LTC Approval for Medically Indigent Individual (Aid Code 53)

  • Aid Code 53 can be granted if the Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) verifies, either in writing or verbally, that arrangements have been made to accommodate the applicant’s admission to the facility.
  • The EW can approve Aid Code 53 and fax a copy of the paper card to the facility prior to client’s physical entry to the facility.

Case Situation

A single individual applies for Non-MAGI Medi-Cal, client receives unemployment benefit in the amount over the MAGI income limit. Individual was involved in a car accident, is in the hospital, and will be transferred to an LTC facility. The EW clears Non-MAGI MC eligibility and confirms the intended admission and documents in the CalSAWS Journal Detail page the expected admission date.

  1. On the Customer Options Detail page:
    1. Select Full Medi-Cal Hierarchy from the Type drop down list.
    2. Complete other required fields.
  2. On the Living Arrangement Detail page.
    1. Select the name from the Name drop down list.
    2. Select Nursing Home/Long Term Care from the Living Arrangement Type drop down list.
    3. Enter the arrival date in the Arrival Date field.
    4. Complete other required fields.
  3. Complete other Data Collection pages relevant to the case.
  4. Run EDBC, review budget and eligibility results on the Medi-Cal EDBC Summary page and Accept and Save results.
    1. The Eligible Budget for MEDS page section signifies the Aid Codes that will be sent to MEDS.

Transactions Generated by CalSAWS to MEDS

Add (EW20) transactions for the current and future months are sent to MEDS. As CalSAWS considers each authorized month a closed period of eligibility, a TERM-DT and a TERM-REAS of ‘99’ will be displayed on the INQM screen. Eligibility for the future month will appear under the Pending column until MEDS renewal.

Refer to MC HB Chapter 4: Application, Section Medically Indigent Adult in Long Term Care for more information.

Related Topics

HCBS-DD (SARC) Waiver Program Approval

DDSD Application Pending for Approval

LTC with Community Spouse Approval

Medi-Cal Approval with Hunt v. Kizer SOC Adjustment

Medi-Cal Special Treatment Program (MSTP) Approval

Minor Consent Approval

Minor Consent Renewal

Non-MAGI Approval - Aged

Non-MAGI Approval - Disabled