A person can be considered categorically related to disability if s/he dies:
- While being treated in the hospital
- While being treated in an ambulance
- Within 2 months of being treated in the hospital, as long as the cause of death is the condition for which s/he was treated.
Worker will need to get verification from the hospital that the client died while in the hospital / ambulance or that death was due to the condition for which the client was treated. If the verification is oral, enter the name and phone number of the person who gave the verification into case notes. The applicant will be considered for QMBP, not the SSP.
“Disability Due to Death While or After Being Treated” only provides categorical relationship. An interview must still be conducted with someone who knows the client’s income, resources, citizenship, etc. Verification of income and resources, if needed, must be provided before the medical benefit can be certified. If there is no one who can be interviewed or who can provide needed documentation, the application must be denied.
If eligibility is determined, the medical benefit can be certified up to three months prior to the date of application.
Example
Gerald Ford was in the Indio Community Hospital for five days beginning on 10/10/2019 after a vehicle accident. He returned to the hospital on 12/03/2019 where he died that day. His sister Betty applied at DHS on 01/28/2020.
She provided a statement from Dr. Hawkeye Pierce with the hospital verifying death as due to complications from the 10/10/2019 accident.
Betty provided paystubs for Gerald for October through November. He was paid bi-weekly. She had a copy of a letter from his personal physician Dr. Henry Blake stating George needed to rest and not work starting 11/15/2019.
After reviewing the income it was determined that Gerald meets the income standard for all three months.
October
Gerald: $903, $903
Countable Income: $903 + $903 (Gerald’s earned income) = $1806 – $20 – $65 = $1721/2 = $860.50 under the QMBP standard
November
Gerald: $903, $452
Countable Income: $903 + $452 (Gerald’s earned income) = $1355 – $20 – $65 = $1721/2 = $635.00 under the QMBP standard
December
Gerald: $0
Gerald meets the income standard for all three months.
She reports he had a bank account and a paid off 2009 Chevy Transverse. She reports no other property or assets. Bank statements were provided for the months of October (balance $4163), November (balance $3564), and December (balance $1988).
Gerald is under the resource standard for QMBP for all three months.
The case can be certified effective 10/01/2019 then closed effective date 12/03/2019 (date of death).
Household Tab: Add Gerald to the Medical Benefit effective 10/01/2019.
Income Tab: Code the income for October. As he is eligible for all three months, only the income for the first month is coded in FACS. However, you must document calculations of paystubs determination of countable income for all other months in case notes.
Resource Tab: Code all applicable resources in FACS. For the savings account balance, code the balance for first month (October) and make sure to document in case notes for the other months.
Medical General Tab: Certify the case for 10/01/2019. App date is 01/28/20.
**Save Case and Push Case completely through** Then, refresh the case.
Medical-General Tab: Close the Medical case for the date of death.
**Save Case and Push Case Closure completely through**
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