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Determining Categorical Relationship To be eligible for SoonerCare/Medicaid Long-Term Care services an individual must first meet the description of a member eligibility group as shown below. Categorical relationship to disability or blindness is established by the Social Security Administration (SSA). An individual who is not ABD-related meets the categorical relationship requirement if s/he is receiving […]
Applying for Medical Benefits An individual may apply for medical benefits in the following ways: Complete a PS-1, FSS-1 and FSS-1-B form Receipt of Form 02HM001E, Uniform Comprehensive Assessment Intake and Referral (Formerly AG-2) Receipt of ABCDM-83 from a nursing facility Verbal request Request received through OKDHSLive! Website
When the LTC applicant has a Spouse The intent of this policy is to ensure the community spouse (CS) avoids being left with nothing. 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 CS’s monthly gross income is less […]
When an applicant has more money or property (resources) than the Maximum Resource Standard allows, they must “spend down” those resources to become eligible for Medicaid LTC services. The Goal: The Resource Standard To be eligible for LTC, the client’s countable resources must be at or below the Individual Maximum Resource Standard (found in Appendix […]
Medical eligibility for the long-term care programs are done by the DHS nurses. The individual’s medical needs must be the appropriate level of care (Nursing facility, Advantage or personal care) for the person to be medically eligible. Completion of the in-home application for Advantage / SPPC or putting the authorization in application status for nursing […]
The requirement for the 60 month look back is part of the Deficit Reduction Act of 2005. The 60 month look back is defined in Section 1917(c) of the Social Security Act. The look back on all assets is 60 months before the first day the individual is both “institutionalized” and has applied for medical […]
Interview Process in Long Term Care
Long-Term Care programs assists individuals who require around the clock nursing care.
Definition of QI-1
Specified Low-Income Medicare Beneficiary (SLMB) Program to pay Medicare Part B premiums for those whose income is above the QMBP standard. Person must be enrolled in Part A Medicare and paying any associated fees if they have them Persons on one of the LTC medical programs (ADvantage, Nursing Home, DDS) can also be eligible for […]