8131 Eligibility Periods - For persons who continue to receive cash benefits (FC, AS, SSI, or State Supplement payments) while in an institutionalized setting, automatic eligibility continues. However, SSI recipients may be obligated for their cost of care per 8172 (for SSI recipients see 2637).
For persons receiving long term care in Medicaid approved institutions, a one month base period shall normally be used. This is applicable to the month an individual begins receiving long term care in a Medicaid approved institution. However, for persons in adult care homes, a one month base shall only be used if the individual passes the 300% special income test or the patient liability is less than or equal to the state rate for the facility in accordance with 8172.2(1). For persons whose patient liability exceeds the state rate per 8172.2 (2) , a six month base shall be used and estimated institutional costs (private rate) for the entire base can be considered to reduce spenddown prior to being incurred.
8132 Prior Medical Eligibility - As with persons in independent living, an applicant may request a determination of medical eligibility for a three month period prior to the month of application. If the person resides in a non-Medicaid approved institutional arrangement, a three month eligibility base shall generally be used and the guidelines of 7330 (2) are applicable.
For persons receiving long term care in a Medicaid approved institution, a one month base period shall be used in accordance with 8131 for each month of the prior period except for persons who fail the 300% special income test and whose patient liability exceeds the state rate in accordance with 8172.2(2). In those instances, a three month base shall be used.
Eligibility shall be effective only for the months in which the client meets both financial and nonfinancial factors of eligibility. Prior eligibility can be established even though there is no current eligibility.