(Revised 7/1/16 ML #3475)
The county shall determine the recipient's responsibility for payment toward the room and board expense in a licensed basic care facility. This is accomplished by completing the appropriate screens in the Resident Payment System.
The county must use the Resident Payment System screen(s) each time there is a change in the amount the recipient is required to pay toward the room and board costs in a licensed basic care facility. Notification of any change in recipient responsibility is sent to the basic care facility and to the recipient.
BUDGETING EXAMPLE -- MONTH OF ENTRY INTO A
BASIC CARE FACILITY
Scenario – Mr. Jones entered the basic care facility on August 13. For the month of August, he had rent expense of $325.00. The deductions in the month of entry are clothing allowance of $100.00, Medicaid level for one of $750.00, rent expense of $325.00, and the Medicaid Recipient Liability disregard in this case of $128.00. Total deductions for Mr. Jones in the month of entry into the basic care facility equals $1288.00. Mr. Jones has income of $700.00. Following is the example as it would appear in the resident payment system:
|
GROSS INCOME: |
DEDUCTIONS: |
|---|---|
|
SSI: |
Clothing/Personal: 100.00 |
|
SSA: 700.00 |
|
|
VA: |
MA Level for One: 750.00 |
|
OTHER: |
Rent: 325.00 |
|
|
MA RL Deduction: 128.00 |
|
TOTAL: $700.00 |
Total: $1,303.00 |
|
|
|
|
Resident Payment Amt: |
00.00 |
Computation: $700.00 income minus $1,303.00 deductions equals $0 recipient responsibility towards room and board expense.
In the month of entry, allow the deduction of Medicaid level for one and reasonable living expenses.
BUDGETING EXAMPLE OF AN INDIVIDUAL IN A
BASIC CARE FACILITY
Scenario -- Ongoing case for George Dakota who entered the basic care facility August 29, and the benefit month is December. George receives SSA of $1,033.00 monthly. The deduction allowed is $100.00 clothing allowance (zero Medicaid recipient liability). Following is an example of how the system would budget this situation.
|
GROSS INCOME: |
DEDUCTIONS: |
|---|---|
|
SSI: |
Clothing/Personal: 100.00 |
|
SSA: 1,033.00 |
|
|
VA: |
|
|
OTHER: |
|
|
|
|
|
TOTAL: $1,033.00 |
Total: $100.00 |
Computation: Income is $1,033.00, minus the allowable deduction of $100.00 equals the basic care recipient responsibility of $933.00. The resident is responsible for paying $933 to the basic care facility for room and board.
BUDGETING EXAMPLE – TEMPORARY STAY OF
LESS THAN SIX MONTHS
Scenario -- Tom Jones is in a licensed basic care facility recovering from surgery. He will return home within six months. Mr. Jones’ stay is temporary; therefore, he is allowed additional deductions such as rent, utilities, and the Medicaid level for one. The additional deductions are allowed in these cases so the individual can maintain their residence while residing temporarily in a basic care facility.
|
GROSS INCOME: |
DEDUCTIONS: |
|---|---|
|
SSI: 129.00 |
Clothing/Personal: 100.00 |
|
SSA: 450.00 |
MA Level: 750.00 |
|
VA: |
BC/BS Prc: 319.00 |
|
OTHER: |
|
|
|
|
|
TOTAL: 579.00 |
Total: $1,169.00 |
Computation: Monthly Income $579.00, a deduction of $1,169.00 leaving a recipient responsibility of $0 for room and board.
