317:35-17-10. ITS

When a person applies for ADvantage Waiver services or other LTC waiver program, the look-back period should start with the application date.

• A client is not eligible for ADvantage Waiver services or other LTC waiver programs until the person is medically and financially eligible.
  • Nurses and AFS LTC staff must be determining eligibility at the same time. The in-home application for ADvantage and SPPC begins this process to request a medical determination.
• The nurse will deny ADvantage if the applicant is not Nursing Home Level of Care and send an alert to the worker and supervisor.
• The nurse will deny if the applicant is Nursing Home Level of Care but the nurse does not recommend ADvantage services.
• The penalty period starts when the client is eligible financially and medically if it were not for the transfer penalty.
• When the client is not financially eligible for a reason other than transfer of resources, AFS staff must deny the case / authorization and notify the nurse.
• When someone is determined otherwise eligible except for the transfer of assets, the client is certified for Medicaid only while he/she completes the penalty period. The penalty is served by the client not receiving ADvantage or other waivered services for the calculated number of days.
  • There is an exception for the continuation of Medicaid coverage if the client requires a Medicaid Income Pension Trust (MIPT) to be eligible and the person needs all his/her income to pay bills while the penalty runs. In this instance, the MIPT must be established and funded for the penalty period to start and then the case can be closed.
  • If the client is otherwise eligible, worker will deny auth line in IMS for ADvantage Waiver, Reason code 21. If financially eligible for SPPC, update to “F” status. Once the penalty period is calculated, worker will mail form, Notice Regarding Transfer of Assets for ADvantage (08MA098E).
• Sometimes a transfer penalty is so large, it will exceed the 60 month look back period. When this occurs, the worker needs to explain the benefits of withdrawing the application to the client. This could prevent the person from having to serve the complete penalty period.

Access the Transfer of Assets Penalty Period Calculator