Page 1945

West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 20 Chapter 24 Long Term Care

24.7.2.C Nursing Facility Coverage Group, Gross Income Test If the client is not currently eligible by having QMB or full coverage Medicaid, Medicaid eligibility may be established as follows: • If the client's gross countable monthly income is equal to or less than 300% of the current maximum Supplemental Security Income (SSI) payment for one person and the client is institutionalized, he may be eligible. • SSI-Related Categorical Medicaid requirements (aged, blind or disabled) and asset guidelines must be met. These clients’ contribution toward cost of care is determined in the post-eligibility process. There is no spenddown amount for these clients. 24.7.2.D SSI-Related / Monthly Spenddown If the client is not otherwise eligible by having QMB, full coverage Medicaid, or Nursing Facility coverage group, his eligibility as an SSI-Related Medicaid client with a monthly spenddown must be explored. All policies and procedures in effect for other SSI-Related cases apply to these cases, including the determination of a spenddown amount. 24.7.2.D.1 Spenddown Calculation 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. EXCEPTIONS: • Income is not deemed. • The Medically Needy Income Level (MNIL) for one person is always used. See Chapter 4, Appendix A. • The spenddown amount is a monthly period of consideration, rather than a six-month period.

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Page 1945

Official source

West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 20 Chapter 24 Long Term Care

24.7.2.C Nursing Facility Coverage Group, Gross Income Test If the client is not currently eligible by having QMB or full coverage Medicaid, Medicaid eligibility may be established as follows: • If the client's gross countable monthly income is equal to or less than 300% of the current maximum Supplemental Security Income (SSI) payment for one person and the client is institutionalized, he may be eligible. • SSI-Related Categorical Medicaid requirements (aged, blind or disabled) and asset guidelines must be met. These clients’ contribution toward cost of care is determined in the post-eligibility process. There is no spenddown amount for these clients. 24.7.2.D SSI-Related / Monthly Spenddown If the client is not otherwise eligible by having QMB, full coverage Medicaid, or Nursing Facility coverage group, his eligibility as an SSI-Related Medicaid client with a monthly spenddown must be explored. All policies and procedures in effect for other SSI-Related cases apply to these cases, including the determination of a spenddown amount. 24.7.2.D.1 Spenddown Calculation 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. EXCEPTIONS: • Income is not deemed. • The Medically Needy Income Level (MNIL) for one person is always used. See Chapter 4, Appendix A. • The spenddown amount is a monthly period of consideration, rather than a six-month period.