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Wisconsin Department of Health and Family Services Obsolete Medicaid Eligibility Handbook For the current MEH, see http://www.emhandbooks.wi.gov/meh-ebd/ For the current BC Plus Handbook, see http://www.emhandbooks.wi.gov/bcplus/ |
5.8.6.2 Both Spouses Institutionalized
5.8.6.3.1 Nursing Home and Hospital Insurance
5.8.6.3.2 Assignment of Nursing Home and Hospital Insurance Payments
5.8.6.5 Fees to Guardians or Attorneys
Monthly need is the amount by which the institutionalized person’s expenses exceed his/her income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter.. It is computed by adding together the following monthly costs:
Personal needs allowance (8.1.5.1).
Cost of institutional care (use private care rate).
Cost of health insurance (5.8.6.3).
Support payments (4.1.3.2.1).
Out-of-pocket medical costs.
Work related expenses (4.1.3.4).
Self-support plan (4.1.3.2.2).
Expenses for establishing and maintaining a court- ordered guardianship or protective placement, including court ordered attorney or guardian fees.
Other Medical Expenses.
Other deductible expenses.
When you determine a hospitalized person’s monthly need use the average daily charge for the hospital the person is in. See 8.1.9. If his/her hospital is not on the list, enter $2,318.08 on Long Term Care Gatepost/Institutions screen.
If both spouses are institutionalized and one has income greater than his/her monthly need, calculate the couple’s combined monthly need and compare it to their monthly income. If their combined monthly need exceeds their combined monthly income, both spouses may become eligible.
Allow health insurance costs only if the primary person is the owner of the policy and is billed for the premium.
Do not deduct health insurance premiums for health insurance that pays for more than the cost of medical care. An insurance policy which pays for accidental injuries, does not qualify as a health insurance premium and cannot be deducted.
When a person pays premiums less often than once a month, prorate the premium to find the monthly amount. Deduct the monthly amount from the monthly income.
The accumulation of these premium amounts is an exempt asset. Exempt them for a period over which they have been prorated.
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Example: Mr. W. pays a health insurance premium of $600 every quarter. The monthly amount, prorated over three months, is $200. Deduct $200 from Mr. W’s monthly income. Each quarter, exempt $600 of Mr. W’s assets until that quarter’s premium due date. |
Nursing home and hospital insurance polices are indemnification policies. Indemnification policies provide benefits in a fixed amount for a confinement, such as a hospitalization, regardless of the expenses actually incurred by the insured.
Nursing home and hospital insurance policies pay a flat rate to the policy holder for each day that s/he resides in the nursing home or hospital, respectively.
Consider nursing home and hospital insurance as a type of medical insurance. Allow the premiums as a deduction in the eligibility test and post-eligibility calculation.
All clients must cooperate in providing Third Party Liability ( TPL ) coverage and access information (6.3.3.5). All clients must sign over to the State of Wisconsin all their rights to payments from hospital or nursing home insurance (6.3.3.5.1). Terminate eligibility for any individual that will not cooperate in:
Providing TPL coverage and access information.
Turning over payments from indemnity insurance policies.
Support payments are payments which an institutionalized MA client makes to another person for the purpose of supporting and maintaining that person. See 4.1.3.2.1.
See 4.1.3.2.3.
This page last updated in Release Number : 06-04
Release Date :10-23-06
Effective Date :10-23-06