If an individual who needs LTC services is not eligible for or receiving an SSI payment, the CAO must determine eligibility for MA LTC. The CAO must authorize payment for MA LTC services in one of the following categories:
PAN, PJN, or PMN—SSI-related in an LTC facility |
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PAN 80 |
An individual age 65 or older in an LTC facility who is enrolled in the Medicare Savings Program (buy-in). This category provides payment for the Medicare premium, co-insurance, and Medicare deductibles. |
PAN 66 |
An individual age 65 or older in an LTC facility who is enrolled in buy-in. This category provides payment for the Medicare premium. |
PAN 00 |
An individual age 65 or older in an LTC facility who is not enrolled in buy-in. |
PJN 80 |
A disabled individual under age 65 in an LTC facility who is enrolled in buy-in. This category provides payment for the Medicare premium, co-insurance and Medicare deductibles. |
PJN 66 |
A disabled individual under age 65 in an LTC facility who is enrolled in buy-in. This category provides payment for the Medicare premium. |
PJN 00 |
A disabled individual under age 65 in an LTC facility who is not enrolled in buy-in. |
PMN 80 |
A blind individual age 21 through 64 in an LTC facility who is enrolled in buy-in. This category provides payment for the Medicare premium, co-insurance, and Medicare deductibles. |
PMN 66 |
A blind individual age 21 through 64 in an LTC facility who is enrolled in buy-in. This category provides payment of the Medicare premium. |
PMN 00 |
A blind individual age 21 through 64 in an LTC facility who is not enrolled in buy-in. |
PVN—SSI related in a Veterans' home |
|
PVN 80 |
An individual of any age in a Veterans' home who is enrolled in buy-in. This category provides payment for the Medicare premium, co-insurance,and Medicare deductibles. |
PVN 66 |
An individual of any age in a Veterans' home who is enrolled in buy-in. This category provides payment for the Medicare premium. |
PVN 00 |
An individual of any age in a Veterans' home who is not enrolled in buy-in. |
PCN—In a federal or state foster care program, receiving federal or state adoption assistance, or refugee |
|
PCN 02 |
A refugee in an LTC facility. |
PCN 31 |
A federal foster care recipient in an LTC facility. |
PCN 32 |
A federal adoption assistance recipient in an LTC facility. |
PCN 33 |
A state foster care recipient in an LTC facility. |
PCN 34 |
A state adoption assistance recipient in an LTC facility. |
PCN 35 |
An out-of-state foster care recipient in an LTC facility. |
PCN 36 |
An out of-state adoption assistance recipient in an LTC facility. |
PAW, PJW, or PMW—SSI-related in HCBS |
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PAW 80 |
An individual in HCBS who is age 65 or older and is enrolled in buy-in. This category provides payment for the Medicare premium, co-insurance, and Medicare deductibles. |
PAW 66 |
An individual in HCBS who is age 65 or older and is enrolled in buy-in. This category provides payment for the Medicare premium. |
PAW 00 |
An individual in HCBS who is age 65 or older and is not enrolled in buy-in. |
PJW 80 |
A disabled individual in HCBS who is under age 65 and is enrolled in buy-in. This category provides payment for the Medicare premium, co-insurance, and Medicare deductibles. |
PJW 66 |
A disabled individual in HCBS who is under age 65 and is enrolled in buy-in. This category provides payment for the Medicare premium. |
PJW 00 |
A disabled individual in HCBS who is under age 65 and is not enrolled in buy-in. |
PMW 80 |
A blind individual age 21 through 64 in HCBS who is enrolled in buy-in. This category provides payment for the Medicare premium, co-insurance, and Medicare deductibles. |
PMW 66 |
A blind individual age 21 through 64 in HCBS who is enrolled in buy-in. This category provides payment for the Medicare premium. |
PMW 00 |
A blind individual age 21 through 64 in HCBS who is not enrolled in buy-in. |
NOTE: If an individual in one of the six veterans' homes administered by the Department of Military and Veterans Affairs (DMVA) applies for MA LTC, he may receive LTC benefits in the PVN category through the Enhanced Veterans Reimbursement (EVR) Initiative. The Central Unit (CU) is responsible for determining eligibility for people in one of the six veterans' homes. See Section 405.5, Enhanced Veterans Reimbursement for more information.
Not all individuals in HCBS programs will have a category with three letters. In some cases, it is better to include an individual who is eligible for a HCBS program in the eligibility determination for the entire family. In these cases, the person’s category will not be identified with a third letter. Entry of the appropriate waiver code will indicate eligibility of HCBS and ensure payment of HCBS.
Example: A family, including a child in an HCBS program, is eligible for NMP MA. The child must be placed in the correct “PC” category above, but the CAO must use a waiver code to indicate the HCBS program.
Updated January 12, 2021, Replacing March 12, 2012