Purpose: This section will assist in determining eligibility for IMD 65+ (Uinta and Campbell Halls).
Current Policy Effective Date: January 1, 2008
Date Last Reviewed: November 30, 2007
Previous Policy: January 1, 2007
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POL M1001B: Determining Eligibility for IMD 65+ (Uinta and Campbell Halls)
1. Applicants Must Meet Basic Eligibility
Reference Section M600 for a description of all basic eligibility factors.
2. Applicants Must Be Age 65 or Older
3. SSI Eligibles Do Not Need to Submit Application
If SSI is lost, an application will be required to redetermine eligibility.
4. Applicants Must Meet Income Requirements
Require the countable income to be within the maximum income standard per month. Reference Medicaid Table 1A to see income standards. Reference Section M901 to determine if income is countable.
Use only the applicant’s income when determining if income requirements are met.
5. Applicants Must Meet Resource Requirements
Require the countable resources to be within the maximum resource limit. Reference Medicaid Table 7 to see resource standards. Reference Section M801 to determine if resources are countable.
6. Clients Must Be Reviewed
Clients must be periodically reviewed every 12 months to determine continued eligibility. Reference Section M1403 for information on reviewing eligibility.
A review is not required for SSI clients.
Clients must be reviewed for other Medicaid program eligibility before closing cases.
7. Clients May Lose Benefits
The case will close on the first day of the next month when any of the following occur:
· Client does not complete review.
· Client enters a public institution, excluding Uinta Hall.
· Client dies.
· Client determined no longer eligible.
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Reference:
Defining Group: Social Security Act § 1902(a)(10)(A)(ii)(xv)
Income: 42 CFR 435 Subpart K
Resources: 42 CFR 435 Subpart L
Clarifying Information:
1. Applicants Do Not Have to Meet Medical Necessity.
2. Applicants Do Not Have to Meet 30 Consecutive Days of Institutionalization Requirement.
3. Applicants Do Not Have to Make Patient Contributions.
Training Link: Not available at this time.
Worker Responsibilities:
Determining Countable Income
1. Refer to Section M901 for information on determining countable income.
Determining Countable Resources
1. Refer to Section M800 for information on determining resources.
Approving Benefits
1. Enter program type “ME SS” on SEPA screen in EPICS.
2. Enter subtype “IP” on MERE screen in EPICS.
3. Authorize case on SSRM screen in EPICS, using appropriate code from Medicaid Table 3.
4. Send approval notice from Medicaid Table 16.
Denying Benefits
1. Enter program type “ME SS” on SEPA screen in EPICS.
2. Enter subtype “IP” on MERE screen in EPICS.
3. Deny case on SSRM screen in EPICS, using appropriate code from Medicaid Table 15.
4. Send denial notice from Medicaid Table 16.
Reviewing Cases
1. Refer to Section M1403 for information on reviewing cases.
Closing Cases
1. Close case on SSRM screen in EPICS for the appropriate benefit month, using closure code from Medicaid Table 15.
2. Send 10-Day closure notice from Medicaid Table 16 when an adverse action has occurred.