Sinclair Jefferson

<%@LANGUAGE="JAVASCRIPT" CODEPAGE="65001"%> Sinclair Jefferson

Income and MA-LTC

Sinclair Jefferson

Sinclair Jefferson.

Using Sinclair’s case documentation, answer each of the following questions to help you determine the appropriate income calculation.

1. Is Sinclair residing in an LTCF or requesting services through a waiver?

Sinclair is requesting services through the CADI Waiver.

2. When are services anticipated to begin?

Based on the Lead Agency Case Manager/Worker Communication Form (DHS-5181) received from Zach Benson (Sinclair’s case manager), Sinclair’s CADI services are anticipated to begin upon approval of MA-LTC.

3. When will MA-LTC begin for Sinclair?

The DHS-3531 was received on the first of this month (CM/01/CY). He is requesting one month of retroactive coverage (LM/YY). Eligibility for MA-LTC cannot begin earlier than the date of the LTCC. The date of the LTCC and the anticipated begin date for CADI services are the same as noted on the Lead Agency Case Manager/Worker Communication Form, which is CM/01/YY, and this is the date MA-LTC eligibility could begin. Determine eligibility for basic MA for last month.

4. Does Sinclair have a community spouse?

No, there is no community spouse. Even though Mary is not receiving LTC services and is married to Sinclair, the term “community spouse” only applies when a person is receiving EW or residing in an LTCF.

5. Will Sinclair use an LTC income calculation?

No, Sinclair is requesting coverage through a disability waiver. All people requesting coverage through a disability waiver use an MA Method B income calculation.

6. What income calculation will you use for this month?

MA Method B community income calculation, even though waiver services are anticipated to start this month, all people receiving services through a disability waiver use a community income calculation.

7. What income calculation will you use for last month?

MA Method B community income calculation. Sinclair has a disability basis of eligibility because he has been determined disabled by the Social Security Administration.

To Do: Update your version of Sinclair’s DHS-5590 (MA-LTC Case Checklist) with the information about the income calculation begin and end dates.

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Types of Income Calculations - Caseload Activity

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Updated September 15, 2021.
Copyright © 2011 Health Care Eligibility and Access (HCEA).