PART VII: SPECIAL MA PROCESSING Table of Contents Chapter 1: Special MA Groups and Programs Introduction 1.1 Legal Authority 1.2 Transitional Medicaid Assistance (TMA) 1.3 Refugee Medical Assistance (RMA) 1.4 Cobra Assistance Program 1.5 Pickle Amendment 1.6 Disabled Widow(er)s 1.7 Early Widow(er)s 1.8 Grandfathered 1972 and 1973 Recipients 1.9 Disabled Adult Children 1.10 Qualified Medicare Beneficiaries (QMB) 1.11 Special Low-income Medicare Beneficiaries (SLIMB) 1.12 Qualified Individuals I (QI-1) 1.13 Qualified Disabled and Working Individuals (QDWI) 1.14 Disabled Individuals Returning to Work 1.15 50-64 Demonstration 1.16 Exhibit VII-1: Income and Asset Standards Chapter 2: Long-Term Care/Impoverished Spouse Introduction 2.1 Legal Authority 2.2 Medical Certification for LTC 2.3 LTC Application Processing 2.4 Transfer of Case Record 2.4.1 Time Standards 2.4.2 Assistance Unit Requirements 2.4.3 SSI Recipients 2.4.4 MA Income Eligibility Determination 2.5 LTC Income Allowances 2.6 Personal Needs Allowance (PNA) 2.6.1 Allowance for Health Insurance Premiums 2.6.2 Allowance for Maintenance of the Unoccupied Home 2.6.3 Allowance for Representative Payee/Conservator 2.6.4 Allowance for Medical Expenses 2.6.5 Community Spouse Monthly Income Allowance 2.6.6 Family Members' Monthly Income Allowance 2.6.7 Projected Income 2.7 Assessment of Assets 2.8 MA Asset Eligibility Determination 2.9 Protected Spousal Amount 2.9.1 Spousal Share 2.9.2 Retroactive Asset Eligibility Determination 2.10 Multiple Applications in the Same Continuous Period of Institutionalization 2.11 Treatment of Assets before or after MA Eligibility Determination 2.12 Limitation on Home Equity for Long Term Care Assistance 2.12a Transfer of Assets Before or after MA Eligibility Determination 2.13 Patient Pay Amount (PPA) 2.14 PPA and Spend-Down 2.14.1 Determining Total Countable Income for PPA Calculation 2.15 Treatment of Income from Non-trust Property 2.15.1 Treatment of Income from Trust Property 2.15.2 Adjustment of Spend-down Liability 2.16 Therapeutic Leave 2.17 Notification Requirements 2.18 Community Based LTC Waiver 2.19 Exhibit VII-2: Diagram of LTC Processing Exhibit VII-3: Provisions for Pre-October 1989 Institutionalization Chapter 3: Other Health Programs and Referrals Introduction 3.1 Legal Authority 3.2 DC Healthcare Alliance 3.3 Elderly and Physically Disabled Home- and Community-Based Services Waiver 3.4 HIV Programs 3.5 Breast and Cervical Cancer Programs 3.6 Mental Health and Special Rehabilitation Option 3.7 Drug Abuse Program (Addiction Recovery and Prevention) 3.8 Mental Retardation and Developmental Disabilites Home- and Community-Based Services Waiver 3.9 Page 1 of 2 1 2 << Back to IMA Policy Manual Main
