LTC with Community Spouse Approval

Case Situation

Wife applies for Medi-Cal for her husband who had a stroke and has entered an LTC facility. Husband receives RSDI disability benefit and is receiving Medicare. Property reported, one vehicle and one checking account.

Important: For a person in LTC with spouse at home not applying for aid, a single case is needed with the LTC person as the primary applicant/recipient. Cases containing a married couple who are both in LTC can be aided within the same case. However, they each need their own Med-Cal program block, each must be designated as the primary applicant/recipient in their MC program block and each program block needs to be assigned to EW.

On the Customer Options Detail page:
1. Select Full Medi-Cal Hierarchy from the Type drop down list.
2. Complete other required fields.
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. Complete other required fields.
On the Income List page select Social Security from the Income Category drop down list and update necessary information on the Income Detail page.
Enter reported property information on the Property Detail page.
On the Medicare Detail page:
1. Enter Medicare Part A&B information. MBI and HIC number.
2. Complete other required fields.
Complete other Data Collection pages relevant to the case.
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.

Click hereClick here for CalSAWS step-by-step process.

Note: For Board and Care, Living Arrangements Detail page needs to be completed with Bard and Care selected from the Living Arrangement Type drop down list as well as Expense Detail page.

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 Chapter 19: Long Term Care (LTC), for detailed information.

Refer to CalSAWS "Job Aid (JA) Long Term Care (LTC)", for additional LTC processing instructions.

LTC with Community Spouse Approval

Case Situation

Transactions Generated by CalSAWS to MEDS

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