Basis of Eligibility and LTCF Residence

A person in an LTCF may use any of the following bases of eligibility:

Child under age 21.
Pregnant woman.
Parent/caretaker.
Age 65 or older.
Blind or disabled, certified by SSA or SMRT.
Adults without Children
Automatic MA eligibility based on eligibility for another program, such as MSA, 1619(a) or 1619(b), etc.
MA for Breast/Cervical Cancer.
EMA.
Refugee MA.
Center for Victims of Torture.

Note: A child who also receives IV-E or state-funded adoption assistance must use the appropriate adoption assistance basis of eligibility and does not use a disabled basis of eligibility. However, the disability must still be verified to be eligible for long-term care services.

Reminder icon. Remember to follow asset and income methodologies according to the basis of eligibility.

Example 1:

Linda, who is pregnant, is admitted to an LTCF. She is requesting MA-LTC. She is not disabled nor age 65 and over.

Action:

Use a pregnant woman basis of eligibility to determine Linda’s MA eligibility. Linda does not have an asset test. Follow MA Method A income rules (counted, excluded, etc.) to determine her eligibility, even when using an LTC income calculation.

Example 2:

Gary is admitted to an LTCF and is requesting MA-LTC. He is receiving RSDI, disability payments. He has no children.

Action:

Use a disabled basis of eligibility. Apply an asset limit of $3,000. Follow MA method B income rules (counted, excluded, etc.) to determine his eligibility, even when using an LTC income calculation.