Categorically Needy LTC - SSI Related Undocumented Alien (L04)

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 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.
  3. 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 update the following fields:
  • Add a Facility page for the applicant and update the following:
    • Type field - 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.
    • ID field - Enter the [provider number] if the provider is a Nursing Facility - Medicaid (MD) or Hospice Care Center (HC).
    • Entry Date field - Enter the [date client entered the facility].
    • Level Care field - Select the client's level of care using the drop-down menu.
    • 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 [facility's private daily rate]. Contact the facility for rate information.
    • State Rate field - Enter the [facility's state daily rate].
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. If appropriate, 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.
  2. If the applicant in a medical facility has an approved housing maintenance allowance, add a Housing Maintenance Allowance page and update the following information:
  • 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.
  • Check the box to the left of Approved if the housing maintenance allowance has been approved.
  • 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.
  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. 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.
  2. Add Community Spouse Resource Assessment (CSRA) pages if the client has a community spouse.
  3. 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?

 

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