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It is important to determine what month a vendor payment begins once a person enters the nursing home.

ICF Eligibility requirement must be determined prior to certification and assessment of a vendor payment.

When a client enters ICF or ICF/IID it is assumed that his/her intent is to remain in the facility 30 days or longer. The 30 day institutionalized requirement for ICF/IID coverage is not required if his/her income meets QMB+ standards.

If his/her income is over the QMB+ standard he/she must remain in the Nursing Home for 31 days for the 30 day institutionalized requirement to be met. Once a person has been in ICF or ICF/IID care for 31 days then he/she is considered to be “institutionalized” and a Zero vendor payment or a Full vendor payment will be assessed based on the information below.

When to Apply a Zero Vendor Payment:

• A $0 vendor payment is applied for the initial month of entry when the client is admitted to ICF or ICF/IID after the 1^st day of the month.
• A $0 vendor payment is applied when the client’s countable monthly income is less than the monthly maintenance standard.
• A $0 vendor payment is applied if it is calculated that ALL of the IS’s (Institutionalized Spouse) countable monthly income will be deemed to the CS (Community Spouse).

When to Apply a Full Vendor Payment:

• A full vendor payment will be applied for the initial month of entry when the client is admitted into ICF or ICF/IID on the 1^st day of the month from his/her home or assisted living center.
• A full vendor payment will be applied when the client has been on private pay-spenddown in ICF or ICF/IID and has been institutionalized more than 30 days. The vendor payment begins the month in which the client is determined both medically and financially eligible for Medicaid.

Examples

Alan entered ICF (nursing home) from an assisted living center on 09/12/18.

Alan will have a $0 vendor payment for September 2018 since he entered the nursing home after the first day of the month. Alan will have a full vendor payment beginning October 2018.

Dan, an SSP recipient, entered the hospital on 05/10/18. Next, Dan transferred to Skilled Care on 05/15/18. Finally Dan transferred to ICF/IID on 05/25/18.

Worker updated case to close the SSP effective 07/01/18. SSI will adjust Dan’s SSI down from $750 to $30. Dan’s countable income will be $71 until 07/01/18.

Dan entered ICF/IID after the first day of the month in May. Dan will have a $0 vendor payment for May 2018 as he entered the nursing home after the 1^st of the month.

Dan will have a full vendor payment for June 2018, based on the SSP payment of $41 and the $30 SSI minus the monthly maintenance standard.

The vendor payment for July 2018 and forward will be $0 based on Dan’s countable income of $30 (Reduced SSI) is less than the monthly maintenance standard.

Alice entered the hospital on 05/07/18. Alice transferred to Skilled Care on 05/12/18 and then to the nursing home on 06/01/18.

Alice will have a full vendor payment for June 2018 as she entered the nursing home on the 1^st day of the month.

Jane entered the hospital on 06/24/18. On 08/02/18, Jane moved to Skilled Care where she stayed until she transferred to the nursing home on 8/20/18.

Jane will have a $0 vendor payment for August 2018 since she entered nursing care after the first of the month. Jane will have a full vendor payment beginning September 2018.

Bobby has been in the nursing home since 1/25/16 as a private pay resident. An application for LTC assistance was submitted on 08/04/18. Verification was received showing spenddown to below resource standard as of 08/28/18. Bobby’s vendor payment is calculated to be $1,750.

Bobby has been institutionalized since 02/25/16 (31^st day after nursing home entry on 01/25/16). Bobby is financially and medically eligible for LTC assistance as of 08/28/18. Case is certified 08/28/18 with full vendor payment.

Note: Nursing home is not allowed to charge more than the amount of care/days provided.