If a client applies for Medical Assistance, the system checks if the client is eligible for a number of coverage types within the program. If the client is eligible for a coverage type at the top of the cascade, the lower coverage types are not checked. If the client fails a higher coverage type the system checks the next coverage type below, and keeps checking until the rules find a coverage type the client passes. The Long Term Care (SIL) coverage type (and succeeding coverage types) runs in parallel with QMB (then SLMB) cascade and LIFC/ABD cascade (and succeeding coverage types). If the individual is not eligible for the Long Term Care coverage type, the Medically Needy Long Term Care coverage type is checked. Then if not eligible, the Medically Needy Long Term Care with Spend Down coverage type is checked. Each is checked through the process described in this section. For more information on the cascade, see the Overview chapter of the Cúram Medical Assistance Program Guide.
When processing the Long Term Care rules, the system will then identify the appropriate financial resource unit for any eligible individual(s). In all cases, the rules will determine whether the individual passes the non financial requirements, categorical, level of care, and 30 consecutive day requirements, expensive home, and whether there is an existing or new invalid resource transfer. The system will then run through the income and resource rules for the appropriate financial unit. If required, the rules check the post-eligibility deductions.
Rules calculate the amount of assets to be transferred and this amount is displayed as part of the eligibility decision. The institutionalized individual must agree to transfer the required amount of resources within a specified period defined by the state, known as the protected period. The begin date of the protected period is the date of eligibility. Once the caseworker selects the Product Delivery, this information is stored in the Spousal Impoverishment entity.
If an institutionalized individual fails Long Term Care eligibility because of excess income, the individual may be eligible for Medically Needy Long Term Care. If the individual fails the income test in this coverage type, the individual may be eligible for Medically Needy Long Term Care with Spend Down.