Lump Sums

Explanation of Lump Sum Policy and Scenarios

30 Day Out of Home Requirement (ICF or ICF/IID Institutionalization)

Intended to explain when payment can be made for ICF or ICF/IID care and which income/resource guidelines are used.

30 Day Out of Home Requirement (Hospital & Skilled Care)

Exceptions to the rules

Appendix C-1

Link to Appendix C-1

Spousal Impoverishment Examples – Income

Income is determined separately for an individual and his/her spouse for ADvantage, Nursing Home Care and Home Community Base Waiver / Intellectually Disabled (HCBW/ID) services. If the Community Spouse (CS’s) monthly gross income is less than the Maximum monthly income standard as shown on Appendix C-1, Schedule XI, the Institutionalized Spouse (IS) may deem a […]

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 […]

ADvantage and Other Waivers – Determining Income Eligibility

317:35-17-9 317:35-17-10 317:35-17-11 Determining Countable Income 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. If income is between the Categorically Needy Standard and the Maximum monthly countable income for a Medicaid Income Pension Trust, also found on Schedule […]