General eligibility requirements that apply to all Apple Health programs

Hospice special circumstances

Revised Date: 
February 14, 2018

Purpose: Some cases require processing alternatives or fall outside of these instructions. 

  • If a single client elects hospice and receives noninstitutional Medicaid in an Alternative Living Facility (ALF), maintain eligibility under the G03/G95 series as these clients are paying their income toward the cost of care on this program. The hospice service can be added to the case.
  • Active MN Medicaid clients who have met spenddown and are placed in a nursing home would be allowed the following deductions to determine the amount of the client’s participation in the cost of care:
    • Allow the MNIL if the client is at home the first day of the month he or she is admitted to the facility, or the appropriate personal needs allowance (PNA) based on the client’s living arrangements if not at home on the first day of the month. Client’s monthly spenddown liability that has been met for each month through the certification period
    • Note: The spenddown liability deduction is coded on the institutional screen in ACES with notation in remarks. The determination of the MNIL/PNA is based on the information coded on the INST screen and DEM1 screen in ACES.
    • The $20.00 disregard used as a deduction for MN noninstitutional spenddown is counted towards the client’s monthly nursing home participation in the post eligibility process.

Example: Single client on Medicaid MN program with base period 1/2017-3/2017. Spenddown was met in February and case was certified effective 2/1/2017. Client has monthly income of $825 per month. He enters the nursing home from home on 3/5/2017.

His MN spenddown was computed as follows:

  • $825.00 monthly income
  • -$20.00
  • -735.00 MNIL
  • $70.00 per month available for spenddown use as a deduction

Nursing Home Participation for 3/2017 is computed as follows:

  • $825.00 monthly income
  • -$735.00 MNIL (at home 3/1/2017)
  • -$70.00 spenddown liability
  • $20.00 participation to the nursing facility.

The spenddown base period ended in March. This deduction can only be used through the last month of the original MN base period.