Categorically Needy LTC in a Medical Facility – SSI Related (L02)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L02 (Categorically Needy LTC in a Medical Facility – SSI Related) medical?

Clients who meet the eligibility criteria described in the following manual sections may be eligible for L02 medical:

How long is the L02 (Categorically Needy LTC in a Medical Facility – SSI Related) certification period?

The L02 medical program is certified for 12 months.

Online Processing

How do I screen L02 (Categorically Needy LTC in a Medical Facility - SSI Related) medical?

To screen an L02 Assistance Unit, take the following steps:

  1. Follow the instructions in Screening a Application.
  • On the Programs page, click the checkmark next to Long Term Care.

How do I process a pending L02 (Categorically Needy LTC in a Medical Facility - SSI Related) Assistance Unit (AU)?

To process a pending L02 AU, take the following steps;

  1. From the Case Actions page, click the Start Interview link in the Pending Application section.
  2. Check Begin Intake on the Pending Applications page to initiate the interview. For more information on completing the intake, see How do I initiate and complete an intake interview?  
  3. On the Contact Information page, add an Authorized Representative/Payees if appropriate. See How do I add an authorized representative (AREP) during screening?
  4. On the AU Details page, complete the Financial Responsibility fields for each Household (HH) member as follows:
  • Applicant (PN) - for the applicant
  • Ineligible Spouse (SP)  - for applicant spouse (if applicable)
NOTE: Dependents are coded on the Family Member Allowance page. This allows the correct post-eligibility allowance calculation for the dependents. A dependent is a child, sibling or parent the individual is claiming to the IRS as a dependent.
  1. On the Client Details page update the following information for each HH member:
  • Marital Status field - select the valid value for client’s marital status from dropdown.
    • The marital status of both the applicant and spouse must be coded as S - Legally SeparatedP - SeparatedA - Married Living Apart or M - Married for the system to recognize the couple as married. This information is needed for the system to determine if the spouse is a community spouse or an institutional spouse and correctly calculate the spousal allocation.
  • Living Arrangement field – select client’s living arrangement from the living arrangement dropdown menu.
NOTE: If the client is 65 or older, the Disability/Incapacitated/Psychiatric section can be left blank.
  1. On the Income page, add income for each household member.
  • On the Earned Income page, complete this page if the client has earned income.
  • On the Unearned Income page, enter the types and amounts of all unearned income.
  1. On the Resources page, enter [client resource information] on the Liquid Resources Vehicle/Vessel, Real Property, Insurance Policy, Other Resources and Transferred Resource pages. For information on how to complete the resource pages, see Resources.
  1. On the Institutional Care page:
  • If the client’s living arrangement code is outside an At Home (AH) setting, update the  Facilities section with the following information:
    • Type field - Select the facility type from the dropdown.
    • ID field - Enter the [provider ID number] if required. To find the provider’s ID number click on the Search link to go to the Provider Search page. For additional information on Vendor payments, see: How do I inquire on a Vendor?
    • Entry Date field - Enter the [date the client entered the facility].
    • Level of Care field - Select appropriate level of care from the dropdown.
    • Payment Auth Date field -Enter the [date payment to the facility should begin].  This is the date the LTC services are approved and displays on the award letter.
    • Private Rate field Enter the [facilities private daily rate]. Contact the facility for the rate information.
    • Daily Rate field Enter the [facilities state daily rate]. Select Details to inquire on the Most Recent Level of Care Rate Amt.
      • For non-medical facilities, use the rate provided by the Home & Community Services (HCS), Developmental Disabilities Administration (DDA), or HCS Social Worker (SW) / Community Nurse Consultant (CNC) case manager.
NOTE: If the Payment Auth Date is not entered, it is possible the AU will approve, however, the cost of care is not calculated.
NOTE: To add details to the Institutional Care Page, click the Add icon from the toolbar.
  1. On the Home and Community Based Services (HCBS) page enter the following information if the client receives waiver, hospice or other services:
  • Type field - Select the appropriate waiver or service type from the dropdown.
  • Provider ID field - Enter the [provider ID number] if required, to find the provider’s ID number Search to go to the Provider Search page. See Vendor Payment – How do I search for a vendor?
  • Start Date field - Enter the [date the waiver service begins].
  • Approval Source field - Select approval source from the dropdown menu.
  • Payment Auth Date field - Enter the [date payment is to begin]. This is the date the LTC services are approved and displays on the award letter.
NOTE: If the Payment Auth Date is not entered it is possible the AU will approve, however, the cost of care will not be calculated.
  • For non-medical facilities, use the rate provided by the Home & Community Services (HCS), Developmental Disabilities Administration (DDA), or HCS Social Worker (SW) / Community Nurse Consultant (CNC) case manager.
  • If the HCBS type is Hospice – (H) update the following fields:
  • Private Rate field - Enter the [provider’s private daily rate]. Call the facility to get the current private rate.
  • State Rate field - Enter the [facilities state daily rate].
NOTE: To find the most current state rate for nursing facilities, veteran facilities or hospice care centers go to the MMEN and enter option DProvider Name List.
  1.  If the client has long term care expenses or deductions, update the  Long Term Care Expenses/Deductions page with the following information:
  • Type field- Select any qualified expenses or deductions that can be used to reduce participation or excess resources from the dropdown.
  • Amount field - Enter the [amount of the expense/deduction].  
  • End Month field - Enter the [date the expense/deduction ends].
  1. If the client has long term care expenses or deductions, update the  Room & Board Exceptions page with the following information;
  • Type field - Select any qualified exception that can be used to reduce room and board from the dropdown.
  • Amount field - Enter the [amount of exception]
  • End Month field - Enter the [date the exception ends].
NOTE: Expense type Predictable Ongoing Expense (RP) is NOT a post eligibility deduction. This amount is added to the facility rate and used as recurring medical expenses when calculating the net income in initial eligibility for HCBS waivers in Group 3 - clients who have gross income above the SIL and net countable below the MNIL.
  1. If a client is in a medical facility and has approved Housing Maintenance Allowance, enter the following information:
  • Amount field- Enter the housing maintenance amount authorized by HCS or DDA social services.
    • The maximum amount used in the post-eligibility calculation is the one-person MNIL.
  • Begin Month field- Enter the [beginning month & year].
    • This allowance is for six months, starting with the month entered in this field.
  1. If the client has dependent(s), enter the following on the Dependent/Child Income and Allowance page:
  • Type field - Use the drop down menu to select one of the following:
    • Dependent child living with Community Spouse (C) - an applicant/recipient's natural or adopted child who is living in the household with the Community Spouse (CS).
    • Dependent not living with Community Spouse (O) - any dependent (child or otherwise) not living with a CS.
    • Other Dependent living with Community Spouse (D) - dependents other than the applicant/recipient's natural or adopted child.
  • Amount field: Enter the gross income amount of the dependent. If the dependent does not have any income, leave the Amount field blank.
  1. Complete the Community Spouse Resource Allowance (CSRA) screen(s) if the client has a community spouse and they are getting a CSRA higher than the state rate. If not, only complete the Most Recent Continuous Period of Institutionalization (MRCPI) or Service Start Date. See Help linkHelp.
NOTE: If the LTC client has a CS, shelter expenses must be entered on the spouse’s Shelter Expense page in order to compute the excess shelter portion of the spousal maintenance allowance (and the shelter deduction for the spouse’s Basic Food, when applicable).
  1. After committing the interview data, follow the instructions in the How do I complete Process Application Month for all pending months.
  2. Once the pending months have been processed, follow the instructions in the How do I complete Finalize Application.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.