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5.13.5 FAMILY CARE NON-MA ELIGIBILITY DETERMINATION

5.13.5.1 Non-Financial Requirements

5.13.5.2 FC Non-MA Financial Eligibility Determination

5.13.5.2.1 FC Non-MA Net Countable Asset Determination

5.13.5.2.2 FC Non-MA Income Determination

5.13.5.2.3 FC Non-MA Cost Share

 

Use Family Care Non-MA eligibility criteria if the applicant has failed eligibility for all other categories of full benefit MA.  This includes those with unmet deductibles.

5.13.5.1 Non-Financial Requirements

To be non-financially eligible, Family Care applicants must meet the EBD MA nonfinancial requirements with the following exceptions:

 

  1. S/he must be 18 years of age or older.
     

  2. S/he must be FC functionally eligible or meet the grandfather criteria.
     

  3. The CMO network of providers must have the capacity to enroll the client and providefor his/her needs.  The Resource Center worker gives this information to the IM worker.
     

  4. S/he is not required to be determined disabled by the Disability Determination Bureau ( DDB ).
     

  5. S/he must be a resident of the Family Care ( FC ) pilot county.

 

Note:  The client may be placed by the CMO outside of the county and maintain residency.

5.13.5.2 FC Non-MA Financial Eligibility Determination

Determination of FC Non-MA eligibility is a three-step process.  The IM worker determines countable monthly asset and income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. amounts.  The total of countable monthly assets and income is called the client’s monthly resource amount. From this, calculate a monthly cost share.

 

There are no income or asset limits for Family Care Non-MA. An client is financially eligible if the monthly FC cost share is less than the projected monthly cost of the client’s care plan at either the intermediate or comprehensive level.  When determining initial eligibility, use a projected cost of care plan.

 

Use the Family Care Eligibility Non-MA Financial Determination worksheet (WKST 12) to determine eligibility.

5.13.5.2.1 FC Non-MA Net Countable Asset Determination

  1. Determine the client’s monthly net countable assets using EBD rules and MAHB sections 4.5.1 and 5.10.1.  Count the assets of both the client and spouse if the client is legally married.  If both spouses are applying, do calculations for each individually.  Do not include Independence Accounts, or interest generated from these accounts.
     

  2. From the total countable assets, deduct the following:
     

    1. The Community Spouse Asset Share ( CSAS ), if applicable (5.10.6).  If both spouses are being tested for FC/Non-MA, allow the CSAS for each spouse separately.  
       

    2. A Family Care basic asset allowance:
       

  5. Divide the remainder by twelve.  The result is the monthly net countable assets of the client.

5.13.5.2.2 FC Non-MA Income Determination

  1. Determine the client’s monthly earned income. Count any unemployment or worker’s compensation payments as earned income for Family Care Non-MA.
     

  2. Deduct $200 and 2/3 of the earned income from the client’s monthly earnings. This is the adjusted earned income.
     

  3. Determine unearned income using EBD rules (4.1.1).
     

  4. Add the adjusted earned and unearned income together.
     

  5. Deduct $20 from the combined income. The total is the client’s countable monthly net income.  

 

5.13.5.2.3 FC Non-MA Cost Share

  1. Add the client’s countable monthly net asset and countable monthly net income amounts. The total is the countable monthly resource amount.  
     

  2. From the total countable monthly resource amount, deduct the following, if applicable:
     

    1. Community Spouse income allocation amount (5.10.1).
       

    2. Court ordered payments (4.1.3.2.1).
       

    3. Basic needs allowance.  The amount is based on the client’s living arrangement:

 

      • Basic needs allowance (8.1.12.1) if s/he lives in a   Nursing Home, Adult Family Home or Community Based Residential Facility, or  
         

      • If the person lives in his/her own home or other  community setting, the client receives the greater of the SSI Payment Level Plus the E Supplement (8.1.5) for one person or actual maintenance costs up to the EBD Maximum Personal Maintenance Allowance (8.1.5.1). Actual maintenance costs consist of shelter costs (rent, mortgage, taxes, insurance, condo fees, standard utility allowance, FoodShare allotment for one person, and standard clothing allowance of $100 per month).

 

 

 

The total countable monthly resource amount minus applicable deductions equals the monthly cost share amount.

 

To determine eligibility, compare the cost share amount to the cost of a Family Care projected plan of care for the functional  level assigned to the client.  The projected cost of care for clients is listed in 8.1.12.
 

If the cost share is less than the cost of the projected care plan, the client is eligible for Family Care Non-MA and must pay the determined cost share amount monthly.  

 

If the cost share is greater than the projected plan of care, the client is not eligible for Family Care.  However, the person may choose to purchase an assessment from the CMO to develop an actual care plan.  If the cost of the actual care plan is greater than the person’s cost share amount, the person is eligible for Family Care Non-MA.  Use the actual care plan costs from the CMO in subsequent eligibility tests.

 

 

This page last updated in Release Number : 02-04

Release Date : 10-01-02

Effective Date :10-01-02