DETERMINING THE BEGIN DATE OF MA-LTC
Factors
Use the following factors to determine the begin date for MA-LTC:
• Date the request for MA-LTC is received at the county.
• Date of admission for clients residing in an LTCF, or if in a hospital, the
date skilled nursing facility services began.
• Date the case manager anticipates services will begin based on the
LTCC for clients requesting services through one of the home and
community-based waiver programs.
Begin Date Rules
Follow these rules based on living arrangement when determining the
begin date for MA-LTC for the following clients:
• Residents of an LTCF.
The begin date for a person residing in an LTCF is the date on which all
of the following is true:
 The client resided in the LTCF or began receiving skilled nursing
facility services in a hospital.
 The client requested coverage for that month.
 The client meets all eligibility requirements for MA-LTC.
• People requesting services through a home and community-based
waiver program.
The begin date for a person requesting services through one of the
home and community-based waiver programs is the date on which all of
the following is true:
 The case manager anticipates services will begin based on a
LTCC.
 The client requested coverage for that month.
 The client meets all eligibility requirements for MA-LTC.
Rev. 01/23/13 – Health Care Training
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EXAMPLES
Shawn:
Shawn is single and applying (EW). The case manager indicates on the DHS5181 that Shawn is requesting EW services, he had an LTCC completed on
November 23, and services are anticipated to begin that same date. Shawn
requests MA-LTC services on November 24, with no request for retro.
On December 30th, the case is approved in MAXIS with an MA eligibility begin
date of November 1, and an MA-LTC eligibility begin date of November 23, which
is the anticipated service begin date indicated on the DHS-5181.
Worker Action:
•
Enter a worker comment that payment of EW services begins on
November 23. (The notice will state that MA-LTC begins November 1.)
•
Complete Part 2 of the DHS-5181 right away with the eligibility
information.
•
In MMIS update RELG with the eligibility begin date of November 1.
•
Update RLVA with an end date on the U span of November 22. (One day
prior to the anticipated begin date indicated on the DHS-5181.)
Note: if Shawn were an SIS-EW or EW client with a community spouse the LTC
income calculation would begin in November based on the anticipated begin date
indicated on the DHS-5181. In this example, Shawn does not have a community
spouse so the LTC income calculation will begin the month after the MA-LTC
eligibility begin date, which is December.
Transfer Penalty: If Shawn had made an uncompensated transfer within the
lookback period that was subject to a transfer penalty, the transfer penalty would
begin in November, the month he was otherwise eligible for MA-LTC.
Rev. 01/23/13 - Health Care Training
EXAMPLES
Jenny and Joe:
Jenny and Joe are married and living together and only Jenny is applying for EW.
The case manager indicates on the DHS-5181 that she meets the requirements
to need EW services, she had an LTCC completed on November 12, and that
services are anticipated to begin that same date. Jenny requests MA-LTC on
November 13, with no request for retroactive coverage.
Eligibility for MA and MA-LTC was approved on December 9. Her MA-LTC
eligibility begin date is the anticipated begin date of waiver services listed on the
DHS-5181 which was November 12.
Worker Action:
•
Enter a worker comment that payment of EW services begins on
November 12. (The notice will state that MA-LTC begins November 1.)
•
Complete Part 2 of the DHS-5181 right away with the eligibility
information.
•
In MMIS update RELG with the eligibility begin date of November 1.
•
Update RLVA with an end date on the U span of November 11. (One day
prior to the anticipated begin date on the DHS-5181.)
Transfer Penalty: If Jenny or Joe made an uncompensated transfer within the
lookback period that was subject to a transfer penalty, the transfer penalty would
begin in November, the month she was otherwise eligible for MA payment of LTC
services.
Rev. 01/23/13 - Health Care Training
EXAMPLES
Charlie and Lori:
Charlie and Lori are married and living together. Charlie is an MA enrollee who is
now applying for MA-LTC for CADI waiver services. He has been getting RSDI
disability income for three years and is currently open on MA. He had an LTCC
completed on November 12, indicating he meets the requirements for CADI
services. The case manager indicates on the DHS-5181 that services are
anticipated to begin November 12, the same date as the LTCC. Charlie requests
MA-LTC on November 13.
Communication is sent to the case manager using the DHS-5181 on December
26, letting them know that the MA-LTC application was still pending processing
for verifications.
Eligibility for MA-LTC is approved by the worker on January 18, and MA-LTC is
opened effective November 12, as no updated information was received from the
case manager even though it has been over 60 days since the LTCC.
Note: It is up to the case manager to provide you any updates to the anticipated
begin date of waiver services. Workers need to use the anticipated begin date
listed on the most current DHS-5181 on file without regard to how long ago it was
received.
Worker action:
•
In MAXIS we will code the CADI waiver information on STAT/DISA in the
month MA-LTC is anticipated to begin as indicated on the DHS-5181 in
November. This will give CADI results in HC ELIG and change Charlie to a
household size of 1 beginning in November.
o Note: On this panel we will not make any changes to the Disability
Begin Date field or the Health Care Disability Status field.
•
Enter a worker comment that payment of CADI services begins on
November 12. (The notice will state that MA-LTC begins November 1.)
Rev. 01/23/13 - Health Care Training
EXAMPLES
•
Complete Part 2 of the DHS-5181 right away with the eligibility
information.
•
In MMIS we will not change the eligibility span on RELG as the major
program has not changed, it is still MA and his spenddown type has not
changed from when he first opened on MA.
•
On RLVA under the LTC Ineligible Information, the U span will have a
begin date that is the same date that MA eligibility began on RELG a few
years ago. For Charlie the CADI waiver will begin on November 12, based
on the anticipated begin date indicated by the case manager on the DHS5181. End date the U span one day prior to that date which is which is
November 11, even though we are processing in January.
Transfer Penalty: If Charlie or Lori made an uncompensated transfer within the
lookback period that was subject to a transfer penalty, the transfer penalty would
begin in November, the month he was otherwise eligible for MA payment of LTC
services.
Rev. 01/23/13 - Health Care Training