When a community case without a spenddown or a community spenddown case in met status (codes 1 or 3 in Item 80) enters an LTC facility, complete Form 552 as follows:

  • Item 2 -Enter the current processing month and year (MM/YY).
  • Item 3 -Enter 31.
  • Item 20 -Delete the unit composition code. Enter the correct long term care facility code.
  • Item 33 -Enter 57.
  • Item 45 -See WAG 27-45-00.
  • Item 80 -Delete 390 if currently coded. Enter 395 GCARE in the AMOUNT column. Enter the amount of nonexempt income. Change the amount following 392, if needed. Delete 158 CI. Delete 396, if present.