Client must be out of his/her home for 30 days to be able to use the Categorically Needy (LTC) income and resource standards found on Appendix C-1, Schedule VIII.B and Schedule VIII.D in order to pay for hospital and/or Skilled Care – Medicaid coverage beginning on the 31st day out of the home.
The 30 days out of the home requirement can be a combination of hospital and/or Skilled Care.
Use Appendix C-1, Schedule VI (QMBP) for individuals who do not meet the 30 day out of the home requirement.
Example 1:
Client enters the hospital on 3-21-19. Client then went to skilled care on 4-7-19. Client applies for Medicaid / Skilled Care coverage on 4-10-19. The 31st day is 4-20-19. Client is over the QMB income standard. Medicaid would be certified for 4-1-19 (the month that the 31st day falls in) if otherwise eligible. Client is ineligible in March for Medicaid.
Example 2:
Same scenario as above. Client is under the QMB income standard. If the client has previous medical expenses then Medicaid can be certified three months prior to April (month of application) if also otherwise eligible.
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