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

07/01/04

I. INTRODUCTION

Long-term care budgeting applies when the individual will be in a Medicaid certified medical institution for more than 12 months. When budgeting for long term care, a Patient Monthly Liability (PML) amount must be entered in EIS.

A. Definition of Medicaid Certified Medical Institution

1. A licensed acute care inpatient medical facility providing medical, surgical, and psychiatric or substance abuse treatment,

OR

2. A facility enrolled with the NC Medicaid Program as a psychiatric residential treatment facility (PRTF), providing services to an individual under age 21.

OR

3. A nursing facility (NF) or care for the mentally retarded (ICF-MR).

NOTE: If there is a question regarding whether a medical institution is Medicaid certified, contact the facility or, as a last resort, the Provider Services Unit at, DMA (919) 855-4050) for verification.

B. Aid Program/Category

An individual under 21 in long-term care (LTC) may be eligible under any of the following aid program/categories:

1. MAF: Individual under age 21. Evaluate under regulations in MA-3230, Eligibility of Individuals Under 21.

2. MIC: Individual under age 19. Evaluate under regulations in MA-3230, Eligibility of Individuals Under 21.

3. HSF: Individual under age 21 and the county agency or a private adoption/child-caring agency has legal custody and/or placement responsibility. Evaluate under regulations in MA-3230, Eligibility of Individuals Under 21.

(I.B.)

4. MAD: Individual under age 21 who has been determined to be disabled. Evaluate under regulations in MA-2000, Non-SSI Eligibility Regulations, in the Aged, Blind, and Disabled Medicaid Manual. Parental financial responsibility ceases at age 18. Also refer to MA-2270, Long Term Care Need and Budgeting.