(a)The eligibility determination regarding every applicant for long-term care nursing facility placement shall be made according to the criteria in the rules promulgated by the Department of Human Services.
(b)The department shall promulgate rules to establish eligibility determinations for long-term care nursing facility placement.
(c)(1) (A) Under 42 C.F.R. § 435.725 , certain amounts of income may be deducted from income to: (i)Calculate the amount certain institutionalized recipients of long-term care Medicaid must contribute to the cost of their care; and (ii) Determine the amount by which the Medicaid payment to the institution is to be reduced.
(B)The federal regulations also provide for deduction amounts for incurred expenses for "necessary medical or remedial care recognized
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(a) The eligibility determination regarding every applicant for long-term care nursing facility placement shall be made according to the criteria in the rules promulgated by the Department of Human Services. (b) The department shall promulgate rules to establish eligibility determinations for long-term care nursing facility placement. (c) (1) (A) Under 42 C.F.R. § 435.725 , certain amounts of income may be deducted from income to: (i) Calculate the amount certain institutionalized recipients of long-term care Medicaid must contribute to the cost of their care; and (ii) Determine the amount by which the Medicaid payment to the institution is to be reduced. (B) The federal regulations also provide for deduction amounts for incurred expenses for "necessary medical or remedial care recognized under state law but not covered under the state's Medicaid plan, subject to reasonable limits the agency may establish on amounts of these expenses", which are commonly referred to as "Medicaid income offsets". (2) The Department of Human Services shall clarify the proper administration of 42 C.F.R. § 435.725 , as it existed on January 1, 2017, by creating and promulgating rules that: (A) Identify and define the types of expenses that are not covered by the Medicaid state plan that are potentially eligible for Medicaid income offsets; (B) Identify the types of expenses that are not eligible for Medicaid income offsets; (C) Define a process for determining whether the medical or remedial service is medically appropriate and necessary and not covered under the Medicaid state plan; and (D) Set reasonable limits on the amounts allowed for eligible Medicaid income offsets. (d) (1) To the extent approved by the United States Government, the department shall exclude any assets accumulated in a person's independence account and any income or assets from retirement benefits earned or accumulated from employment income or employer contributions while the person was employed and eligible for and receiving benefits under the low-income disabled working person category of Medicaid eligibility, as established under § 20-77-1201 et seq., when determining that person's financial eligibility and cost-sharing requirements, if any, for the long-term care medical assistance. (2) As used in this section, "independence account" means an account approved by the department that consists solely of savings, and dividends or other gains derived from those savings, from income earned from paid employment after the initial date on which a person began receiving medical assistance under the low-income disabled working person category of Medicaid eligibility, as established under § 20-77-1201 et seq.