Changes in Medicaid Income

Changes in Medicaid Income A. Medicaid income is defined as the amount of income an institutional beneficiary must pay to the nursing facility toward the cost of his or her care. B. Changes in income, marital status or non-covered medical expenses will increase or decrease Medicaid income with the effective dates of such changes determined as follows: 1. A decrease in Medicaid income is effective the month in which the change is reported or becomes known to the Division of Medicaid. 2. An increase in Medicaid income requires advance notice to the beneficiary advising of the increase. a) Advance notice for Medicaid income increases is based on issuing notice ten (10) days before the date the Division of Medicaid makes its payment to the nursing facility. b) If a state or local hearing is requested within the advance notice period, the increase is not effective until the final hearing decision is rendered. 3. A temporary decrease in Medicaid income occurs due to the allowance of a deduction including, but not limited to, a health insurance premium or other non-covered medical expense. a) Medicaid income is subsequently returned to the amount previously in effect. b) This action is not considered an increase in Medicaid income subject to advance notice. 4. An increase in Medicaid income combined with a closure occurs when income is counted in the month received and receipt of the income also renders the beneficiary ineligible. The excess income is included in the Medicaid income computation provided there are ten (10) calendar days left in the month of receipt to allow for advance notice. 5. A temporary increase in Medicaid income occurs when excess resources are not an issue, but receipt of additional income results in the monthly income total being over the income limit for long-term care eligibility. a) The case will remain open if there is not time to allow for advance notice of closure. b) If there are ten (10) calendar days left in the month, Medicaid income is increased to the amount of that month’s income or the Medicaid reimbursement per-diem rate for the facility, whichever is less.