Long Term Care (LTC): Nursing Facility Services for ABD Related – Determining Income Eligibility

Determining Countable Income

If client has been out of their home for 30 consecutive days or longer and is now receiving care in an intermediate care facility (ICF), countable income must be equal to or less than the Categorically Needy Standard (300% of Federal Benefit Rate) found on Appendix C-1 Schedule VIII B.1 beginning the 31st day out of the home. The 30 days can be a combination of hospital, skilled and/or ICF care. If income is between the Categorically Needy Standard and the Maximum monthly countable income for a Medicaid Income Pension Trust, also found on Schedule VIII B.1, a Medicaid Income Pension Trust must be established and funded prior to applicant being determined financially eligible.

If the individual leaves the facility prior to meeting the 30 day out of the home requirement, or does not require services past the 30 days, the categorically needy standard as found on Appendix C-1, Schedule VI is used. The rules on determination of income and resources are applicable only when an individual has entered a nursing facility (NF) and is likely to remain under care for 30 consecutive days. The 30-day requirement is considered to have been met even if it is interrupted by a hospital stay or the individual is deceased before the 30 day period ends. It is also considered to be met if client has received ADvantage Waiver services for at least 30 days and is transitioning to NF Services.

If payment of income is made to the individual and another person(s), the income is considered in proportion to the individual’s interest. Otherwise, we look at the income of the applicant only in determining income eligibility.

If a nursing facility applicant receives a Veterans Pension or VA Aid & Attendance, refer to article Veterans Pension / Aid & Attendance.

Income from a nursing facility client can be deemed to a community spouse even when the spouse receives ADvantage Waiver or Home Community Based Waiver services. If the community spouse (CS) is receiving a waiver service the deemed income amount must not cause the CS to go over the categorically needy standard on Appendix C-1, Schedule VIII B.1.

For additional information, please refer to the following policy:

317:35-19-20 Determining financial eligibility of categorically needy individuals

317: 35-5-42 Determining of countable income for individuals categorically related to aged, blind, and disabledin an intermediate care facility (ICF)

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