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Determine the first day a person’s eligibility can be established under the special income limit. Form 3618, Resident Transaction Notice; Form 3619, Medicare/SNF Patient Transaction Notice; and Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution, provide adequate verification of dates of admission to a Medicaid facility. In absence of the above-listed forms, eligibility staff may contact the administrator, bookkeeper or office manager for the date of admission.
Eligibility under the special income limit cannot be processed or disposed until the applicant has resided in an institutional setting for at least 30 consecutive days.
The 30-day requirement begins with confinement to one or more Medicaid-certified facilities (Medicare-SNF, NF or ICF/IID) for at least 30 consecutive days. The date of admittance to an institution is day zero.
Example 1: Mr. Smith entered the nursing facility on March 27. He stayed there for 30 consecutive days – not going home, to the hospital or to another nursing facility. The earliest staff can certify the case is the 31st day, which is April 27.
Example 2: Mr. Lopez entered the hospital on Feb. 10 and entered the nursing facility on Feb. 19. He stayed there for 30 consecutive days – not going home, to the hospital or to another nursing facility. The start of the 30 consecutive days started on Feb. 19, not Feb. 10. The earliest staff can certify the case is the 31st day, which is March 22.
Example 3: Mr. Johnson entered the nursing facility on March 1. He went to the hospital on March 5. He returned to the nursing facility on March 10. The 30 consecutive days started on March 1 and was not interrupted by the hospital stay. The earliest staff can certify the case is the 31st day, which is April 1.
Example 4: Mr. Brown entered the nursing facility on May 10. The 31st day is June 10. He went home on June 1. He did not stay the required 30 consecutive days. Staff cannot certify the case.
Example 5: Mr. Leo entered the nursing facility on April 20. The 31st day is May 21. He died on May 10. He did not stay the required 30 consecutive days, however, staff can certify the case if the person meets all other eligibility requirements.
Example 6: Mr. Smith entered the hospital on Feb. 15 and then went directly to the nursing home on March 10. His wife continues to live in their home in the community. The 30 consecutive days starts on March 10, not Feb. 15. The earliest staff can certify the case is the 31st day, which is April 10th.
Note: The hospital stay in February is the start date for the continuous period in an institution for the spousal resource assessment – which is different than the 30-consecutive day’s requirement.
See Chapter J, Spousal Impoverishment, regarding the resource assessment and spousal protected resource amount (SPRA). When determining the 30 consecutive day requirement, consider both the days in a medical facility and the days in the Home and Community-Based Services waiver setting.
Use the special income limit for the month of entry to a Medicaid-certified long-term care facility (Medicare-SNF, NF or ICF/IID) if it is anticipated that the person will remain in a Medicaid-certified facility for at least 30 consecutive days. When eligibility is based on the special income limit, finalization of the person’s eligibility cannot be processed or disposed until the 30 consecutive days in an institutional setting have been met. See MEPD Due Date Chart job aid on The LOOP, to determine the 31st day.
It may be necessary to verify the living arrangement for prior months by contacting the applicant or authorized representative to ensure the appropriate income limit is used for determining eligibility for prior months. It may also be necessary to contact the facility, the Home and Community-Based Services waiver provider or the hospital, if an applicant has been discharged to a hospital, to ensure that the 30 consecutive day requirement is met.
The case record must include the following verification and documentation :
- Date the applicant entered the Medicaid facility.
- Date the applicant met the 30 consecutive day requirement (or date of death).
- Source of verification.
See Appendix XXX, Medical Effective Dates (MEDs). Use the information under the Institutional Based area to determine the appropriate income limit for the month of application and the prior months.
The 30 consecutive day requirement does not apply to a regular Medicaid recipient who:
- is eligible for SSI; or
- was eligible for SSI and continues regular Medicaid eligibility through one of the cost of living adjustment (COLA) disregard programs.
The COLA disregard programs are:
- ME-Pickle
- ME-Disabled Adult Child
- ME-Disabled Widow(er)
- ME-Early Aged Widow(er)
Related Policy
Medical Effective Dates (MEDs), Appendix XXX
Medicaid Certified Person Enters Nursing Facility or Home and Community-Based Services Waiver Program, B-7450
Institutional Eligibility Budget Types, G-6000
Prior Coverage, G-7000