POL 1001E: DETERMINING ELIGIBILITY FOR ICF-ID (Wyoming Life Resource Center)

1. Applicants Must Meet Basic Eligibility Factors

Reference Section M600 for a description of all basic eligibility factors.

2. Applicants Must Meet Level of Care Requirement

Applicants must be approved for ICF/ID level of care as indicated on the LT-104.

3. Applicants Must Meet Disability Requirements

Applicants meeting the level of care requirement, as indicated on the LT-104, fulfill disability requirements.

4. SSI Eligibles Do Not Need to Submit Application

If SSI is lost, an application will be required to redetermine eligibility.

5. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A to see income standards. Refer to Section M901 to determine if income is countable.

6. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource limit. Refer to Medicaid Table 7 to see resource standards. Refer to Section M801 to determine which resources are counted.

7. Some Services Withheld for Nonexempt Resource Transfers

Resources cannot be transferred for less than fair market value during the look-back period prior to application or when a client is receiving benefits.

If a client transfers resources for less than fair market value, but meets all other eligibility factors, a penalty period must be imposed. During the penalty period:

• • Payment for Wyoming Life Resource Center services must be withheld.

  • Other Medicaid services must be authorized.

Clients must receive notification that they are Medicaid eligible even though room and board will not be covered for the penalty period.

Refer to Section M803 to determine if a resource transfer is exempt.

8. Benefits Begin First Day of Month of Institutionalization

Applicants are not required to meet the 30-day stay.

9. Clients Pay Patient Contribution

Client is required to pay a contribution toward the cost of care.

Require the client to pay toward the cost of care when a partial month penalty is imposed from an uncompensated resource transfer.

Refer to Section M906 for details on calculating the patient contribution.

10. Clients May Pay Prorated Amount

If the client does not reside in the facility for a full month, they may pay a prorated amount based on the number of days they resided in the facility. Reference Section M906 for details on calculating the patient contribution.

11. Clients May Not Pay Patient Contribution First Month

Clients previously Medicaid eligible do not pay a patient contribution during their first month of eligibility. Clients must pay a patient contribution the first full month following 30 days of placement.

12. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to 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.

13. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

• • Client leaves Wyoming Life Resource Center.

  • Client does not complete review.

  • Client enters a public institution, excluding the Geriatric Hall at the State Hospital in Evanston.

  • Client dies.

  • Client determined no longer eligible.