550      ELIGIBILITY CATEGORIES FOR AN INDIVIDUAL LIVING IN AN INSTITUTION

550 a.     SSISupplemental Security Income OR APAAdult Public Assistance RECIPIENT LIVING IN AN iNSTITUTION

An individual who receives SSISupplemental Security Income or APAAdult Public Assistance cash assistance while residing in a medical institution or nursing facility may remain eligible for cash assistance and Medicaid.  Some individuals may be eligible for cash assistance because they are living in an institution.  Because these individuals are eligible for Medicaid as a cash assistance recipient, they are not subject to Medicaid cost of care requirements.  See Section 570.  However, they may have their cash assistance grant reduced.  See APA MS 450-5 and 452-5C.

Example 1:

Mr. Scott is a disabled man residing in the community with his employed wife.  He has no income of his own.  Because of his wife's income, Mr. Scott is not eligible for SSISupplemental Security Income or APAAdult Public Assistance.  On March 5th, Mr. Scott enters a nursing facility.  SSISupplemental Security Income rules require that the wife's income be considered as available to her husband through the month in which they cease to live together (March).  In April, his wife's income is no longer considered available to him since he is institutionalized, unless it is actually given to him.  Mr. Scott applies for SSISupplemental Security Income and APAAdult Public Assistance is found to be eligible as of April.  He is Medicaid eligible as of April 1 based on the receipt of SSISupplemental Security Income and APAAdult Public Assistance and is not required to contribute toward the cost of his care.  Mr. Scott is not Medicaid eligible in March.

Example 2:

Mr. Sawyer is a disabled man residing in the community and is receiving SSISupplemental Security Income and APAAdult Public Assistance.  On March 5th Mr Sawyer enters a nursing facility.  He is eligible for Medicaid based on receipt of his March SSISupplemental Security Income and APAAdult Public Assistance cash assistance.  It is determined that Mr. Sawyer will remain eligible for reduced SSISupplemental Security Income and APAAdult Public Assistance cash assistance in the institution because he has no other source of income.  He is Medicaid eligible and is not required to contribute toward the cost of care.

550 b.  iNDIVIDUAL ELIGIBLE FOR SSISupplemental Security Income, APAAdult Public Assistance CASH ASSISTANCE, OR REFUSED CASH MEDICAID IF NOT IN AN INSTITUTION

An individual who would be eligible for SSISupplemental Security Income, APAAdult Public Assistance cash assistance, or Refused Cash Medicaid if he or she were not residing in an intermediate care or skilled nursing facility is Medicaid eligible.  This individual cannot qualify for a cash assistance program because his or her needs are less in the institution than they would be if the individual were residing in the community.  First, establish eligibility and then establish the amount the individual must contribute toward the cost of care.  See Section 570 for policy on cost of care determinations.

550 c.      sPECIAL LONG TERM CARE ELIGIBILITY CATEGORY

Note:

Historically, this eligibility category was known as the Special Income 300% eligibility category because the income standard was 300% of the SSISupplemental Security Income standard.  In 2003, the income standard was frozen at the 2003 level of $1,656 and no longer reflected 300% of the current SSISupplemental Security Income standard.  As of September 1, 2010, the Long Term Care income limit again reflects 300% of the prevailing SSISupplemental Security Income standard, which increases each year.

Nursing Home:  An individual who resides in an intermediate care of skilled nursing facility is Medicaid eligible if the individual:

1. Meets all requirements of the SSISupplemental Security Income or APAAdult Public Assistance program except for income and the financial eligibility rules in Sections 553 - 555;
    

2. Has gross income equal to or below the Long Term Care Income Standard (no income disregard applies) See Addendum 1 for amount; and
   
   Has resided in the institution for 30 consecutive calendar days. If the individual in the institution dies on or before the 30th day, the deceased individual is considered to have met the 30 day requirement.
   
   Although the individual may not qualify for the Special LTC category until day 30 of institutionalization, their effective date of eligibility is retroactive to the first day of the 30-day period of institutionalization.  

HCBHome and Community-Based Waiver:  An individual who has been approved by DSDSDivision of Senior and Disabilities Services to receive Home and Community Based (HCB) waiver services is Medicaid eligible if the individual:

1. Meets all requirements of the SSISupplemental Security Income or APAAdult Public Assistance program except for income, age and the financial eligibility rules in Sections 553 - 555; and
    
2. Has gross income equal to or below the Long Term Care Income Standard (no income disregard applies) See Addendum 1 for amount.  When determining eligibility for a disabled child who has a current DDSDisability Determination Service decision on file, the income and resources of the child's parents are not counted, even if the child is living with his or her parents.  Individuals who can qualify for Medicaid under regular need standards are not subject to the Long Term Care income eligibility standard.

Because a recipient of HCBHome and Community-Based waiver services lives in his or her own home (or assisted living home), and not in an institution, the 30-day waiting period described above does not apply.