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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 18 Chapter 24 Long Term Care

24.7 INCOME FOR ELIGIBILITY DETERMINATION There is a two-step income process for providing Medicaid coverage for nursing facility services to individuals in nursing facilities. The client must be eligible for Medicaid and there must be a determination to see if the client must contribute to the cost of care. Medicaid eligibility can be established by virtue of being a Qualified Medicare Beneficiary (QMB) client, of being a member of a full Medicaid coverage group, by meeting a special income test for the nursing facility coverage group, or by meeting a SSI-Related/Monthly Spenddown. See Chapter 23 to determine which coverage groups provide full coverage Medicaid. Once Medicaid eligibility is established, if applicable, the client's contribution toward his cost of care in the facility is determined in the post-eligibility process. The post-eligibility process is described in Section 24.7.3 below. 24.7.1 BUDGETING METHOD See Section 4.6 for generally applicable information about determining income. Monthly income is determined based on averaging income over multiple months, if applicable, and converting or prorating income for time periods other than monthly from each source. For each month of residence in a facility, all countable income must be used in determining eligibility and in post-eligibility calculations, even if he resides only one day in the facility. No deductions or exclusions are allowed for income already spent in the month the client enters the nursing facility or for expenses he anticipates in the month he leaves. 24.7.2 FINANCIAL ELIGIBILITY PROCESS Eligibility for payment for nursing facility services is determined in any of the following four ways, in priority order. 24.7.2.A QMB Clients When a client needs nursing facility services and Medicare is participating in the payment or will participate when the client enters the nursing facility, it may be to the client's advantage to