Long Term Services and Supports for Persons Enrolled in ACA Adult
ACA Adults are eligible to receive Long Term Services and Supports (LTSS). LTSS includes Nursing Home (NH), Supportive Living Program (SLP) and Department on Aging (DoA) Home and Community Based Services (HCBS). This policy applies to persons requesting LTSS who are applying for medical assistance and persons who are already receiving medical assistance.
To receive LTSS under the ACA Adult group the person:
- Does not have to be determined disabled.
- Can have an adjudicated disability as long as they don't receive Medicare.
- Must meet ACA Adult income requirements (138% of FPL).
- Does not have a resource limit.
- Does not have to transfer resources to their spouse.
- Must meet the screening requirements described in PM 20-08-04.
- Must complete HFS 3654 and provide requested verification of resource transfers.
Post-Eligibility Determination for ACA Adult and LTSS
Income and current resource amounts are not used in LTSS post-eligibility determination for ACA Adults. Because a resource limit does not apply to the ACA Adult group, figuring resources in excess of the Community Spouse Resource Allowance (CSRA) is not necessary.
Resource/Income Transfers for ACA Adult requesting LTSS
To be approved for LTSS, ACA Adults and their spouses are required to report and verify transfers of resources and income during the lookback period.
Resource transfer requirements:
When Not to Approve for LTSS
Do not approve an ACA Adult for LTSS when the person doesn't cooperate with the resource/income transfer requirements.
Persons who fail to cooperate with LTSS may still be approved, if eligible, for medical benefits.
The LTSS spouse and the community spouse may transfer resources and income for ACA Adults to each other in any amount without penalty. See PM 07-02-20-b for additional guidance on allowable transfers.
Unallowable Transfers and Penalty Periods
Penalty periods are applied when an ACA Adult requesting LTSS transfered resources or income for less than fair market value during the lookback period. A transfer of resources or income occurs when a person or his/her spouse (regardless of who has an interest in the resources or income) buys, sells, or gives away real or personal property, or changes the way property is held, PM 07-02-20 and PM 07-02-20-c.