Transcript Transfer of Resources SA-3205

Universal
Worker
Introduction
to …………..
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State/County Special
Assistance and Special
Assistance In-Home
The Basics
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What Is Special Assistance (SA)?
 SA
is an optional state supplement to the
federal SSI program that provides assistance
to individuals to pay for room and board in a
licensed SA approved facility or,
 Special Assistance In-home (SA/IH) is for
individuals who need adult care home (ACH)
level of care but desire to remain at home
and need assistance to remain safely at
home.
 To be determined eligible for SA, or for SA/IH
an individual must make an application at the
county DSS.
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More SA Eligibility Requirements
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All SA and SA/IH applicant/recipients (a/bs) must meet certain
eligibility requirements such as:
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Age
Citizenship/identity
NC residency
Countable income limits,
Countable resources limit
SSI recipients automatically meet the citizenship and identity,
income and resources requirements.
All SA and SA/IH a/bs must have a valid FL-2.
For SA the a/b must reside in a licensed, SA approved facility.
For SA/IH the a/b must need adult care home level of care and
be eligible for full Medicaid benefits, and reside in a private living
arrangement (PLA.)
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General SA Eligibility Rules
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SAD (Special Assistance to the Disabled): the a/b must be
Age 64 and under and determined disabled by SSI
standards, or legally blind or
If under age 18, determined legally blind must reside
in Specialized Community Residential Centers (i.e., those
that are not ICF/MR Medicaid facilities) .
SAA (Special Assistance to the Aged): and Age 65 older.
All a/bs: Countable resources must be no more than
$2,000.
Countable income must be below the appropriate SA
Maintenance amount of either Basic or Special Care Unit
(SCU.)
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SA Eligibility Requirements
The a/b must be eligible for SSI or be ineligible for
SSI solely due to income.
 If an a/b is non-SSI eligible due to income he/she
must meet the SSI resources criteria (this also
applies to Medicaid passalong recipients requesting
SA/IH.)
 To qualify for SA/IH the a/b must also have a need
for the SA/IH payment, and for services in order to
be able to remain safely at home.
 The SA/IH Case Manager will make the
determination of need (SA/IH payment amount) and
assess whether the SA/IH a/b can remain safely at
home.
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What about Medical Coverage?
SSI recipients are automatically eligible for Medicaid.
 SA recipients who do not receive SSI obtain Medicaid
coverage because they are eligible for SA if receiving
SA in a licensed SA approved facility.
 SA/IH a/bs must first qualify for full Medicaid as
categorically needy (CN). a/bs receiving Medicaid
due to passalong are considered CN.
 Medicaid provides most recipients coverage for some
personal care services, transportation for medical
purposes and other Medicaid covered services.
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What is a Valid FL-2?
Establishing the Need for ACH Level of
Care FL-2 must indicate the need for adult care home
level of care.
 Recommended/requested level of care - It
is acceptable for the FL-2 to indicate the need for
supervised living, assisted living or group home
care which is equivalent to “domiciliary” or “adult
care home” or “dom” level of care.
 The completed FL-2 form must be signed and
dated by a licensed physician, physician assistant,
or nurse practitioner.
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What is a Valid Date for an FL-2 for
SA/IH?
Unlike SA payments for assisted living
facility recipients, the SA/IH payment begins
the date the application is made (if all
eligibility criteria are met) and is not tied to
the date the FL-2 is signed.
 However, the FL-2 must not be dated more
than 90 days prior to the date of SA/IH
application and must be received during the
application processing period.
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Partial Month SA PaymentsDo not Count the A/R’s
Income
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The applicant's income for the month of entry is not counted
if he/she enters the facility and/or meets all eligibility criteria
after the first day of the month.
Request a partial month payment the month of entry if a/b
enters ACH after the first day of the month, and remains the
remainder of the month or,
Request a partial month payment if the a/b is in the ACH on
the first day of the month, but is not eligible for payment
until a later date in the month due to state residence or FL-2
requirements, or became financially eligible for SA upon
entering a licensed Special Care Unit (SCU) after the first of
the month.
Partial pays begin with the date of application for SA/IH if
after the first of the month and/or when the a/b meets the
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SA/IH eligibility requirements.
SA Partial Pay Determinants
The amount of a partial payment for SA
depends upon three things:
The day in the month the a/b becomes SA
eligible.
 The number of days in the month and..
 The SA rate for which the a/b is eligible (Basic,
SCU, or SA/IH)
 Note: The SA payment for SA/IH is based on
the SA Basic rate.
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Budgeting Full Monthly SA Payments
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For all other months after the month of
entry/application or partial eligibility month, count
the a/b’s monthly income when calculating the SA
payment.
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Additional Eligibility Verifications
for SA SCU A/Rs
Valid FL-2 must have a diagnosis of Alzheimer's or a
related disorder.
 Check the Facility Screen to verify the facility has a
Licensed SCU.
 View a/b’s facility record to determine the date of
entry into the SCU.
 A facility visit is required by the county DSS to verify
a/b is in a licensed Special Care Unit for Alzheimer’s
or related disorders,
 Unless the facility has only Special Care Unit
recipients…
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Approving the SA Case:
Verify the Facility Code on Facility Screen.
 SA Basic Ambulation Capacity Code is ‘B’.
 SA SCU Ambulation Capacity Code is “C”.
 SA/IH Ambulation Capacity Code is “H”.
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Resources
Special Assistance
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SA Resources Rules
To be eligible for SA an a/b must be eligible
for SSI or ineligible for SSI solely due to
excess income, so….
 If an SA a/b is over the SSI resources limit
they are not eligible for SA.
 SSI beneficiaries who apply for SA
automatically meet SA resource
requirements,
 Including transfer of resources requirements.
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Some Countable Resources
Which Differ from Medicaid
Cash accruing life insurance policies with a FV
over $1,500.00.
 Burial property (held for non-excludable
relatives.)
 Junked vehicles
 SA allows for intent to sell for real property
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Junked Vehicles
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A "junked vehicle" is one beyond repair
that can only be used for parts and is not
licensed. It does not meet the definition
of a “motor vehicle used for
transportation”.
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Burial Property- Spaces, Crypts,
Vaults, Mausoleums, Caskets and
Urns
SA counts in the resource limit all burial spaces, plots,
vaults, mausoleums, casket and urns in the a/b’s
name, unless they are intended for the a/b, his/her
spouse or an immediate family member:
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Parents, including adoptive parents;
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Minor or adult children, including adoptive and
stepchildren;
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Siblings (brothers and sisters), including
adoptive and stepsiblings.
Of items that serve the same purpose, exclude only
one per person. For example, exclude a cemetery lot
and a casket for the same person, but not a casket and
an urn.
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Transfer of Resources
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Non-SSI Applicant/Recipients
A/rs must be evaluated for transfer of
resources for a possible sanction.
 For SA applicants: all transfers of
resources must be evaluated for transfers
retroactive to 36 months prior to the date
of the SA application (the look back
period).
 The look back period for an SA recipient
is the date of transfer.
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SSI Recipients Automatically Meet the
Resource Requirements for SA,
Including Transfer of Resources
Requirements.
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SSI policy requires sanctions for non-allowable
transfers, except in situations where the sanction
would create a hardship on individuals who have
insufficient income/resources to provide for their
basic maintenance.
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Do Not Apply a Sanction
To the Following Transfers
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Spending Down Liquid Resources
Compensated Transfer
Transfer of the Home site to Allowable Persons
Transfer of Resources To A Spouse
Transfers to the A/R’s Blind/Disabled Child
Excluded Resource at the Time of Transfer (except the
homesite)
Intent to Dispose at Current Market Value
Transfers to certain types of trusts
Resource Transferred Exclusively for Other Reasons
All Transferred Resources Are Returned
A/R Has Been Defrauded
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