monthly Spenddown – when the monthly Medicaid rate for the facility in which the client resides equals or exceeds his monthly spenddown amount, the spenddown is assumed to be met and Medicaid eligibility is established. 24.4.1 THE APPLICATION PROCESS 24.4.1.A QMB Clients When a client needs nursing facility services and Medicare participates in payment, it may be to the client’s advantage to receive payment for nursing facility services as a QMB-eligible until Medicare no longer participates. See Section 24.7.2 for additional information. See Chapter 1 for the application process for QMB. 24.4.1.B Full Coverage Medicaid Clients When the individual is a client under a coverage group which provides full Medicaid coverage at the time he is determined to need nursing facility services, his Medicaid eligibility has already been determined; however, the transfer of resources, trusts and annuities provisions outlined in