Beginning and Ending Examples

Beginng and Ending Examples

Now let’s take a look at a couple of examples and determine what the begin date and the end date would be in each of these circumstances.

LTCF to SIS-EW with a Community Spouse Example:

Fred, age 65, is an MA enrollee. He entered a LTCF and received MA-LTC starting July 1st. Fred will be released in November to the community where he will begin EW services. He and his wife, Georgianna, make $1,500 per month. When does his LTC services begin and end?

Action:

His LTC income calculation will begin in July (the month of admission to the LTCF). Since his EW services are beginning in November, you will not be ending the LTC income calculation. You will continue to use the LTC income calculation for EW services.

July	August	September	October	November	December
LTC Income Calculation	LTC Income Calculation	LTC Income Calculation	LTC Income Calculation	LTC Income Calculation	LTC Income Calculation

LTCF to CADI with No Community Spouse Example:

Ramone, age 60, is an MA enrollee. He entered a LTCF and received MA-LTC starting January 1st. Ramone will be released in May to the community where he will begin CADI services. He does not have a wife, and has $1,300 in income per month.

Action:

Continue to use the MA Method ABD income calculation (age 65 and over basis) through the month of March. Use an LTC income calculation for April, the month SIS-EW services are anticipated to begin.

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

LTCF to SIS-EW with No Community Spouse Example:

Gladys, age 65, is an MA enrollee. She has been in a LTCF and receiving MA-LTC services since she arrived in February. She is scheduled to be discharged home on July 31st. Gladys requests MA-LTC on February 28. Her case manager verifies that Gladys will begin receiving services through the EW on August 1, the day after her discharge from the LTCF. She does not have a community spouse and receives $1,000 of income each month.

Action:

Her LTC income calculation will begin in March since she is arriving in February (the month after admission to the LTCF).

Her LTC income calculation will end in June (the month before her discharge from the LTCF).

She will have an MA-Method ABD community income calculation for July and August.

Her LTC income calculation will then pick back up again on September 1st due to her SIS-EW (the month after EW services are anticipated to begin).

February	March	April	May	June	July	August	September
MA Method ABD Income Calculation	LTC Income Calculation	LTC Income Calculation	LTC Income Calculation	LTC Income Calculation	MA Method ABD Income Calculation	MA Method ABD Income Calculation	LTC Income Calculation

LTCF to SIS-EW with a Community Spouse Example:

Action:

His LTC income calculation will begin in July (the month of admission to the LTCF). Although his EW services are beginning in November, there will be no ending of the LTC income calculation. You continue to use the LTC income calculation.

July	August	September	October	November	December
LTC Income Calculation	LTC Income Calculation	LTC Income Calculation	LTC Income Calculation	LTC Income Calculation	LTC Income Calculation

Page 9

Types of Income Calculations - Beginning and Ending an LTC Income Calculation

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