LTC Services as Non-SIS-EW Without a Community Spouse

When a client received LTC services through the EW as a non-SIS-EW enrollee without a community spouse prior to admittance to an LTCF or receipt of SIS-EW services, begin using an LTC income calculation the month after admission to the LTCF or the month after the SIS-EW status is anticipated to begin.

SIS-EW Example:

Gerard, age 65, is an MA enrollee receiving LTC services through the Elderly Waiver as a non-SIS-EW enrollee. On March 12, he reported his annuity payments ended on March 2. His reduced income is below the SIS beginning in April. He does not have a community spouse and has a certification period of January through June.

Action:

Change Gerard’s income calculation in May from an MA Method ABD income calculation (age 65 or over basis) to an LTC income calculation, because he became SIS-EW for April. Remember, all SIS-EW clients, even those without a community spouse, use an LTC income calculation.

January	February	March	April	May	June
MA Method ABD Income Calculation	MA Method ABD Income Calculation	MA Method ABD Income Calculation	MA Method ABD Income Calculation	LTC Income Calculation	LTC Income Calculation