470-2        CONTINUED BENEFITS FOR TEMPORARILY INSTITUTIONALIZED RECIPIENT

An APA recipient may continue to receive full APA benefits for up to 3 months while living in a long-term care facility, psychiatric facility, hospital, or while receiving nursing care in an Alaska Pioneers’ Home, which would otherwise result in either APA ineligibility or cause the recipient to be subject to the $75 personal needs payment.  To qualify for continued full APA benefits, the individual must meet and fulfill all of the following requirements:

1. The individual must be eligible for APA benefits for the month that he or she enters the institution.  Individuals who are SSI Supplemental Security Income recipients must also continue to receive SSI Supplemental Security Income benefits in order to qualify for continued benefits under this provision; receipt of SSI Supplemental Security Income benefits is an eligibility factor for APA for these individuals.  The case worker must coordinate continued benefits with the SSI Supplemental Security Income claims representative in these cases.

2. The individual must live throughout the affected month in one or more public medical or psychiatric institutions (including the Alaska Psychiatric Institute) or in any other type of Medicaid facility.

3. A physician must certify, in writing, that the individual will live in the institution for 90 days or less.  The physician must prepare and date this certification by the 90th day from admission to the institution, or by the time the individual is actually released if the release happens before the 90 days have elapsed.  The Med 12 form may be used for this purpose.  Send the Med 12 form to the nursing home for physician certification.

4. The individual, or someone acting on the individual's behalf, must show the need to pay some or all the expenses of maintaining a home or living arrangement to which the individual may return.  A written statement which specifies this need is enough to verify the individual's need to maintain a home or living arrangement, unless the case worker has reason to believe otherwise.

Note:  

In some situations, an institutionalized individual may not be found eligible for continued full APA benefits right away.  If continued full APA benefits are approved after nursing home income credits showing a patient liability for the individual's cost of care are issued, the case worker must send an e-mail to the DPA EIS Helpdesk.  The Helpdesk will correct the income credits to show a “0” patient liability for the same months that the individual is determined eligible for continued full APA benefits.