Family and Children's Medicaid MA-3325 LONG TERM CARE BUDGETING

III. Requirements for Placement of More Than 12 Months

A. Long-term care budgeting applies when the duration of continuous care and treatment has exceeded or is expected to exceed 12 months in a Medicaid-certified facility. When budgeting long-term care, a PML amount must be entered in EIS.

B. Parental financial responsibility never applies in long-term care budgeting. The month of entry is private living budgeting and parental financial responsibility applies for that month only.

C. Parental financial responsibility never applies when the individual has been or is expected to be out of his parent(s)’ home for more than 12 months, regardless of the living arrangement, which may be a combination of LTC, acute hospital care, psychiatric residential treatment facility, private group home, and/or other private arrangement. Refer to MA-3305, M-AF, M-IC, H-SF Budgeting, for private living budgeting procedures when the a/r is temporarily out of the home.

D. Budget Unit (B.U.) Membership for LTC Budgeting (Placement exceeding 12 Months)

1. MAF: The b.u. is one following the month of entry.

2. MIC: The b.u. is one following the month of entry.

3. HSF: The b.u. is one.

4. MAD: The b.u. is one. See MA-2270, Long-Term Care Need and Budgeting, in the Aged, Blind and Disabled Medicaid Manual, for procedures.

(III.)

E. Financial Responsibility

1. Parental financial responsibility applies for the month of entry into a LTC budgeting situation for MAF or MIC.

a. Eligibility for the month of entry is based on the individual’s private living arrangement (PLA) on the first day of that month.

b. Refer to MA-3305, MAF, MIC, HSF Budgeting, for procedures.

2. The county department of social services has either custody or placement responsibility for an individual in H-SF. Therefore, parental financial responsibility for the PLA month of entry into LTC for an individual in H-SF with long-term care budgeting is based only on court-ordered support and voluntary contributions from the parent(s). Refer to MA-3305, M-AF, M-IC, H-SF Budgeting, to evaluate for H-SF.

F. Transfer of Resources - Refer to MA-2240, Transfer of Resources, in the Aged, Blind, and Disabled Medicaid Manual

1. If an a/r, budget unit member or legal representative gives away or sells an asset for less than the current market value he may not be eligible for cost of care in a nursing facility.

2. Apply Transfer of Resources rules only to individuals who are:

a. Evaluated under MAF, and

b. Request cost of care in a nursing facility, and

c. Transferred a non-allowable asset during a specified lookback period or later.

3. Always ask an MAF a/r requesting cost of care in a nursing facility whether he (or anyone in his budget unit) has transferred or given away any resources. If he has, refer to MA-2240, Transfer of Resources, in the Aged, Blind and Disabled Medicaid Manual.

Note: Transfer of resources policy does not apply to individuals in LTC receiving under MIC. However, if an a/r begins to receive assistance with nursing home cost of care under the MAF program, CAP, or assistance with in-home health services and supplies under the MAABDQ program, evaluate all non-allowable transfers of resources for sanction. This includes transfers that occurred while the individual was receiving MIC.