Policy Clarifications - Medicaid - Long Term Care
PMN12797468

Submitted: 1/13/06 Agency: CAOs
  Citations:
Subject: Home Maintenance Deduction for Individuals Transitioning to Community

Can the Home Maintenance Deduction be used as a deduction when determining payment towards the cost of care for a recipient of Long-Term Care (LTC) services to assist them in the transition back to the community EVEN IF THE TRANSITION BEGINS MORE THAN SIX MONTHS AFTER INITIAL ADMISSION TO A FACILITY?


Response By: Karen Kistler Date: 1/13/06

In an effort to assist residents of nursing facilities (and other LTC facilities) transitioning to the community, the Home Maintenance Allowance Deduction can be used as a deduction for a period of up to three months EVEN IF THE TRANSITION BEGINS MORE THAN SIX MONTHS AFTER INITIAL ADMISSION TO A FACILITY if the following conditions are met:

  1. A physician must certify that the individual will be discharged to the community within the time frames for the requested Home Maintenance Allowance Deduction.

  2. A nursing home transition coordinator must be actively assisting the individual with the transition back into the community. The County Assistance Office (CAO) must verify this with a contact with the appropriate agency, such as the Area Agency on Aging.

  3. The individual does not need to have an established residence in the community (e.g.: apartment, real property) to be eligible for this deduction.

  4. The maximum three month period of eligibility for the Home Maintenance Allowance Deduction begins the calendar month in which the physician certifies that the individual will be discharged home from the facility.

  5. The deduction will be allowed for up to a maximum of three consecutive months.

  6. The policy remains that an individual can receive the Home Maintenance Allowance deduction for a maximum period of six months unless the individual is discharged from the LTC facility.

  7. If an individual had previously received the Home Maintenance Allowance Deduction for the maximum period of six months when initially admitted to the LTC facility, the individual is not entitled to an additional three months for the transition back to the community (unless the individual had been discharged in between that period of time).

  8. If an individual had received the Home Maintenance Allowance Deduction for three months when initially admitted the individual would be entitled to maximum of three remaining months for the transition back to the community.

  9. The CAO will send a Confirming Notice (PA/FS 162-C) to the individual with copies to the nursing facility/LTC facility, the representative (agent, guardian, etc.) and, if applicable, the program office responsible for the Home and Community-Based Services (HCBS) program in which the individual may receive services once transitioned back to the community.

  10. The Home Maintenance Allowance Deduction is equal to the monthly SSI limit for one person (currently $630.40). This deduction is to be shown on the notice as an income deduction from the individualís gross monthly income to determine the payment towards cost of care along with any other allowable STEP 2 deductions.