Section 120.61  Cases in Intermediate Care, Skilled Nursing Care and DMHDD-MANG (AABD) and All Other Licensed Medical Facilities

a)         The policy set forth in subsections (b), (c), (d) and (e) below applies to cases receiving care in Licensed Intermediate Care Facilities, Licensed Skilled Nursing Facilities, or Department of Mental Health and Developmental Disabilities (DMHDD) Facilities.  The policy set forth in subsection (f) below applies to cases receiving care in Licensed Intermediate Care Facilities, Licensed Skilled Nursing Facilities, DMHDD Facilities and all other Licensed Medical Facilities (see 89 Ill. Adm. Code 140.642).

b)         Treatment of Resources

1)         A one-month eligibility period will be used.  All nonexempt income and non-exempt assets over the applicable asset disregard (Section 120.382) shall be applied towards the cost of care on a monthly basis. Non-exempt income (see Section 120.360) and assets (see 120.381) are applied towards the cost of care beginning with the first full calendar month of anticipated stay in the facility. Non-exempt income shall be applied toward the cost of care first. If insufficient to meet the cost of care at the private pay rate, then non-exempt assets over the applicable asset disregard shall be used.

2)         When a client transfers between non-DMHDD facilities or transfers to a DMHDD facility, non-exempt income and/or excess assets are applied first toward the cost of care at the first facility and any balance is applied toward the cost of care at the second facility. If the client transfers from a DMHDD facility to a non-DMHDD facility, non-exempt income and/or excess assets are not applied toward the cost of care at the non-DMHDD facility for the month the transfer occurs. If the client is discharged from a DMHDD facility or non-DMHDD facility to his/her residence in the community or to a community based residential setting (such as Community Living Facility, Special Home Placement, Supported Living Arrangement, Home Individual Program, Community Residential Alternatives as defined at 59 Ill. Adm. Code 120.10), the MANG Community Income Standard is used (see Section 120.20) beginning with the month of discharge from the DMHDD facility or non-DMHDD.

3)         If non-exempt income and non-exempt assets over the applicable asset disregard are greater than the Department's rate for cost of care, no payment will be made to the facility. However, the client may become eligible for Medical Assistance for other medical expenses by incurring medical expenses equal to the spend-down obligation. The private rate of the facility may be applied to the spend-down obligation in this instance. A full redetermination shall be made every twelve (12) months.

c)         Allow a deduction from the MANG client's income to meet the needs of dependent children under age 21 who do not reside with the community spouse, who do not have enough income to meet their needs and whose assets do not exceed the asset limit.  To determine needs and asset limits:

1)         for dependent children, use AFDC MAG standard and asset disregard (see Sections 120.30 and 120.382).

2)         allow any payments made on medical bills for the children.

d)         Allow deductions from the MANG clients non-SSI income for a Community Spouse Maintenance Needs Allowance and a Family Maintenance Needs Allowance for each dependent family member who does not have enough income to meet his/her needs.  Family members include dependent children under age 21, dependent adult children, dependent parents or dependent siblings of either spouse who are living with the community spouse.  To determine the amount of the deduction:

1)         The deduction for the Community Spouse Maintenance Needs Allowance, as of October 1, 1989, is equal to the community spouse maintenance needs standard ($1,500) less any non-exempt monthly income of the community spouse.  The amount established as the community spouse maintenance needs standard shall be increased for calendar years after 1989 by the same percentage as the percentage increase in the consumer price index for all urban consumers.  The deduction is allowed only to the extent income of the institutionalized spouse is contributed to the community spouse.  However, the deduction for the Community Spouse Maintenance Needs Allowance shall not be less than the amount ordered by the court for support of the community spouse or the amount determined as the result of the fair hearing.

2)         The deduction for the Family Maintenance Needs Allowance for each dependent family member is equal to one-third of the difference between the family maintenance needs standard (122% of the Federal Poverty Level for two persons as of September 30, 1989, 133% as of July 1, 1991, and 150% as of July 1, 1992) and any non-exempt income of the family member.

e)         Allow a $90.00 per month income disregard for veterans, who have neither spouse nor dependent child, or surviving spouses, who do not have a dependent child, who reside in long term care facilities who receive reduced monthly veterans benefits in the amount of $90.00. Persons allowed the $90.00 per month income disregard are not also permitted the $30.00 per month personal allowance (see Section 120.40).

f)          Deduction from MANG program

1)         A deduction from the MANG program participant's income shall be permitted for up to six months to maintain a residence in the community when:

A)        the individual does not have a spouse and/or dependent children in the home; and

B)        a physician has certified that the stay in the facility is temporary and the individual is expected to return home within six months.

2)         To determine the amount of the deduction include:

A)        rent or property expense that would be allowed in the AABD MAG standard if the individual was at home; and

B)        utility expenses that would be allowed in the AABD MAG standard if the individual was at home.

(Source:  Amended at 17 Ill. Reg. 10402, effective June 28, 1993)