Long Term Care Status

Long Term Care status is only applicable to single LTC individuals. LTC status starts the first day of the month following the month of admission when an institutionalized person is expected to remain for a least one full calendar month. LTC status ends the last day of the month before the month of discharge.

Continuous Period of Institutionalization vs. LTC Status

	Continuous Period of Institutionalization	LTC Status
Marital Status	Married	Single
Begins	The first day of the month in which an institution- alized person is expected to remain an inpatient for 30 consecutive days	The first day .of the month after the month of admis- sion when the individual is expected to remain at least one full month.
Ends	The last day of the month in which the individual is discharged.	The last day of the month before he month discharge.

Example of Continuous Period of Institutionalization

An individual with a Community Spouse at home enters a SNF in May. On May 28th, it is determined that the individual is expected to stay at least 30 consecutive days. The Continuous Period of Institutionalization begins on May 1st. The individual is released on September 8th. The Continuous Period of Institutionalization ends September 30th.

Example of LTC Status

A single individual is admitted to a SNF on January 4th and is expected to remain for the entire month of February. LTC Status begins on February 1st. On June 11, the individual is discharged. LTC Status ends on May 31st and the individual will be re-evaluated for regular MC. [

Incompetent Individuals in LTC

Some individuals in LTC may be incompetent and are unable to handle their affairs. EWs must determine if the LTC applicant is mentally able to complete all documents and provide all necessary information and verifications.

An EW may use any of the following methods to determine whether an individual is able to complete the application process:

Call the LTC facility and inquire as to client's ability to handle his/her affairs; or
Make a “home visit” to the facility to communicate with the applicant; or
Obtain satisfactory evidence from family members which would provide sufficient reason to believe that the LTC individual is incapable of handling his/her affairs (for example, conservator documents or a written statement from a family member stating the client is unable to complete the application process without assistance); or
Obtain a statement from the client's physician.

Note: MC does not require a formal certification, such as a doctor's statement, regarding competency. A physician statement is just one example of how the EW may determine the client's ability to complete the application process.

Who Can Complete the Application

If the LTC individual is unable to complete the application process or other eligibility requirements, the individuals listed below, in the order indicated, may complete and sign the Application/Statement of Facts for MC:

If...	Then...
The applicant has a spouse,	The spouse must complete and sign the application for MC.
The applicant has no spouse, but has a conservator, guardian or executor,	The conservator, guardian or executor must complete and sign the application for MC.
There is no spouse, conservator, guardian or executor,	The EW must determine if there is a need for protective services. Refer to Common Place Handbook . If there is no need for protective services, then the appli- cation for MC may be completed and signed by: A relative A person who has knowledge of the applicant's circumstances Example: the office manager, administrator, or social
There is no spouse, conservator, guardian or executor,	worker of a nursing facility A representative of a public agency

DHCS 7068

Completion of the “Responsibilities of Public Guardian/Conservators or Applicant/Beneficiary Representative” (DHCS 7068) form is required when an applicant has a public guardian, conservator or a representative acting in his/her behalf, due to the incompetence of the client.

The DHCS 7068:

Defines the responsibilities of the court-appointed or volunteer representative.
Must be completed at application and redetermination.
Must be given to the representative and a copy must be scanned into IDM.
Gives authority to sign documents on behalf of the client.

Note: An AR can be appointed for incompetent individuals without written authorization.

County of Responsibility

If the family member or AR of an incompetent LTC client lives in another county and requests that the case remain in his/her county of residence, counties must honor the request, however, the LTC client’s MEDS record must still reflect the LTC facility’s address and county code in the Residence County field.

If. . .	Then the County of Responsibility is. . .
The individual in LTC is competent,	The county where the LTC client resides.
The Community Spouse or family member of an incompe- tent LTMailing AddressC client resides in another county,	The county where the Community Spouse resides.
The AR of an incompetent LTC client resides in another county and the client does not have a Community Spouse,	The county where the AR resides.

CalSAWS Entries

To set up LTC cases [Refer to Job Aid (JA) Medi-Cal Long Term Care (LTC)] .