Coverage Types

Because there is such a variety in how states implement LTC, there are three different coverage types which implement three different income tests. These types are:

• Long Term Care - The income test checks for less than 300% of SSI federal benefit rate.
• Medically Needy Long Term Care - The income test checks for less than the average facility rate or less than the average facility rate minus deductions.
• Medically Needy Long Term Care with Spend Down - The income test checks for over 300% of the SSI federal benefit rate.

It is not expected that an agency would implement all three coverage types. The Spend Down coverage type uses the common Spend Down Processing. All rules other than income test are the same between the coverage types. The cascade hierarchy is from Long Term Care to Medically Needy Long Term Care to Medically Needy Long Term Care with Spend Down.