Disability Waivers Example

Petunia, a Medicare enrollee, had an LTCC on June 22 and was determined to need services through the CADI Waiver. She requested MA and MA-LTC on June 23 and is requesting coverage back to May 1. Petunia lives with her husband, Brad. Brad, also a Medicare enrollee, is requesting MA coverage back to May 1.

Click on each month below to find out the correct household size.

May:

Petunia: Use a household size of 2 for MA and MSP eligibility because she had the LTCC in June and she is not eligible for CADI services prior to the date of the LTCC. Brad is counted in her household size.

Brad: Use a household size of 2 for MA and MSP eligibility because Petunia is not yet receiving CADI services. Petunia is counted in Brad’s household size.

June:

Petunia: Use a household size of 1 for MA-LTC eligibility because she has a current LTCC completed on June 22. Brad is not counted in her MA-LTC household size.

Brad: Use a household size of 2 for MA and MSP. Petunia is counted in his household size even though she is receiving CADI services.

July:

Petunia: Use a household size of 1 for MA-LTC eligibility because Petunia is receiving CADI services. Brad is not counted in her MA-LTC household size.

Use a household size of 2 for MSP eligibility. Brad is counted in her MSPA household size.

Brad: Use a household size of 2 for MA and MSP. Petunia is counted in his household size even though she is receiving CADI services.