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DSAS
DSAS
CUYAHOGA COUNTY DEPARTMENT OF SENIOR & ADULT SERVICESMedicaid Benefits Division
1641 Payne AvenueCleveland, OH 44114
Phone: (216) 987-7075; Fax: (216) 987-8390 www.dsas.cuyahogacounty.us
Ohio Relay Service 711
A Quick Guide to Long Term Care Medicaid
COMMISSIONERSJimmy DimoraTimothy F. HaganPeter Lawson Jones
Services & Solutions for Better Living
INTRODUCTION
TheDepartmentofSenior&AdultServicesMedicaidBenefitsDivision serves patients or residents in one of the approximately98Medicaidcertifiednursingfacilitiesor60grouphomeslocatedinCuyahogaCounty.We also offer community PACE, PASSPORT, andAssistedLivingWaiver.Ourmissionistoprovidequalityinhome and community services to seniors, disabled and vulnerable adultsbasedonindividualneed. Eachnursingfacilityisassignedan*eligibility specialist whodeterminesMedicaideligibility for long termcareplacement.TheMedicaid Benefits Division also serves disabled adults living in grouphomesandResidentialStateSupplement(RSS)homes.In addition,wedetermineMedicaideligibilityforPACE,PASSPORT, andAssistedLivingWaiverprograms.
ToapplyforPACE,PASSPORT,theAssistedLivingWaiverorRSS,contacttheWesternReserveAreaAgencyonAgingat (216)621-0303or1-800-626-7277.OhioRelayService711.
You may also pick up an application at:
CuyahogaCountyDepartmentofSenior&AdultServices MedicaidBenefitsDivision 1641PayneAvenue Cleveland,Ohio44114 (216)987-7075oron-lineat:http://www.odjfs.state.oh.us/forms/file.=53304
Mosthospitalsandnursinghomesalsohaveapplications.
*Eligibility Specialist – Cuyahoga County employee who determines an applicant’s eligibility for Medicaid
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PROCESS
Ifnursinghomeplacementisnecessary,theprocessis
determined by the applicant’s current location:
Home: The potential patient/resident must be an active Medicaid recipient or a Medicaid applicant. Call (216) 987-7075for informationabout theapplicationprocessforLongTermCareMedicaid.Next,thepatientorauthorizedrepresentativemustcon-tactthePre-admissionUnitoftheWesternReserveAreaAgencyonAging,(216)621–0303,torequesta *level of care assessment.
Hospital: The hospital discharge planner will verify theMedicaidstatus.IfaMedicaidapplicationisneeded,thedischargeplanner will inform the patient or authorized representative. Thehospitalwillrequestthe*level of carefromthePre-admissionUnit.
Nursing Home: Patients who are paying privately, orhave other payment sources such as Medicare or commer-cial insurance, should apply for Medicaid in the last month before Medicaid assistance is required. The nursing facil-ity will request the level of care from the Pre-admission Unit.
OncethesignedapplicationforMedicaidisreceived,theMedicaid applicant will be contacted by letter with the appointmentdateandtimefortheinitialinterview.
* Level of Care – Determines the medical necessity of nursing home care. (see page 10)
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MEDICAID APPLICATION INTERVIEW
Itistheresponsibilityoftheapplicantor *authorized repre-sentativetokeepthescheduledappointment.Iftheinterviewneedsto be rescheduled, the applicant must call to reschedule. If the applicantorauthorizedrepresentativefailstokeeptheappointmentand does not contact the Department of Senior & Adult Services MedicaidBenefitsDivision,theapplicationmaybedeniedafter30days.
At the interview the applicant or *authorized representative shouldprovideallrequiredverificationsfortheapplicantandspouse,iflegallymarried.BelowisachecklistofverificationsneededfortheMedicaid interview:
Age and Citizenship: includes, but is not limited to, one of the following: birth certificate, baptismal record, state or federal census records, state ID, driver’s license, draft card, militarydischargepapers,USPassport,INSI-94,INSI-151orINSI-155,INSI-688,naturalizationcertificateoralienregistrationcard.
Resources: Bank accounts, stocks, bonds, mutual funds, burialplans,lifeinsurance,trusts,annuitiesandallfinancialassets.Proofofownershipofallpropertyandvehiclesmustbeprovided.
Income: Verification of gross monthly amount of SocialSecurity benefits (RSDI), Supplemental Security Income (SSI), railroad retirement, pensions, dividends and interest payments, veteransbenefits,andanyothersourceofincomewhetherearnedorunearned.
*Authorized Representative – The person (18 years of age or older) designated by the applicant, in writing, to be his/her representative in the Medicaid application process. (See page 10) 3
Medical Expenses:Medicalinsurancepremiums,includingMedicare, supplemental insurance and unpaid medical and pharmacybills.
Household Expenses: (For the spouse who remains in the community only)rentormortgage,gas,electric,water,telephone,propertytaxes,andhomeownerorrenter’sinsurance.
Other verification needed:Thesocialsecuritycardoranyofficialdocumentcontainingthesocialsecuritynumber.The *eligibilityspecialistcanobtainverificationofyoursocialsecuritynumber ifnecessary.
FREQUENTLY ASKED QUESTIONS
Q. DoIhavetobeappointedthelegalguardianorhavepowerofattorney to apply on someone’s behalf?
A.No.Anyonehavingknowledgeoftheapplicant’sassetsandincomemayapply.Theapplicantmaydesignateanauthorizedrepresentativeinwriting.Iftheapplicantisunabletodoso,the*eligibility specialistcandesignatearepresentative.
Q. DoIhavetopayallmyincometothenursingfacilityifIstaytheentire month?
A. No. You may receive a $40 personal allowance. Otherdeductions may include medical premiums and unpaid medical bills. Veterans with no spouse or children in the community, or widowsofveterans,mayreceivea$90personalallowanceaswellastheadditional$40.
*Eligibility Specialist – Cuyahoga County employee who determines an applicant’s eligibility for Medicaid
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Q. IfIamdischargedandreturntomyhomemustIpaymypatientliabilitytothenursinghome?
A.Yes.However, ifyouaredischargedbeforethelastdayof themonth,youwillonlybechargedforthenumberofdaysyouwereactuallyinthenursinghome.Your*patient liability willbeprorated.
Q.AfterIqualifyforMedicaidshouldIterminatemyothermedicalinsurance?
A. Medicaid will allow you to pay the medical premiums from your monthly incomeas long as your coverage is in force. There aresomeadvantages to retainingyourpolicy.For instance,youmaywishtochooseadoctorthatdoesnotacceptMedicaid.
Q. If I choose Medicaid Hospice care do I continue to pay my patient liability?
A.Yes.TheHospiceProgramstillrequiresthatpatientliabilitybe collected.Thisoffsetstheroomandboardcosts.
Q.IsthereanyassistanceavailabletohelpwithMedicarepremiums,co-insuranceanddeductibles?
A. Yes. Ohioans who receive Medicare may be able to receive Medicaid assistance to pay some or all of the Medicare premiums and/or co-insuranceanddeductibles.Formoreinfor-mation, call the MedicaidConsumerHotlineat1-800-324-8680,orourlocalofficeat(216)987-7075.
*Patient Liability - Amount of the resident’s income that is required to supplement the Medicaid cost of his/her care 5
Q. DoIhavetohavezeroassetsbeforeIqualifyforMedicaid?
A.No.Someassetsareexempt.TheMedicaidprogramhasrulesthat determine which are exempt and which are countable resources.
Q.IfImustspenddownsomeofmyassetstoqualify,canIpreplanmy burial?
A.Yes.Itiswisetopurchaseanirrevocable burialcontract.Makesure your plans are complete by including cemetery plot, gravemarkerandanyotherfuneralexpenses.
Q. Can my spouse or dependent children in the community have my assets and income?
A.Yes. Itmaybepossible to protect at least one-half ofmaritalassetsforthecommunityspouse.Thecommunityspouseorrep-resentativeshould requesta resourceassessmentat the timeofadmissionsoassetsarenotoverspent.Iftheincomeofthespousewho remains in the community is below standards set by Medicaid, ortherearehighhousingexpenses,thenursinghomeresident’sin-come may be transferred to the spouse and any dependent children livinginthecommunity.
Q. IfIamacommunityspousemustIspendtheexcessassetsonnursinghomecostssolely?
A.No.Theoveragemaybespentonpurchasesthatbenefitthe*community spouse.Examplesofthisare:homerepairs,carandpersonalitems.
*Community Spouse – A spouse who meets the definition of being legally married and who resides in a non-institutional setting in the community 6
Q. DoestheMedicaidprogramrecognizecommon-lawmarriages?
A. Protection of marital assets and income will be explored only if a common-lawrelationshipwasestablishedbeforeOctober1,1991.
Q.IfIgointoanursingfacilitywhathappenstomyhome?
A. The home must be listed for sale after a person has been in the nursingfacilityfor13months.However,thehouseisexemptfromthesalerequirementifitisthehomeof:
• Your spouse •Achildunderage21,oranadultchildbetween21 and65whoisdisabled •Anadultchildover65whoisfinanciallydependenton his/her parent •Asiblingwhohaslivedinthehouseforatleastoneyear immediatelypriortoyourmovetothenursinghome.
Q. IfIhaveprovidedcareforthenursinghomepatientcanhis/herhome be transferred to me?
A. The patient’s home can only be transferred to an adult child who lived in the house and provided care for at least two years prior to thenursinghomeadmission.The*eligibility specialist will inform the adultchildofthenecessarydocumentstoprocessthisexemption.
*Eligibility Specialist – Cuyahoga County employee who determines an applicant’s eligibility for Medicaid
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Q. WillMedicaidpayformybedifIamtemporarilyabsentfromthenursinghome?
A.Yes.EachMedicaidnursinghomepatient/residenthas30calendardaysperyear.Medicaidwillpaytoholdthebedwhileapatientisinthehospital,orforphysicianpre-approvedtherapeuticvisitswithfamilyorfriends.
Q. CanItransfertoanotherfacilityafterMedicaidisapproved?
A.Yes.Anindividualisfreetochooseand/ortransfertoanycertifiedMedicaidnursingfacilityintheStateofOhio.
Q. Isthereanalternativetonursingfacilityplacement?
A.Yes.TherearethreeMedicaidwaiverprogramsavailable:
• PASSPORTisforindividuals60+whoqualifyfornursing homecarebuthaveenoughsupporttoremainathome.
• PACE is for individuals 55+ who qualify for nursing home level of care as determined by the state and who remain in the community. PASSPORTandPACEprovide services, suchasskillednursing,transportation,housingmodifications, homemaker,choreservicesandmore.
• ASSISTED LIVINGisforindividualswhomeetthenursing home level of care criteria and whose needs can be safely metinalessrestrictivesetting.
Discuss theseoptionswith thenursinghome,hospital dischargeplanner,oryoureligibilityspecialist.
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Q.ArethereadditionalprogramsforMedicaidrecipients?
A.Yes.TheCuyahogaCountyDepartmentofSenior&AdultServicesHomeSupportDivisionservesCommunityMedicaidcon-sumers through theOhioHomeCareWaiverProgram.Personalcare, homemaking, adult day, physical/occupational/speech ther-apy - up to 14hoursperweek - areavailable towaiver patientswhosephysicianhasorderedtheseservices.Call(216)420-6817formoreinformation.
Q. WillIbeeligibleforanyassistanceafterIamdischargedfromthenursinghome?
A. The *eligibility specialist can determine if you are eligible forCommunityMedicaidandFoodStamps.
Q. WhatcanIdoifIdisagreewithadecisionmaderegardingmyapplication?
A. You can request a state hearing by contacting the *eligibility specialist or the Bureau of State Hearings, Ohio Department of HumanServices. (Their address is listed on the notice that youreceiveofthedecision).
Q. IfIamnoteligibleforMedicaidBenefits,arethereother programsavailable?
A.Yes.YoumaywishtocontacttheOptionsprogramat(216)420-6800todetermineifyouareeligible.
For information about Long Term Care Medicaid call (216) 987-7075
*Eligibility Specialist – Cuyahoga County employee who determines an applicant’s eligibility for Medicaid 9
DEFINITIONS
Authorized Representative: Theperson(18+)designatedbytheapplicant, inwriting, to be his/her representative in theMedicaidapplicationprocess.Iftherepresentativehaslegalguardianshiporpowerofattorney,proofmustbepresentedattheinterview.Community Spouse: Aspousewhomeetsthedefinitionofbeingmarriedandwhoresidesinanon-institutionalsettinginthecommunity.Estate Recovery: After the death of the Medicaid recipient, the StateAttorneyGeneral’sOfficeattemptstorecoverfundsforanymedicalpaymentsthathavebeenpaidbyMedicaid.Level of Care: Determinesthemedicalnecessityofnursinghomecare. Medicaid cannot authorize payment to the nursing facilitywithouttheassessment.Thelevelofcare isvalidforupto30days beforeadmission.Patient Liability: Amountoftheresident’sincomethatisrequiredtosupplementtheMedicaidcostofhis/hercare.Resource Assessment: Anaccountingof the resourcesofboththe institutionalized spouse and the community spouse to deter-minethecouple’stotalresourcesthatexist(ed)atthebeginningofthefirstcontinuousperiod(30daysormore)ofinstitutionalizationincludinghospitalstays.Spousal Resource Standard: The maximum amount of a couple’s resourcesallowedforusebythecommunityspouse.Thestandardis revised on January 1st every year. Current standards can beobtainedbycallingTheDepartmentofSeniorandAdultServicesMedicaidBenefitsDivision.Waiver Program: Providesalternativestonursinghomelongtermcare.Allowsparticipantstohavemorecontroloftheirlivesandre-mainactiveintheircommunity.
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DSAS
DSAS
CUYAHOGA COUNTY DEPARTMENT OF SENIOR & ADULT SERVICESMedicaid Benefits Division
1641 Payne AvenueCleveland, OH 44114
Phone: (216) 987-7075; Fax: (216) 987-8390 www.dsas.cuyahogacounty.us
Ohio Relay Service 711
A Quick Guide to Long Term Care Medicaid
COMMISSIONERSJimmy DimoraTimothy F. HaganPeter Lawson Jones
Services & Solutions for Better Living
