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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 19 Chapter 24 Long Term Care

receive payment for nursing facility services as a QMB-eligible, until Medicare no longer participates. QMB covers all Medicare co-insurance and deductibles. QMB clients are exempt by law from the post-eligibility process and, therefore, have no contribution toward their cost of nursing facility services, as long as Medicare participates in the payment. See Chapter 23. However, the Worker must use one of the following ways to determine eligibility, if it would be more beneficial to him than QMB. In addition, when Medicare stops participating in the cost of care, QMB eligibility no longer covers nursing care costs and eligibility must be redetermined according to the options below. 24.7.2.B Full Coverage Medicaid Clients When the individual is a client under a coverage group that provides full coverage Medicaid at the time he is determined to need nursing facility services, his Medicaid eligibility has already been determined. For all full coverage groups, the client must complete the Application for Long Term Care Services for Current Medicaid Clients (DFA-LTC-5) at application for LTC services to evaluate any annuities, trusts and/or other potential resources or transfers so the Worker can determine if there will be a penalty period. See Section 24.8. All Medicaid coverage groups listed in Chapter 23 are full Medicaid coverage groups, unless there is a statement specifically to the contrary. SSI-Related or AFDC-Related individuals who are required to meet a six month spenddown must have previously met their spenddown to be determined eligible under this provision. Those SSI-Related or AFDC-Related individuals who have no spenddown are Medicaid eligible. Those who meet their spenddowns prior to the need for nursing facility care have met the requirement to be eligible, through the current period of eligibility (POE). After the POE during which nursing facility services begin, the client’s eligibility is reviewed according to Section 24.7.2.C or Section 24.7.2.D below. Those who do not meet their spenddowns prior to the need for nursing facility care are reviewed for eligibility according to the two options described in Section 24.7.2.C and Section 24.7.2.D below. These clients’ contribution toward cost of care is determined in the post-eligibility process. There are no post-eligibility calculations for Modified Adjusted Gross Income (MAGI) coverage groups. When an applicant is not receiving full coverage Medicaid, the following test is made to determine eligibility.