Categorically Needy LTC - SSI Related Undocumented Alien (L04)

Created on: 
Oct 09 2015

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

Who is eligible for L04 (Non Citizen CN SSI Related LTC) medical?

Non-citizen clients in a nursing facility who are pre-approved by HCS and meet the eligibility requirements described in the following:

Non-citizen clients in a hospital approved by the Health Care Authority (HCA):

NOTE: All other medical programs must be considered before using the L04 medical program.

How long is the L04 (Non Citizen CN SSI Related LTC) certification period?

L04 medical is certified for 12 months.

Online Processing

How do I screen L04 (Non Citizen CN SSI Related LTC) medical?

An L04 Assistance Unit (AU) is initially screened as a L02 (CN SSI Related Long Term Care) AU following the steps in How do I screen L02 Medical?

The L02 AU trickles to a L04 during finalize, if appropriate, based on the eligibility, living arrangement, and coding on the Clients Detail and Facilities pages.

How do I process a pending L04 (Non Citizen CN SSI Related LTC) Assistance Unit (AU)?

To process a pending L04 AU, take the following steps:

  1. Go to the Case Actions page. For more information, see How do I access the Case Actions page in ACES 3G?
  2. On the Case Actions page in the Pending Applications section, select Start Interview.
  3. On the Contact Information page, add an Authorized Representatives/Payees, if appropriate.
  4. On the AU Details page, update the Financial Responsibility using the drop down menu:
  • Applicant (PN) for the applicant.
  • Ineligible Spouse (SP) for the applicants’ spouse.
NOTE: The dependents are coded on Family Member Allowance page. This allows the correct post-eligibility allowance calculation for the dependent. A dependent is a child, sibling or parent the individual is claiming to the Internal Revenue Service (IRS) as a dependent.
  1. On the Client Details page, update the following fields in each section:
  • In the Identity section:
    • Marital Status - Select the marital status using the drop-down list.
NOTE: The marital status of both the applicant and spouse must be coded as Separated (P), Legally Separated (S), Married Living Apart (A) or Married (M) 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 institutionalized spouse and correctly calculate the spousal allocation.
  • In the Citizenship / Alien section:
    • Citizen Status - Select the appropriate status for the non-citizen applicant from the drop-down list.
    • Alien subsection - Enter the [applicant's citizenship / alien status information].
    • Alien Medical Approval Source - Select ADSA Headquarters Approved (A) from the drop-down list.
  • In the Residency / Living Arrangement section:
    • Living Arrangement - Select Nursing Facility (NF) or Hospital (HS).
  • In the Disability / Incapacitated / Psychiatric section: 
    • Disability/Incapacity - Enter the [applicant’s disability information].
      • If the client is 65 or older, the Disability / Incapacity fields can be left blank.
  1. If any client in the household has earned income, add Earned Income for each client and each income source.
  2. If any client in the household has unearned income, add Unearned Income for each client and each income source.
  1. For information on how to code the Shelter Expense page when there is a community spouse, see How do I code the SHEL screen when there is a community spouse?
NOTE: If the LTC client has a community spouse, 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. If any client in the household has resources, add Resources for each client and resource type. For more information on resources, see Apple Health eligibility manual - Long-Term Care - Eligibility - Resources.
  2. If the client has transferred an asset, complete the Transferred Resources page with the appropriate information. For more information on transfer of assets, see Apple Health eligibility manual - WAC 182-513-1363 Evaluating the transfer of assets for people applying for or receiving long-term care (LTC) services.
  3. On the Institutional Care page:
  • Add a Facility page for the applicant and update the following:
  1. Type - Select Nursing Facility - Medicaid (MD) or Hospital (HS) from the drop-down list. The facility type must be from the same subset as the living arrangement coded on the Clients Detail page.
  2. ID - Enter the [provider number] if the provider is a Nursing Facility - Medicaid (MD) or Hospice Care Center (HC).
  3. Entry Date - Enter the [date client entered the facility].
  4. Level Care - Select the client's level of care using the drop-down menu.
  5. Payment Auth Date - Enter the [date payment to the facility should begin]. This is the date the LTC services are approved and displays on the award letter.
Note: If the Payment Authorized Date is not entered it is possible the AU will approve; however, the cost of care is not calculated.
  1. Private Rate - Enter the [facility's private daily rate]. Contact the facility for rate information.
  2. State Rate - Enter the [facility's state daily rate].
  • Add a Long Term Care Expense/Deduction page for the applicant and enter any [qualified expenses or deductions] that can be used to reduce participation or excess resources in the Type and Amount fields.
  •  If the applicant in a medical facility has an approved housing maintenance allowance, add a Housing Maintenance Allowance page and update the following information
  1. Amount - Enter the [housing maintenance amount] authorized by Home and Community Services (HCS) or Developmental Disabilities Administration (DDA) social services. The maximum amount used in the post-eligibility calculation is the one-person MNIL.
  2. Check the box to the left of Approved if the housing maintenance allowance has been approved.
  3. Begin Month - Enter the month and year as [mm/yyyy]. The housing and maintenance allowance is for six months, starting with the month entered in this field.
  •  If the applicant has a dependent or dependents, add a Family Member Allowance page and update the following information:
  1. Type - Select Child (C) or Other Dependent (O) from the drop down menu.
  2. Amount - Enter the [gross income amount] of the dependent. If the dependent does not have any income, leave the Amount field blank.
  • If the client wishes to waive the spousal portion of the maximum spousal/family allowance, add a Spousal Allowance page, check the box for Waive Spousal Allowance.
  • Add Community Spouse Resource Assessment pages if the client has a community spouse.
  1. If the client wishes to use the name on check rule, add an LTC Income Rule page in the Income section and check the box next to Name on Check Rule.
NOTE: In situations where there is an institutional spouse and both are receiving services, the worker may choose to force the name on the check rule; however, the system requires that they force the rule on both clients' LTC Income Rule pages.
  1. Once all data has been entered follow the steps in How do I initiate and complete an intake interview?
  2. After committing the interview data follow the steps in How do I complete Process Application Months? for all pending months.
  3. Once the pending months have been processed, follow the steps in How do I complete Finalize Application?

Mainframe Processing

How do I screen L04 (Non Citizen CN SSI Related LTC) medical?

An L04 Assistance Unit (AU) is initially screened as a L02 (CN SSI Related Long Term Care) AU following the steps in How do I screen L02 medical?

The L02 AU trickles to a L04 during finalize, if appropriate, based on the eligibility, living arrangement, and coding on the INST and ALAS screens.

How do I process a pending L04 (Non Citizen CN SSI Related LTC) Assistance Unit (AU)?

To process a pending L04 AU, take the following steps:

  1. From the AMEN screen, select Option O - Interview.
  2. On the PEND screen, enter a [Y] - Yes in the Beginning Processing for ALL pending AUs listed with Blank Intake Begin Date? field or enter [Y] - Yes in the S field for each individual AU to initiate the intake interview.
  3. On the ADDR screen, enter a [Y] - Yes in the Auth Rep/Payee field, if appropriate.
  4. On the STAT screen, complete the Finl Resp fields as follows:
  • [PN] - Applicant for the applicant.
  • [SP] - Ineligible Spouse/Non-Applying Spouse for the applicants’ spouse.
NOTE: The dependents are coded on the LTCX screen in the Family Member Allowance section. This allows the correct post-eligibility allowance calculation for the dependent. A dependent is a child, sibling or parent the individual is claiming to the Internal Revenue Service (IRS) as a dependent.
  1. On the DEM1 screen, compete the following fields:
  • Liv Arng field - Enter the [NF] - Nursing Facility or [HS] - Hospital.
  • Mrtl Stat field - Enter the [marital status].
NOTE: The marital status of both the applicant and spouse must be coded as [S] - Legally Separated, [P] - Separated, [A] - Married Living Apart or [M] – Married Living with Spouse 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.
  1. On the DEM2 screen, complete the following fields:
  • Citiz field - Enter the [appropriate code] for the non-citizen applicant. See <F1> and <F2> Help.
  • Disability/Incapacity fields - Enter the applicant’s disability information.
    • If the client is 65 or older, the Disability / Incapacity fields can be left blank.
  1. On the INST screen in the Facility section, complete the following:
  • INST Type field - Enter [MD] - Nursing Facility - Medicaid or [HS] - Hospital. The facility type must be from the same subset as the living arrangement coded on the DEM1 screen.
  • Provider ID field - Enter the [provider number] if the provider is a MD - Nursing Facility - Medicaid or HC - Hospice Care Center.
  • Entry Date field - Enter the [date client entered the facility].
  • Level Care field - Enter the [client’s level of care].
  • Payment Auth Date field - Enter the [date payment to the facility should begin]. This is the date the Long Term Care (LTC) services are approved and displays on the award letter.
Note: If the Payment Authorized Date is not entered it is possible the AU will approve; however, the cost of care is not calculated.
  • Private Rate field - Enter the [facilities private daily rate]. Contact the facility for rate information.
  • State Rate field - Enter the [facilities state daily rate]. Press <F20> to access the MMEN for state rates for providers.
  1. On the ALAS screen for the applicant:
  • Enter the applicant’s citizenship / alien status information. For instructions on completing the ALAS screen, see Mainframe Screens - ALAS - Aliens, Students and PII screen.
  • Alien Medical Approv Source field - Enter [A] - ADSA HEADQUARTERS APPROVED.
  1. On the LTCX screen:
  • In the LTC Expenses / Deductions section, enter any [qualified expenses or deductions] that can be used to reduce participation or excess resources in the Type and Amount fields.
  • In the Housing Maintenance Allowance section, enter the following information if a client in a medical facility has an approved housing maintenance allowance:
    • 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.
    • Approved field - Enter [Y] -Yes or [N] - No.
    • Begin Month field - Enter the [beginning month and year]. The housing and maintenance allowance is for six months, starting with the month entered in this field.
  • In the Family Member Allowance section, enter the following information if the client has a dependent(s).
    • Type field - Enter [C] - Dependent who lives with a Community Spouse or [O] - Dependent who does not live with a community spouse.
    • Amount field - Enter the [gross income amount] of the dependent. If the dependent does not have any income, leave the Amount field blank.
  • Force Name on Check Rule field - Enter [Y] - Yes if the client wishes to use the name on the check rule.
NOTE: In situations where there is an institutional spouse and both are receiving services, the worker may choose to force the name on the check rule; however, the system requires that they force the rule on both clients LTCX screens.
  • Waive Spousal Allocation field - Enter [Y]- Yes if the client wishes to waive the spousal portion of the maximum spousal/family allowance.
  1. On the RES1RES2 and RES3 screens, enter the client's resource information. For more information on resources, see Apple Health eligibility manual - Long-Term Care - Eligibility - Resources.
  2. If the client has transferred an asset, complete the TRAN screen(s) with the appropriate information. See <F1> and <F2> Help. For more information, see Apple Health eligibility manual - WAC 182-513-1363 Evaluating the transfer of assets for people applying for or receiving long-term care (LTC) services.
  3. On the EARN screen:
  1. On the UNER screen:
  1. Complete the CSRA screen if the client has a community spouse.
  2. For information on how to code the SHEL screen when there is a community spouse, see How do I code the SHEL screen when there is a community spouse?
NOTE: If the LTC client has a community spouse, shelter expenses must be entered on the spouse’s SHEL screen 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 steps in How do I complete Process Application Months? for all pending months.
  2. Once the pending months have been processed, follow the steps in How do I complete Finalize Application?

 

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