Long Term Care

Created on: 
Nov 07 2019

Categorically Needy LTC in a Medical Facility - SSI Recipient (L01)

Created on: 
Nov 07 2019

Online Processing

 See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L01 (Categorically Needy LTC in a Medical Facility - SSI Recipient) medical?

A person who receives federal cash benefits under the Supplemental Security Income (SSI) program who also meets the eligibility and institutional criteria in the following may be eligible for L01 medical:

How long is the L01 (Categorically Needy LTC in a Medical Facility - SSI Recipient) certification period?

L01 medical has no review end date and is certified for as long as the client is eligible for both Supplemental Security Income (SSI) and institutional Long-Term Care (LTC) services.

Online Processing

How do I screen L01 (Categorically Needy LTC in a Medical Facility - SSI Recipient) medical?

To screen an L01 Assistance Unit (AU), take the follow the steps:

  1. Follow the instructions in Screening an Application.
  • On the Programs page:
    • Click the Long Term Care checkbox in the Programs section.
    • Click the SSI Eligible checkbox in the Determination Criteria section.

How do I process a pending L01 (Categorically Needy LTC in a Medical Facility - SSI Recipient) Assistance Unit (AU)?

To process a pending L01 AU, follow the steps in How do I process a pending L02 AU? 

How does ACES issue cash to an active L01 (Categorically Needy LTC in a Medical Facility - SSI Recipient) Assistance Unit (AU)?

When Social Security Administration (SSA) determines a Supplemental Security Income (SSI) only recipient’s stay in a medical facility is to exceed three months, the SSI cash payment is reduced to $30 a month. When this occurs, ACES issues a cash supplement to bring the client’s income up to the Personal Needs Allowance (PNA) standards. For more information, see Apple Health eligibility manual - Long-Term Care - Personal Needs Allowance (PNA) Chart.

When a cash benefit is issued from an L01 AU, the program type is set to SSI MIL Client/Aged with Cash Payment (M),  Blind with Cash Payment (N) or Disabled with Cash Payment (O) and the benefit amount displays in the PNA/CPI field in the Income/Expenses section on the Eligibility Details page.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Categorically Needy LTC in a Medical Facility – SSI Related (L02)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L02 (Categorically Needy LTC in a Medical Facility – SSI Related) medical?

Clients who meet the eligibility criteria described in the following manual sections may be eligible for L02 medical:

How long is the L02 (Categorically Needy LTC in a Medical Facility – SSI Related) certification period?

The L02 medical program is certified for 12 months.

Online Processing

How do I screen L02 (Categorically Needy LTC in a Medical Facility - SSI Related) medical?

To screen an L02 Assistance Unit, take the following steps:

  1. Follow the instructions in Screening a Application.
  • On the Programs page, click the checkmark next to Long Term Care.

How do I process a pending L02 (Categorically Needy LTC in a Medical Facility - SSI Related) Assistance Unit (AU)?

To process a pending L02 AU, take the following steps;

  1. From the Case Actions page, click the Start Interview link in the Pending Application section.
  2. Check Begin Intake on the Pending Applications page to initiate the interview. For more information on completing the intake, see How do I initiate and complete an intake interview?  
  3. On the Contact Information page, add an Authorized Representative/Payees if appropriate. See How do I add an authorized representative (AREP) during screening?
  4. On the AU Details page, complete the Financial Responsibility fields for each Household (HH) member as follows:
  • Applicant (PN) - for the applicant
  • Ineligible Spouse (SP)  - for applicant spouse (if applicable)
NOTE: Dependents are coded on the Family Member Allowance page. This allows the correct post-eligibility allowance calculation for the dependents. A dependent is a child, sibling or parent the individual is claiming to the IRS as a dependent.
  1. On the Client Details page update the following information for each HH member:
  • Marital Status field - select the valid value for client’s marital status from dropdown.
    • The marital status of both the applicant and spouse must be coded as S - Legally SeparatedP - SeparatedA - Married Living Apart or M - Married for the system to recognize the couple as married. This information is needed for the system to determine if the spouse is a community spouse or an institutional spouse and correctly calculate the spousal allocation.
  • Living Arrangement field – select client’s living arrangement from the living arrangement dropdown menu.
NOTE: If the client is 65 or older, the Disability/Incapacitated/Psychiatric section can be left blank.
  1. On the Income page, add income for each household member.
  • On the Earned Income page, complete this page if the client has earned income.
  • On the Unearned Income page, enter the types and amounts of all unearned income.
  1. On the Resources page, enter [client resource information] on the Liquid Resources Vehicle/Vessel, Real Property, Insurance Policy, Other Resources and Transferred Resource pages. For information on how to complete the resource pages, see Resources.
  1. On the Institutional Care page:
  • If the client’s living arrangement code is outside an At Home (AH) setting, update the  Facilities section with the following information:
    • Type field - Select the facility type from the dropdown.
    • ID field - Enter the [provider ID number] if required. To find the provider’s ID number click on the Search link to go to the Provider Search page. For additional information on Vendor payments, see: How do I inquire on a Vendor?
    • Entry Date field - Enter the [date the client entered the facility].
    • Level of Care field - Select appropriate level of care from the dropdown.
    • Payment Auth Date field -Enter the [date payment to the facility should begin].  This is the date the LTC services are approved and displays on the award letter.
    • Private Rate field Enter the [facilities private daily rate]. Contact the facility for the rate information.
    • Daily Rate field Enter the [facilities state daily rate]. Select Details to inquire on the Most Recent Level of Care Rate Amt.
      • For non-medical facilities, use the rate provided by the Home & Community Services (HCS), Developmental Disabilities Administration (DDA), or HCS Social Worker (SW) / Community Nurse Consultant (CNC) case manager.
NOTE: If the Payment Auth Date is not entered, it is possible the AU will approve, however, the cost of care is not calculated.
NOTE: To add details to the Institutional Care Page, click the Add icon from the toolbar.
  1. On the Home and Community Based Services (HCBS) page enter the following information if the client receives waiver, hospice or other services:
  • Type field - Select the appropriate waiver or service type from the dropdown.
  • Provider ID field - Enter the [provider ID number] if required, to find the provider’s ID number Search to go to the Provider Search page. See Vendor Payment – How do I search for a vendor?
  • Start Date field - Enter the [date the waiver service begins].
  • Approval Source field - Select approval source from the dropdown menu.
  • Payment Auth Date field - Enter the [date payment is to begin]. This is the date the LTC services are approved and displays on the award letter.
NOTE: If the Payment Auth Date is not entered it is possible the AU will approve, however, the cost of care will not be calculated.
  • For non-medical facilities, use the rate provided by the Home & Community Services (HCS), Developmental Disabilities Administration (DDA), or HCS Social Worker (SW) / Community Nurse Consultant (CNC) case manager.
  • If the HCBS type is Hospice – (H) update the following fields:
  • Private Rate field - Enter the [provider’s private daily rate]. Call the facility to get the current private rate.
  • State Rate field - Enter the [facilities state daily rate].
NOTE: To find the most current state rate for nursing facilities, veteran facilities or hospice care centers go to the MMEN and enter option DProvider Name List.
  1.  If the client has long term care expenses or deductions, update the  Long Term Care Expenses/Deductions page with the following information:
  • Type field- Select any qualified expenses or deductions that can be used to reduce participation or excess resources from the dropdown.
  • Amount field - Enter the [amount of the expense/deduction].  
  • End Month field - Enter the [date the expense/deduction ends].
  1. If the client has long term care expenses or deductions, update the  Room & Board Exceptions page with the following information;
  • Type field - Select any qualified exception that can be used to reduce room and board from the dropdown.
  • Amount field - Enter the [amount of exception]
  • End Month field - Enter the [date the exception ends].
NOTE: Expense type Predictable Ongoing Expense (RP) is NOT a post eligibility deduction. This amount is added to the facility rate and used as recurring medical expenses when calculating the net income in initial eligibility for HCBS waivers in Group 3 - clients who have gross income above the SIL and net countable below the MNIL.
  1. If a client is in a medical facility and has approved Housing Maintenance Allowance, enter the following information:
  • Amount field- Enter the housing maintenance amount authorized by HCS or DDA social services.
    • The maximum amount used in the post-eligibility calculation is the one-person MNIL.
  • Begin Month field- Enter the [beginning month & year].
    • This allowance is for six months, starting with the month entered in this field.
  1. If the client has dependent(s), enter the following on the Dependent/Child Income and Allowance page:
  • Type field - Use the drop down menu to select one of the following:
    • Dependent child living with Community Spouse (C) - an applicant/recipient's natural or adopted child who is living in the household with the Community Spouse (CS).
    • Dependent not living with Community Spouse (O) - any dependent (child or otherwise) not living with a CS.
    • Other Dependent living with Community Spouse (D) - dependents other than the applicant/recipient's natural or adopted child.
  • Amount field: Enter the gross income amount of the dependent. If the dependent does not have any income, leave the Amount field blank.
  1. Complete the Community Spouse Resource Allowance (CSRA) screen(s) if the client has a community spouse and they are getting a CSRA higher than the state rate. If not, only complete the Most Recent Continuous Period of Institutionalization (MRCPI) or Service Start Date. See Help linkHelp.
NOTE: If the LTC client has a CS, shelter expenses must be entered on the spouse’s Shelter Expense page in order to compute the excess shelter portion of the spousal maintenance allowance (and the shelter deduction for the spouse’s Basic Food, when applicable).
  1. After committing the interview data, follow the instructions in the How do I complete Process Application Month for all pending months.
  2. Once the pending months have been processed, follow the instructions in the How do I complete Finalize Application.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Categorically Needy LTC - SSI Related Undocumented Alien (L04)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L04 (Non Citizen CN SSI Related LTC) medical?

Non-citizen clients in a nursing facility who are pre-approved by HCS and meet the eligibility requirements described in the following:

Non-citizen clients in a hospital approved by the Health Care Authority (HCA):

NOTE: All other medical programs must be considered before using the L04 medical program.

How long is the L04 (Non Citizen CN SSI Related LTC) certification period?

L04 medical is certified for 12 months.

Online Processing

How do I screen L04 (Non Citizen CN SSI Related LTC) medical?

An L04 Assistance Unit (AU) is initially screened as a L02 (CN SSI Related Long Term Care) AU following the steps in How do I screen L02 Medical?

The L02 AU trickles to a L04 during finalize, if appropriate, based on the eligibility, living arrangement, and coding on the Clients Detail and Facilities pages.

How do I process a pending L04 (Non Citizen CN SSI Related LTC) Assistance Unit (AU)?

To process a pending L04 AU, take the following steps:

  1. Go to the Case Actions page. For more information, see How do I access the Case Actions page in ACES 3G?
  2. On the Case Actions page in the Pending Applications section, select Start Interview.
  3. On the Contact Information page, add an Authorized Representatives/Payees, if appropriate.
  4. On the AU Details page, update the Financial Responsibility using the drop down menu:
  • Applicant (PN) for the applicant.
  • Ineligible Spouse (SP) for the applicants’ spouse.
NOTE: The dependents are coded on Family Member Allowance page. This allows the correct post-eligibility allowance calculation for the dependent. A dependent is a child, sibling or parent the individual is claiming to the Internal Revenue Service (IRS) as a dependent.
  1. On the Client Details page, update the following fields in each section:
  • In the Identity section:
    • Marital Status - Select the marital status using the drop-down list.
NOTE: The marital status of both the applicant and spouse must be coded as Separated (P), Legally Separated (S), Married Living Apart (A) or Married (M) for the system to recognize the couple as married. This information is needed for the system to determine if the spouse is a community spouse or an institutionalized spouse and correctly calculate the spousal allocation.
  • In the Citizenship / Alien section:
    • Citizen Status - Select the appropriate status for the non-citizen applicant from the drop-down list.
    • Alien subsection - Enter the [applicant's citizenship / alien status information].
    • Alien Medical Approval Source - Select ADSA Headquarters Approved (A) from the drop-down list.
  • In the Residency / Living Arrangement section:
    • Living Arrangement - Select Nursing Facility (NF) or Hospital (HS).
  • In the Disability / Incapacitated / Psychiatric section: 
    • Disability/Incapacity - Enter the [applicant’s disability information].
      • If the client is 65 or older, the Disability / Incapacity fields can be left blank.
  1. If any client in the household has earned income, add Earned Income for each client and each income source.
  2. If any client in the household has unearned income, add Unearned Income for each client and each income source.
  3. For information on how to code the Shelter Expense page when there is a community spouse, see How do I code the SHEL screen when there is a community spouse?
NOTE: If the LTC client has a community spouse, shelter expenses must be entered on the spouse’s Shelter Expense page in order to compute the excess shelter portion of the spousal maintenance allowance (and the shelter deduction for the spouse’s Basic Food, when applicable).
  1. If any client in the household has resources, add Resources for each client and resource type. For more information on resources, see Apple Health eligibility manual - Long-Term Care - Eligibility - Resources.
  2. If the client has transferred an asset, complete the Transferred Resources page with the appropriate information. For more information on transfer of assets, see Apple Health eligibility manual - WAC 182-513-1363 Evaluating the transfer of assets for people applying for or receiving long-term care (LTC) services.
  3. On the Institutional Care page update the following fields:
  • Add a Facility page for the applicant and update the following:
    • Type field - Select Nursing Facility - Medicaid (MD) or Hospital (HS) from the drop-down list. The facility type must be from the same subset as the living arrangement coded on the Clients Detail page.
    • ID field - Enter the [provider number] if the provider is a Nursing Facility - Medicaid (MD) or Hospice Care Center (HC).
    • Entry Date field - Enter the [date client entered the facility].
    • Level Care field - Select the client's level of care using the drop-down menu.
    • Payment Auth Date field - Enter the [date payment to the facility should begin]. This is the date the LTC services are approved and displays on the award letter.
    • Private Rate field - Enter the [facility's private daily rate]. Contact the facility for rate information.
    • State Rate field - Enter the [facility's state daily rate].
Note: If the Payment Authorized Date is not entered it is possible the AU will approve; however, the cost of care is not calculated.
  1. If appropriate, add a Long Term Care Expense/Deduction page for the applicant and enter any [qualified expenses or deductions] that can be used to reduce participation or excess resources in the Type and Amount fields.
  2. If the applicant in a medical facility has an approved housing maintenance allowance, add a Housing Maintenance Allowance page and update the following information:
  • Amount - Enter the [housing maintenance amount] authorized by Home and Community Services (HCS) or Developmental Disabilities Administration (DDA) social services. The maximum amount used in the post-eligibility calculation is the one-person MNIL.
  • Check the box to the left of Approved if the housing maintenance allowance has been approved.
  • Begin Month - Enter the month and year as [mm/yyyy]. The housing and maintenance allowance is for six months, starting with the month entered in this field.
  1. If the client has dependent(s), enter the following on the Dependent/Child Income and Allowance page:
  • Type field - Use the drop down menu to select one of the following:
    • Dependent child living with Community Spouse (C) - an applicant/recipient's natural or adopted child who is living in the household with the Community Spouse (CS).
    • Dependent not living with Community Spouse (O) - any dependent (child or otherwise) not living with a CS.
    • Other Dependent living with Community Spouse (D) - dependents other than the applicant/recipient's natural or adopted child.
  • Amount field: Enter the gross income amount of the dependent. If the dependent does not have any income, leave the Amount field blank.
  1. If the client wishes to waive the spousal portion of the maximum spousal/family allowance, add a Spousal Allowance page, check the box for Waive Spousal Allowance.
  2. Add Community Spouse Resource Assessment (CSRA) pages if the client has a community spouse.
  3. If the client wishes to use the name on check rule, add an LTC Income Rule page in the Income section and check the box next to Name on Check Rule.
NOTE: In situations where there is an institutional spouse and both are receiving services, the worker may choose to force the name on the check rule; however, the system requires that they force the rule on both clients' LTC Income Rule pages.
  1. Once all data has been entered follow the steps in How do I initiate and complete an intake interview?
  2. After committing the interview data follow the steps in How do I complete Process Application Months? for all pending months.
  3. Once the pending months have been processed, follow the steps in How do I complete Finalize Application?

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Categorically Needy Waiver or Hospice Services – SSI Recipients (L21)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L21 (Categorically Needy Waiver or Hospice Services - SSI Recipients) medical?

A person with SSI income who meets the criteria in the following manual sections may be eligible for L21 medical:

How long is the L21 (Categorically Needy Waiver or Hospice Services - SSI Recipients) certification period?

L21 medical has no review end date and is certified for as long as the client is eligible for both SSI and waiver service coverage.

Online Processing

How do I screen L21 (Categorically Needy Waiver or Hospice Services - SSI Recipients) medical?

To screen an L21 AU, take the following steps:

  1. Follow the instructions in Screening an Application.
  • On the Programs page, click the checkbox next to HCS Waiver/DDA Waiver/Hospice.
  • In the Program Determination Criteria section, click the checkbox next to SSI Eligible.
  • If ONLY the HCS Waiver/DDA Waiver/Hospice box is checked on the Programs page in screening, the AU initially starts as a L22 (Categorically Needy Waiver or Hospice Services – SSI Related) AU.

How do I process a pending L21 (Categorically Needy Waiver or Hospice Services - SSI Recipients) Assistance Unit (AU)?

To process a pending L21 AU, follow the steps in How do I process a pending L02 AU?

  • If a client is living in an assisted living facility, adult family home, or in a medical facility on hospice it is necessary to complete the Facility and the Home Community Based Services pages.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Categorically Needy Waiver or Hospice Services - SSI Related (L22)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible to receive L22 (Categorically Needy Waiver - SSI Related) medical?

A person who is Supplemental Security Income (SSI) related and who meets the criteria in the following manual sections may be eligible for L22 medical:

How long is the L22 (Categorically Needy Waiver - SSI Related) certification period?

The certification period for L22 medical is 12 months.

Online Processing

How do I screen L22 (Categorically Needy Waiver - SSI Related) medical?

To screen an L22 Assistance Unit, take the following steps:

  1. Follow the instructions in How do I screen an application for a client?
  • On the Programs page, click the checkbox next to HCS Waiver/DDA Waiver/Hospice.

How do I process a pending L22 (Categorically Needy Waiver - SSI Related) Assistance Unit (AU)?

To process a pending L22 AU, follow the steps in How do I process a pending L02 AU?

Note: If a client is living in an assisted living facility, adult family home or a medical facility on hospice it is necessary to complete the Facility or the Home Community Based Service pages.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

State Funded LTC - SSI Related for Non-Citizens at Home or Alternate Living Facility (L24)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L24 (State Funded LTC - SSI Related for Non-Citizens at Home or Alternate Living Facility) medical?

Non-citizen clients at home or in an Alternate Living Facility (ALF) who are pre-approved by the Aging and Long-Term Support Administration (ALTSA) and meet the eligibility requirements described in: 

How long is the L24 (State Funded LTC - SSI Related for Non-Citizens at Home or Alternate Living Facility) medical certification period?

L24 medical is certified for 12 months.

Online Processing

How do I screen an L24 (State Funded LTC - SSI Related for Non-Citizens at Home or Alternate Living Facility) medical Assistance Unit (AU)?

An L24 AU is initially screened as L22 (Categorically Needy Waiver or Hospice Services - SSI Related). Follow the steps in How do I screen an application for a client?

  • On the Programs page, click the checkbox next to HCS Waiver/DDA Waiver/Hospice.
  • On the Finalize page, select the L22 AU. The L22 AU will trickle to an L24 during finalize if appropriate based on eligibility, living arrangement, institutional coding, and citizenship coding.

How do I process an L24 (State Funded LTC - SSI Related for Non-Citizens at Home or Alternate Living Facility) medical Assistance Unit (AU)?

To process a pending L24 AU, follow the steps in How do I process a pending L02 AU?

  1. On the Institutional Care/Expenses page in the Home Community Based Service section, complete the following fields:
  • HCBS Type field - Select WA State Waiver (W) from the drop down menu..
  • Start Date field - Enter the [date the new waiver service begins].
  • Approval Source field - Select Home & Community Services (HC) from the drop down menu.
  • Payment Auth Date field - Enter the [date payment should begin]. This is the date services are approved and displays on the award letter.
NOTE: If the Payment Auth Date field is not completed, the AU may approve; however, the cost of care is not calculated.
  1. On the Client Details page in the Alien Medical section, update the following field:
  • Alien Medical Approval Source field ADSA Headquarter Approved (A) using the drop down menu.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Categorically Needy PACE or Institutional Hospice – SSI Recipients (L31)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L31 (Categorically Needy PACE or Institutional Hospice SSI Recipients) medical?

A person with SSI income who meets the criteria in the following Apple Health Manual sections may be eligible for L31 medical:

L31 should not be used for recipients who are not in a medical facility; instead, S01 (SSI Categorically Needy) medical should be approved for these clients.

L31 recipients in a medical facility may be issued a cash payment to bring their income up to the Personal Needs Allowance (PNA).

How long is the L31 (Categorically Needy PACE or Institutional Hospice SSI Recipients) certification period?

L31 medical has no review end date and is certified for as long as the client is eligible for SSI.  

Online Processing

How do I screen an L31 (Categorically Needy PACE or Institutional Hospice SSI Recipients) Assistance Unit (AU)?

To screen an L31 AU, take the following steps:

  1. Follow the instructions in Screening an Application.
  • On the Programs page, click the checkbox next to HCS Waiver/DDA Waiver/Hospice.
  • In the Program Determination Criteria section, click the checkbox next to SSI Eligible.
NOTE: If the HCS Waiver/DDA Waiver/Hospice box is the ONLY box checked on the Programs page, the AU initially starts as an L22 (CN SSI Related HCB Waiver AU).

How do I process a pending L31 (Categorically Needy PACE or Institutional Hospice SSI Recipients) Assistance Unit (AU)?

To process a pending L31 AU, follow the steps in How do I process a pending L02 AU?

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Categorically Needy PACE or Hospice – SSI Related (L32)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible to receive L32 (Categorically Needy PACE or Hospice - SSI Related) medical?

A person who is SSI related who meets the criteria in the following manual sections may be eligible for L32 medical:

How long is the L32 (Categorically Needy PACE or Hospice - SSI Related) certification period?

L32 is certified for 12 months.

Online Processing

How do I screen L32 (Categorically Needy PACE or Hospice - SSI Related) medical?

To screen an L32 Assistance Unit (AU), take the following steps:

  1. Follow the instructions in Screening an Application
  • On the Programs page, click the checkbox next to HCS Waiver/DDA Waiver/Hospice.

How do I process a pending L32 (Categorically Needy PACE or Hospice - SSI Related) Assistance Unit (AU)?

To process a pending L32 AU, follow the steps in How do I process a pending L02 AU?

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Categorically Needy – Roads to Community Living – SSI Recipients (L41)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L41 (Categorically Needy - Roads to Community Living - SSI Recipients) medical?

A person with SSI income who meets the following criteria may be eligible for L41 medical:

L41 recipients may also be eligible for and receive State Supplement Payments (SSP) or Ongoing Additional Requirements. 

How long is the L41 (Categorically Needy - Roads to Community Living - SSI Recipients) certification period?

L41 medical has no review end date.  Roads to Community Living (RCL) has continuous eligibility for 365 days from the date client is authorized.  Income or Resource changes don’t impact the client’s eligibility.

Online Processing    

How do I screen L41(Categorically Needy - Roads to Community Living - SSI Recipients) medical?

To screen an L41 Assistance Unit (AU), take the following steps:

1.    Follow the instructions in Screening an Application.

  • In the Programs section of the Programs page, click the checkbox next to HCS Waiver/DDA Waiver/Hospice.
  • In the Program Determination Criteria section, click the checkbox next to SSI Eligible.
NOTE: If ONLY the HCS Waiver/DDA Waiver/Hospice box is checked on the Programs page in screening, the AU initially starts as a L22.

How do I process a pending L41 (Categorically Needy - Roads to Community Living - SSI Recipients) Assistance Unit (AU)?

To process a pending L41 AU, follow the steps in How do I process a pending L02 AU?

NOTE: Roads to Community Living (RCL) requires an end date. The client  is categorically eligible for 365 days once RCL is approved. The RCL approval source determines the personal needs allowance (PNA) for the AU.  For more information see Apple Health eligibility manual - WAC 182-513-1235 Roads to Community Living (RCL)

How do I close an active L41 (Categorically Needy - Roads to Community Living - SSI Recipients) Assistance Unit (AU)?

An active L41 (AU) can only be closed for one of the following reason codes:

  • Failed Residency Requirement (210)
  • Death (244)
  • Living Arrangement - Cash/Medical Assistance (201)
  • Whereabouts Unknown (551)
  • RCL Error in Initial Eligibility (554)
  • AU Requested Closure (557)
  • Already Eligible for Program in Different AU (587)

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

 

Roads to Community Living - SSI-Related Recipients (L42)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L42 (SSI Related Roads to Community Living) medical?

An SSI-related person who meets the criteria in the Apple Health eligibility manual - WAC 182-513-1235 Roads to Community Living (RCL) may be eligible for L42 medical.

How long is the L42 (SSI Related Roads to Community Living) certification period?

The certification period for L42 medical is set to the last day of the month of the Roads to Community Living (RCL) end date.  If this doesn't allow enough time to put the Assistance Unit into a review cycle, the system auto adjusts the Certification Period by one or two months.

Online Processing

How do I screen an L42 (SSI Related Roads to Community Living) Assistance Unit (AU)?

To screen an L42 AU, take the follow the steps:

  1. Follow the instructions in How do I screen an application for a client?
    • On the Programs page, click the check box next to HCS Waiver/DDA Waiver/Hospice.

How do I process a pending L42 (SSI Related Roads to Community Living) Assistance Unit (AU)?

To process a pending L42 AU, follow the steps in How do I process a pending L02 AU?

NOTE: Roads to Community Living (RCL) requires an end date.  A client is categorically eligible for RCL for 365 days. The RCL approval source determines the personal needs allowance (PNA) for the AU. For more information, see Apple Health eligibility manual - WAC 182-513-1235 Roads to Community Living (RCL)

How do I close an active L42 (SSI Related Roads to Community Living) Assistance Unit (AU)?

An active L42 AU can only be closed for one of the following reason codes:

  • Citizenship/Alien Status (202)
  • Failed Residency Requirements (210)
  • Death (244)
  • Living Arrangement (201)  
    • Jail (JL)
    • Prison (PR)
  • Whereabouts Unknown (551)
  • RCL Error in Initial Eligibility (554)
  • AU Request Closure (557)
  • Already Eligible in Another AU (557) 

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

SSI Non-Institutional CN CFC or MPC (L51)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for L51 (SSI Non-Institutional CN CFC or MPC) medical?

A person with SSI income who meets the criteria in the following manual sections may be eligible for L51 medical:

Recipients of L51 may also be eligible for and receive Ongoing Additional Requirements (OAR). For more information, see EA-Z Manual Ongoing Additional Requirements (OAR).

How long is the L51 (SSI Non-Institutional CN CFC or MPC) certification period?

L51 medical has no review end date and is certified for as long as the client is eligible for both Supplemental Security Income (SSI) and Community First Choice. 

Online Processing

How do I screen an L51 (SSI Non-Institutional CN CFC or MPC) Assistance Unit (AU)?

To screen an L51 AU, take the following steps:

  1. Follow the instructions in How do I screen an application for a client?
  • On the Programs page, click the checkbox next to HCS Waiver/DDA Waiver/Hospice.
  • In the Program Determination Criteria section, click the checkbox next to SSI Eligible.
NOTE: If the HCS Waiver/DDA Waiver/Hospice box is the ONLY box checked on the Programs page, the AU initially starts as a L22 (Categorically Needy Waiver or Hospice Services - SSI Related ) AU.

How do I process a pending L51 (SSI Non-Institutional CN CFC or MPC) Assistance Unit (AU)?

To process a pending L51 AU, follow the steps in How do I process a pending L02 AU?

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

SSI-Related Non-Institutional CN CFC or MPC (L52)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible to receive L52 (SSI-Related Non-Institutional CN CFC or MPC) medical?

A person who is Supplemental Security Income (SSI) related and meets the criteria in the following sections may be eligible for L52 medical:

How Long is the L52 (SSI-Related Non-Institutional CN CFC or MPC) certification period?

L52 is certified for 12 months.

Online Processing

How do I screen L52 (SSI-Related Non-Institutional CN CFC or MPC) medical?

To screen an L52 Assistance Unit (AU), take the following steps:

1.    Follow the instructions in How do I screen an application for a client?

  • In the Programs section of the Programs page, click the checkbox next to HCS Waiver/DDA Waiver/Hospice.

How do I process a pending L52 (SSI-Related Non-Institutional CN CFC or MPC) Assistance Unit (AU)?

To process a pending L52 AU, follow the steps in How do I process a pending L02 AU? 

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Medically Needy LTC or Hospice - No Spenddown (L95)

Created on: 
Nov 07 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible for Medically Needy LTC or Hospice - No Spenddown (L95) medical?

Supplemental Security Income (SSI) related clients who reside in a medical institution, including clients who receive hospice services, and have non-excluded income over the Special Income Level (SIL) and less than the facility’s department contracted rate. 

Children who are blind or disabled, reside in a medical institution, and have non-excluded income over the categorically needy (CN) standard for the children’s medical program and less than the facility’s department contracted rate.

For more information, see Apple Health eligibility manual - WAC 182-513-1395 Determining eligibility for institutional or hospice services for people living in a medical institution under the SSI-related medically needy program.

How long is the Medically Needy LTC or Hospice - No Spenddown (L95) certification period?

The certification period for L95 medical is 12 months.

What happens when a Medically Needy LTC or Hospice – No Spenddown (L95) recipient becomes eligible for Categorically Needy (CN) medical?

When a client active on L95 medical becomes eligible for CN medical, the medical coverage group is changed to CN SSI Related Long Term Care (L02), Non-Citizen CN SSI Related Long Term Care (L04), PACE or Hospice (L32), Roads to Community Living (L42), or Community First Choice (L52).

Online Processing

How do I screen Medically Needy LTC or Hospice - No Spenddown (L95) medical?

  1. An L95 Assistance Unit (AU) is initially screened as a Categorically Needy LTC in a Medical Facility - SSI Related (L02) AU following the instructions in How do I screen an application for a client?
NOTE: If the HCS Waiver/DDA Waiver/Hospice box is checked on the Programs page in screening, the AU initially starts as Categorically Needy Waiver or Hospice Services - SSI Related (L22).

How do I process a pending Medically Needy LTC or Hospice - No Spenddown (L95) Assistance Unit (AU)

  1. While pending the AU remains Categorically Needy LTC in a Medical Facility - SSI Related (L02) or Categorically Needy Waiver or Hospice Services - SSI Related (L22) and is processed following the steps in How do I process a pending L02 AU?
NOTE:HOSPICE indicator displays on the Eligibility Details and Assistance Unit Details pages when hospice is the priority program for the AU.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Medically Needy LTC in a Medical Facility – with Spenddown (L99)

Created on: 
Nov 08 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Who is eligible to receive LTC MN or Hospice with Spenddown (L99)?

Clients who meet the criteria described in Apple Health (Medicaid) Manual – WAC 182-513-1395 Determining eligibility for institutional or hospice services for people living in a medical institution under the SSI-related medically needy program.

How long is the LTC MN or Hospice with Spenddown (L99) certification period?

The default certification/base period for L99 is six months, which can be shortened to three months following the instructions in Spenddown – How do I set up a spenddown Assistance Unit and base period?

Under certain conditions, the base period can be set to a period other than three or six months. See Apple Health (Medicaid) Manual - WAC 182-519-0110 Spenddown of excess income for the medically needy program for these conditions.

What happens when a Medically Needy LTC in a Medical Facility – with Spenddown (L99) recipient becomes eligible for Categorically Needy (CN) medical or Medically Needy LTC or Hospice – No Spenddown (L95)?

When a client active on L99 medical becomes eligible for CN or MN No Spenddown medical, the worker receives message: Client appears eligible for CN or MN no Spenddown. Screen new AU.

Online Processing

How do I screen LTC MN or Hospice with Spenddown (L99)?

An L99 Assistance Unit (AU) is initially screened as a CN SSI Related Long Term Care (L02) AU. For more information on screening, see How do I screen L02 medical?

  • If the HCS Waiver/DDA Waiver/Hospice box is checked on the Programs page in screening, the AU initially starts as a CN Waiver or Hospice - SSI Related (L22) AU.

If appropriate the L02/L22 AU trickles to an L99 when finalizing. This determination is based on the income, living arrangement and the coding on the Facility or Home and Community Based Services page. For more information on finalizing the AU, see How do I complete Finalize Application?

How do I process a pending LTC MN or Hospice with Spenddown (L99) Assistance Unit (AU)?

While pending, the AU is still CN SSI Related Long Term Care (L02) or CN Waiver or Hospice - SSI Related (L22) and is processed following the steps in How do I process a pending L02 AU?

If the AU exceeds the income standard for L02, it trickles to L99 in MA Spenddown (M) status.

For additional information on the spenddown process, see Apple Health (Medicaid) Manual - WAC 182-519-0110 Spenddown of excess income for the medically needy program.

The Hospice (H) indicator displays in the Cost of Care section on the Eligibility Details page when hospice is the priority program.

How do I enter spenddown medical expenses for a LTC MN or Hospice with Spenddown (L99) Assistance Unit (AU) in M status?

To enter medical expenses to meet the client’s spenddown liability on an L99 AU in MA Spenddown (M) status, follow the instructions in How do I enter medical expenses?

How do I add a person to a LTC MN or Hospice with Spenddown (L99) Assistance Unit (AU)?

When a CN SSI Related Long Term Care (L22) or CN Waiver or Hospice - SSI Related (L22) trickles to  L99, additional AU members cannot be added.

To add a person to an L99 AU, take the following steps:

  1. Manually close the current L99 AU following the instruction in the Online Processing - How do I manually close an Assistance Unit (AU) or client?.
NOTE: Before manually closing the current L99 AU, review the base period and shorten if necessary. For more information, see Online Processing - How do I shorten a spenddown Assistance Unit (AU) base period?.
  1. Screen in a new L02 AU including the new AU member(s) and following the instructions in Online Processing - How do I screen Categorically Needy LTC in a Medical Facility - SSI Related (L02) medical?.
  2. Process the pending L02 AU following the instructions in Online Processing - How do I process a pending Categorically Needy LTC in a Medical Facility - SSI Related (L02) Assistance Unit (AU)?.

When can I initiate an Eligibility Review on an LTC MN or Hospice with Spenddown (L99) Assistance Unit (AU)?

Eligibility reviews can be initiated on L99 AUs in Active (A) status. If the AU is in MA Spenddown (M) status, an eligibility review can be initiated when the ongoing month is the month after the current base period end month.

Complete the eligibility review on an active L99 AU following the instructions in the Eligibility Review chapter.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Tailored Supports for Older Adults (TSOA) Medical (T02)

Created on: 
Nov 08 2019

Online Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is Tailored Supports for Older Adults (TSOA) Medical (T02)?

TSOA provides limited support services to family caregivers when the care is for a client who is not a current recipient of Categorically Needy or Alternative Benefit plan (CN/ABP) Medicaid and the client:

  • Is age 55 or older,
  • Is a Citizen or Federally Qualified Alien, US National or qualified American Indian born abroad,
  • Provides a valid Social Security Number (SSN),
  • Is not Medicaid eligible,
  • Resides in an at home sub-setting and,
  • Does not reside in an Alternate Living Facility (ALF) or Medical Facility.

For more information on the TSOA medical program, see Apple Health eligibility manual - Tailored supports for older adults (TSOA).

Who is eligible to receive Tailored Supports for Older Adults (TSOA) Medical T02)?

A client who resides in an at home sub-setting and is found to be functionally, financially, and resource eligible may be eligible for TSOA.

For more information on the TSOA medical program, see the Apple Health eligibility manual - WAC 182-513-1615 Tailored Supports for Older Adults (TSOA) - General Eligibility and Apple Health eligibility manual - WAC 182-513-1655 Tailored supports for older adults (TSOA) - Renewals.

Online Processing

How do I screen a Tailored Supports for Older Adults (TSOA) Medical (T02) Assistance Unit (AU)?

To screen in a T02 AU, take the following steps:

  1. Follow the instructions in the How do I screen an application for a client chapter.
  2. On the Finalize page, click the Specify Program button and complete the following:
  • Program field - Select Medical Assistance (MA).
  • Medical Coverage Group field - Select Tailored Supports for Older Adults (TSOA).

How do I process a pending Tailored Supports for Older Adults (TSOA) Medical (T02) Assistance Unit (AU)?

  1. Complete the interview following the instructions in the Interview chapter.
  2. Add a Home and Community Based Service and complete the following fields:
  • Type field - Select Tailored Supports for Older Adults (T).
  • Start Date field - Enter the date the client was found to be functionally eligible for TSOA services
  • Approval Source field - Select the appropriate approval source code.
  • Payment Auth Date field - Enter the payment authorization date.
  1. After committing the interview data, follow the instructions in the How do I complete Process Application Month chapter for all pending months.
  2. Once the pending months have been processed, follow the instructions in the How do I complete Finalize Application chapter.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Case Specific Situations - LTC

Created on: 
Nov 08 2019

Online Processing

Mainframe Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What program do I open for a client in a hospital?

If the client does not meet institutional status to establish eligibility in the hospital, then users need to consider S02 (Categorically Needy SSI Related Medical) eligibility. However, there are certain situations when L-track medical would be to the client’s advantage. These cases need to be reviewed by policy if the worker is uncertain what program would be best for the client.

Online Processing

How do I process a change when a client changes from one setting or service to another?

To process a change when a client changes from one setting or service to another, take the following steps:

  1. On the Case Actions page in the Change of Circumstances section, select the month that the change occurred from the Benefit Month drop down menu and then click Start Changes.
  2. On the Facility page, complete the following fields:
  • Leave Date field - Enter the [date the client left the facility] if the client has discharged from a facility already coded on the Facility page.
  • If the client has entered another facility or Alternate Living Facility (ALF) add a new Facility page and complete the following fields:
    • Type field - Select the appropriate facility type from the drop down menu.
      • The facility type must be from the same subset as the living arrangement coded on the Client Details page.
    • ID field - Enter the [provider number] if required.
    • Entry Date field - Enter the [date the client entered the facility or ALF].
    • Level of Care field - Select the level of care from the drop down menu.
    • Payment Auth Date field - Enter the [date payment should begin]. This is the date services are approved and displays on the award letter.
Note: If the Payment Auth Date field is not completed the Assistance Unit (AU) may approve; however, the cost of care is not calculated.
  • Private Rate field - Enter the [facilities private daily rate]. Contact the facility for rate information.
  • State Rate field - Enter the [facilities state daily rate].
  1. On the Home and Community Based Services page, complete the following fields:
  • End Date field - Enter the [date the services ended] if the existing services have ended.
  • If new services have been approved, add a new Home and Community Based Services page and complete the following fields:
    • Type field - Select the new waiver service type from the drop down menu.
    • Provider ID field - Enter the [provider number] if required.
    • Start Date field - Enter the [date the new waiver service begins].
    • Approval Source field - Select the approval source from the drop down list.
    • Payment Auth Date field - Enter the [date payment is to begin].
Note: If the Payment Auth Date field is not completed the AU may approve; however, the cost of care is not calculated.
  • If the type is Hospice (H), complete the additional following fields:
    • Private Rate field - Enter the [provider’s private daily rate]. Call the facility to get the current private rate.
    • State Rate field - Enter the [provider’s state daily rate].
  1. From the Navigation tree, select Review.
  2. If there are no errors on the Review page, click Eligibility on the Navigation tree.
  3. On the Eligibility page, a Details link displays to the right of any AU that is currently active. Click the Details link.
  4. Review the Eligibility Details page for each AU. If all looks correct, click Confirm Benefits.
  5. Click Commit Changes on the Eligibility page.

To process the change for the months after the change took place, take the following steps:

  1. On the Case Actions page in the Change of Circumstances section, click Start Changes.
  2. On the Facility page, complete the following fields:
  • If the client has discharged from a facility or ALF already on the Facility page, delete the page containing the old facility information.
  • If the client has entered a new facility, add a new Facility page. For more information on how to add a new page, see How do I add details?
  • On the Facility page, complete the following fields:
    • Type field - Select the type of facility from the drop down list. The facility type must be from the same subset as the living arrangement coded on the Client Details page.
    • ID field - Enter the [provider number] if required.
    • Entry Date field - Enter the [date the client entered the facility or ALF]. This can be the same date as the leave date from a prior facility.
    • Level of Care field - Select the level of care from the drop down list.
    • Payment Auth Date field - Enter the [date payment should begin]. This is the date services are approved and displays on the award letter.
Note: If the Payment Auth Date field is not completed the AU may approve; however, the cost of care is not calculated.
  • Private Rate field - Enter the [facilities private daily rate]. Contact the facility for rate information.
  • State Rate field - Enter the [facilities state daily rate].
  1. On the Home and Community Based Services page, complete the following fields:
  • If existing services have ended that are already coded on the Home and Community Based Services, delete the page to remove the old information.
  • If new services have been approved, complete the following fields:
    • Type field - Select the appropriate waiver service type from the drop down list.
    • Provider ID field - Enter the [provider number] if required.
    • Start Date field - Enter the [date the new waiver service begins].
    • Approval Source field - Select the approval source from the drop down list.
    • Payment Auth Date field - Enter the [date payment is to begin].
Note: If the Payment Auth Date field is not completed the AU may approve; however, the cost of care is not calculated.
  • If the type is Hospice (H), complete the following fields:
    • Private Rate field - Enter the [provider’s private daily rate]. Call the facility to get the current private rate.
    • State Rate field - Enter the [provider’s state daily rate].
  1. From the Navigation tree, select Review.
  2. If there are no errors on the Review page, click Eligibility on the Navigation tree.
  3. On the Eligibility page, a Details link displays to the right of any AU that is currently active. Click the Details link.
  4. Review the Eligibility Details page for each AU. If all looks correct, click Confirm Benefits.
  5. Click Commit Changes on the Eligibility page.

How do I code the Shelter Expenses page when there is a community spouse?

For a Long-Term Care client with a Community Spouse, shelter expenses must be entered on the Community Spouse’s Shelter Expenses page to be used in the community spousal allowance/excess shelter calculation.

The excess shelter allocation is the amount in excess of the appropriate standard. For additional information, see Apple Health eligibility manual - WAC 182-513-1380 Determining a person's financial participation in the cost of care for long-term care (LTC) services.

ACES uses the four-person Standard Utility Allowance (SUA) in this computation. If utilities are included in the rent, mortgage, maintenance fees or condo fees, deduct that amount of the four-person SUA from these expenses so it is not allowed twice.

What do I do if the client’s Supplemental Security Income (SSI) stops and the system cannot auto-determine a client's Categorically Needy eligibility?

If the State Data Exchange (SDX) interface indicates a client is no longer SSI eligible the following occurs:

  • On the Unearned Income page, ACES updates the client’s income type SSI Benefits (SI) to $0 and the L01 (Categorically Needy LTC in a Medical Facility - SSI Recipient) or L51 (SSI Non-Institutional CN CFC or MPC) Assistance Unit (AU) remains active.
  • Alert 248 - SSI TERMINATED, REDETERMINE MEDICAL ELIGIBILITY is generated for the worker of record.
  • ACES generates Letter 022-05 (Redetermination for Medical at SSI Termination) with Form 14-078 (Eligibility Review) attached.
  • If the ER Received field on the Case Actions page is not updated with Yes (Y) within 60 days from the date the eligibility review was sent, the AU is automatically terminated with Reason Code 235 - Review not complete.
  • Once the SSI income is removed from the Unearned Income page, the AU trickles from L01 to L02 (Categorically Needy LTC in a Medical Facility - SSI Related) medical.

When a client’s SSI benefits are terminated, re-determine the client’s medical eligibility for other programs (such as L02 if the client is still residing in a medical institution) following the processes outlined in the Apple Health eligibility manual - WAC 182-504-0120 Washington apple health - Effective dates of changes.

When should I use the Facility page?

The Facility page should be used when:

  • A client is admitted to a medical facility for over 29 days; or
  • When a client is admitted to a medical facility and does not return to the same setting.
EXAMPLE: Client resides in a Nursing Facility (NF), and has a medical condition requiring hospitalization. The client discharges from the NF and enters the hospital. After two weeks, the client enters a new NF. This situation should be coded on a Facility page because the client had discharged from the NF.
EXAMPLE: Client resides in an Assisted Living Facility (ALF), and has a medical condition that requires a stay in a NF or hospital for over 29 consecutive days. The Client then returns to the same ALF. This situation should be coded on a Facility page.
EXAMPLE: Client resides in an ALF, and enters a NF. After two weeks the client discharges from the NF and enters a different ALF. This situation should be coded on a Facility page.

How do I close a Long Term Care (LTC) medical program for a client who is deceased?

To close a LTC medical program for a client who is deceased, complete the following steps:

  1. From the Case Actions page in the Change of Circumstances section, select the month the client passed away from the Benefit Month drop down menu and click Start Changes.
  2. On the Client Details page, complete the following fields:
  • Death Date field - Enter the [date of death].
  • Death State field - Select the state where the client passed away from the drop down menu.
  1. On the Facility page, complete the following field:
  • Leave Date field - Enter the [date of death].
  1. On the Home and Community Based Services page, complete the following field:
  • End Date field - Enter the [date of death].
  1. On the Eligibility page click the Details link. This takes you to the Eligibility Details page.
  2. On the Eligibility Details page, verify the benefit information then click the Confirm Benefits button.
  3. On the Eligibility page, click the Commit Changes button. 
  • The Assistance Unit (AU) remains active for the month the client passed away.
  1. From the Case Actions page in the Change of Circumstances section, select each month after the client passed away from the Benefit Month drop down menu and update the following on the Client Details page:
  • Death Date field - Enter the [date of death].
  • Death State field - Select the state where the client passed away from the drop down menu.
  1. Delete the Facility and Home and Community Based Services pages. For more information on how to delete a page, see How do I delete entered details?
  2. Commit the changes on the Eligibility page.The AU closes with Reason Code 244 - Death and the paid through date is the date of death.

How do I code the non-applying spouse’s demographic, income and resource information?

To correctly calculate eligibility for a Long Term Care (LTC) Assistance Unit (AU) and the spousal/dependent allocation amount, the following data is required:

  • The Financial Responsibility code must be entered as Ineligible Spouse (SP) on the AU Details page.
  • The living arrangement must be completed on the Client Details page.
  • The marital status of both the recipient and spouse on the Client Details page must be one of the following:
    • Legally Separated (S).
    • Separated (P).
    • Married Living Apart (A).
    • Married (M).

Information regarding the spouse’s resources and income must be entered using the standard client based screens such as the Client DetailsUnearned IncomeEarned Income, Shelter Expenses and Resources pages.

How do I code a legal dependent on a Long Term Care (LTC) Assistance Unit (AU)?

To code a legal dependent on an LTC AU, complete the following fields on the Dependent/Child Income and Allowance page: 

  • Type field - Use the drop down menu to select one of the following:
    • Dependent child living with Community Spouse (C) - an applicant/recipient's natural or adopted child who is living in the household with the Community Spouse (CS).
    • Dependent not living with Community Spouse (O) - any dependent (child or otherwise) not living with a CS.
    • Other Dependent living with Community Spouse (D) - dependents other than the applicant/recipient's natural or adopted child.
  • Amount field: Enter the gross income amount of the dependent.
Note: Leave the Amount field blank if the dependent does not have any income.

How do I view the participation amounts when they are split between multiple providers?

When participation is split between multiple providers, the participation amounts for each provider can be viewed on the Eligibility Details page in the Post Eligibility section.

The Post Eligibility section displays:

  • The gross income amount used to calculate the client’s cost of care responsibility.
  • The assignment section displays the service or facility/provider types to which the cost of care for the month may be assigned.
  • The cost of care for each provider when the client's cost of care for a single month is split between multiple services/providers.
  • The discharge date is the facility discharge date or service end date when the client received care from more than one service or setting during the month.

In ACES.online, the split participation can be viewed on the Medical Eligibility page in the Split Cost of Care section.

Mainframe Processing 

How do I view the participation amounts when they are split between multiple providers?

The participation amounts can be viewed on the LTCP screen when it is split between multiple providers.

The MAFI screen displays the LTCP indicator next to the Total Payment field and it can be accessed by pressing <F16> on the MAFI screen.

The LTCP screen is an inquiry only screen and can be accessed from any other data collection screen. For more information, see How do I fast-path to a specific screen?

The LTCP screen displays:

  • The gross Post Eligibility (PETI) income amount used to calculate the client’s cost of care responsibility.
  • The income processing rule used to determine the gross income amount used in the eligibility calculation.
    • N - "Name on Check" rule or
    • C - "Community Income" rule.
  • The assignment section displays up to four service or facility/provider types to which the cost of care for the month may be assigned. The first occurrence is a duplicate of the provider or service whose information is displayed on the MAFI screen.
  • The cost of care for each provider when the client's cost of care for a single month is split between multiple services/providers.
  • The discharge date is the facility discharge date or service end date when the client received care from more than one service or setting during the month.

The STAY screen displays when a medical client is institutionalized or elects Hospice for a short period of time. Use the STAY screen to access the SSCC screen that displays the amount the client owes the provider for a specified Short Stay. The SSCC screen is accessible only from the STAY screen.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

Personal Needs Allowance (PNA)

Created on: 
Oct 20 2015

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is a personal needs allowance (PNA)?

This is the standard amount of income that an institutional client is allowed to keep to use for housing, clothing, personal items and other incidentals. This allowance is sometimes referred to as Clothing and Personal Incidentals (CPI). For more information see Apple Health eligibility manual – WAC 182-513-1380 Determining a client’s financial participation in the cost of care for long-term care (LTC) services. The PNA is deducted from the client’s countable income when determining their cost-of-care responsibility.

How is a personal needs allowance (PNA) determined?

A client’s PNA is calculated based on the clients living arrangement, authorized services and marital status. For more information see Apple Health eligibility manual – Long-Term Care Personal Needs Allowance (PNA) charts. When a client is in multiple settings during the month, the PNA used in the cost-of-care calculation will be the highest PNA the client was eligible for at any point during the month.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.