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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 29 Chapter 24 Long Term Care

During the first month of Medicaid participation in the cost of care, when the client is not in the facility for a full month, if necessary, the Worker can calculate how much the client retains for his personal needs and how much is contributed to the community spouse and other family members as follows: • Determine the client’s total monthly Personal Needs Allowance (PNA), CSMA, or FMA for a full month. • Divide the client’s monthly PNA, CSMA, or FMA by the actual number of days in the calendar month. This is the client’s daily deduction rate which is used for this purpose only. • Determine the number of days in the calendar month the client expects to reside in the facility and multiply the number of days by the daily deduction then round up. • The result is the amount of income the client may retain for the PNA, CSMA, or FMA. 24.7.5 FULL MEDICAID AND QMB ELIGIBLE CLIENTS When a client is eligible for payment for nursing facility services under a full coverage Medicaid group, and is also QMB eligible, he must pay his full monthly contribution, even when Medicare participates in his cost of care, unless Medicare participates for the entire month. When the contribution is prorated for the first or last month of care, it is prorated using the procedure above. The contribution is not prorated based on the date that Medicare begins or ceases participation. When the Worker learns that Medicare participated for an entire month for a QMB eligible client, a DFA-NH-3 must be completed manually by the Worker to change the contribution to $0 for that month. 24.7.6 DETERMINING THE CLIENT’S TOTAL CONTRIBUTION If the individual is a full Medicaid coverage client or in the Nursing Facility Medicaid coverage group without a spenddown, the resource amount determined in the post eligibility process from above is his total cost contribution. Because the amount of medical expenses used to meet the client's spenddown cannot be paid by Medicaid, the spenddown amount becomes part of the client's contribution toward his cost of care, unless the client has a community spouse. This amount is added to the resource amount determined above to determine the client’s total monthly contribution toward the cost of his nursing care.