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STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services Division
PO Box 45600, Olympia, WA 98504-5600
HCS MANAGEMENT BULLETIN
H20-103 – Information
December 15, 2020
TO:
Home and Community Services (HCS) Division Regional Administrators
Developmental Disabilities Administration (DDA) Regional Administrators
Area Agency on Aging (AAA) Directors
FROM:
Bea Rector, Director, Home and Community Services Division
Shannon Manion, Director of the Division of Field Services, Developmental Disabilities Administration
SUBJECT:
January 2021 Changes with COLA
PURPOSE:
To notify staff of their responsibilities regarding client payments for services starting January 1, 2021.
BACKGROUND:
Many clients are required to pay toward the cost of their care before the Department pays for services. The Department determines this amount for all long-term care services.
HCS and DDA residential clients, other than Adult Protective Services (APS) residential clients, pay toward their cost of room and board. HCS staff: see Chapter 8 - Residential Services, in the Long-Term Care Manual for details on room and board. DDA staff: see DDA Policy 6.06 Client Responsibility for details on room and board. The client’s total contribution for room and board and the cost of their personal care services is indicated on the provider’s authorization in ProviderOne. Clients receive correspondence from ProviderOne that reflects their social service authorizations and details related to applied client responsibility.
WHAT’S NEW, CHANGED, OR CLARIFIED:
Effective January 1, 2021, the following benefits will increase:
· Social Security Benefits by 1.3%
· Railroad Retirement (RR) and Veteran’s (VA) Benefits by 1.3%
· Some pensions, such as federal civil service pensions by 1.3%
Effective January 1, 2021, the following standards will increase:
· Special Income Level (SIL)
· Categorically Needy Income Level (CNIL)
· Medically Needy Income Level (MNIL)
· Federal Benefit Rate (FBR)
· Maintenance allowance for in-home waiver recipient with community spouse
· Residential room and board standard
· Community spouse maintenance allocation
· Federal spousal resource transfer maximum
· Home Equity Limit
· Medical Institution Personal Needs Allowance (PNA)
· HCS and DDA Waiver Residential PNA
Effective January 1, 2021:
· ACES will:
· Auto update SSA and SSI income amounts for most clients.
· Recalculate client responsibility for January 2021 and generate COLA letters and translations, if necessary, for HCS and DDA waivers, PACE, SSI-related residential MPC, CFC, and Roads to Community Living clients.
· ACES will not:
· Generate a letter for any clients receiving MAGI-based coverage who receive MPC or CFC in a residential setting.
· Generate a letter for any clients active on Medical Care Services (A01/A05) coverage group in a residential setting.
VA and RR benefits must be manually updated in ACES. Clients with cases requiring manual updates will receive a postcard reminder (see attached memo) in early January advising them to report their new income amounts.
The personal needs allowance (PNA) for clients living in medical institutions and residential settings increases from $70.00 to $71.12 per month.
The new room and board amount for all HCS and DDA residential settings is $722.88. This amount is determined by using the following formula of the Federal Benefit Rate: $794 - $71.12 PNA = $722.88. Current residential authorizations with R&B rate of $713 are automatically updated to $722.88 by ProviderOne by January 1, 2021 for clients in the following programs:
· SSI-related residential MPC
· CFC
· HCS and DDA waivers
· PACE
· Roads to Community Living
Service authorizations must be entered before the month of service begins for Client Responsibility to calculate correctly and send the correct letters timely to clients and providers.
ACTION:
Action Required by Case Managers:
· Calculate and update client responsibility using the calculator attached below on the financial screen in CARE for clients on the following programs:
· HCS Waivers/MPC/CFC Fast Track
· DDA and HCS MAGI-based coverage groups (N-track) in residential settings
· DDA and HCS Non-citizens on the ABD Cash/HEN programs (A01/A05)– AFH
· DDA and HCS State-funded LTC Program for Non-Citizens if receiving MAGI coverage (N21 and N25 coverage groups) in residential settings
· DDA State Funded Group Homes
· Send the Client Responsibility Notice (DSHS 18-720 for HCS or DSHS 18-692 for DDA) to these clients informing them of the amount they have to pay for room and board.
· If the client is active on basic food or cash, the social service specialist must verify the income by looking at the income verified in ACES.
· If the client is only active on a MAGI-based program, the case manager may use the client’s self-attested income found in ACES online on the client level screen under Health Plan Finder Income.
Action Required by Public Benefit Specialists:
· Manually update cases for clients:
· Who have Veteran’s, Railroad Retirement, or SSA/SSI benefits that were not auto updated by ACES.
· With a community spouse with income that needs to be updated.
Note: Adhoc reports in Barcode can be printed for the Veteran's and Railroad Retirement pensions. A Barcode tickle has been sent for SSA/SSI clients not auto updated by ACES (COL3).
· Update Food Stamp Medical Expense for at-home HCS or DDA waiver clients who pay client responsibility in excess of $35.00 and receive Basic Food.
· Update room and board (R&B) exception to rule (ETR) amounts for a monthly maintenance needs allowance (MMNA), update the spouses unearned income type of AN (MMNA ETR Amount) as well.
RELATED REFERENCES:
ATTACHMENT(S):
January 2021 Medical Income and Resources Standards Chart:
Manual Updates Memo:
Medical Coverage Group Chart:
January 2021 Client Responsibility Calculator
CONTACT(S):
Jennifer Ferguson, Office Chief, LTC Financial Eligibility & Policy
(360) 725-3406
Marcell Birdsall, Unit Manager, DDA LTC and Specialty Program Teams
(360) 407-1576
Graham Zuch, HCS ACES Program Manager
(206) 341-7781
Dustin Quinn Campbell, Payment Policy and Systems Unit Manager
(360) 725-2535
Lonnie Keesee, DDA Eligibility and Payment Systems Unit Manager
(360) 407-1547
January 2021 WAH
Income & Resource Standards.pdf
WASHINGTON APPLE HEALTH INCOME AND RESOURCE STANDARDS January 1, 2021 Changes Modified Adjusted Gross Income (MAGI) and SSI-related
PROGRAM STANDARDS (4/1/2020) 1 2 3 4 5 6 7 8 9 10 11+
Family (N01) 511 658 820 972 1127 1284 1471 1631 1792 1951 N/A
133% FPL - New Adult (N05) 1415 1911 2408 2904 3401 3897 4394 4890 5387 5884 497
193% FPL - Pregnancy (N03/N23) N/A 2773 3494 4214 4935 5655 6376 7096 7817 8538 721
210% FPL - Children (N11/N31) 2233 3017 3801 4585 5369 6153 6937 7721 8505 9289 784
260% FPL - Take Charge 2765 3736 4706 5677 6648 7618 8589 9560 10530 11501 971
260% FPL - CHIP T1 (N13/N33) $20 premium 2765 3736 4706 5677 6648 7618 8589 9560 10530 11501 971
312% FPL - CHIP T2 (N13/N33) $30 premium 3318 4483 5648 6812 7977 9142 10307 11472 12636 13801 1165
HWD (S08) No upper income limit
Include an unborn child in the household size for family and pregnancy medical AU’s
MNIL STANDARD (1/1/21) 794 794 794 794 858 975 1125 1242 1358 1483 1483
MN RESOURCES 2000 3000 3050 3100 3150 3200 3250 3300 3350 3400 50
INSTITUTIONAL STANDARDS
Amount
Medicaid Special Income Level (SIL) (1/1/21) $2,382
DDA PNA at home (1/1/21) $2,382
Cash PNA ALF $38.84
Cash PNA Medical Institution $41.62
PNA State Veterans Home Maximum $160
All other PNA Med Inst. (1/1/21) $71.12
HCS & DDA Waivers, CFC & MPC PNA in ALF (1/1/21) $71.12
HCS & DDA Waivers, CFC & MPC R&B in ALF (1/1/21) $722.88
HCS Waivers at home PNA with CS (1/1/21) $794
HCS Waivers at home PNA without CS (4/1/20) $1,064
Housing Maintenance Allowance Maximum (4/1/20) $1,064
CS Maintenance Needs Allowance Maximum (1/1/21) $3,260
CS & Dependent Allowance (7/1/20) $2,156
Standard Utility Allowance (10/1/20) $449
CS Excess Shelter (7/1/20) $647
Home Equity Limit (1/1/21) $603,000
TSOA Resources (9/7/17) $53,100
TSOA Resources with CS (7/1/19) $111,175
State Spousal Resources (7/1/19) $58,075
Federal Spousal Resource Maximum (1/1/21) $130,380
Daily Private NF Rate (10/1/20) $346
Monthly Private NF Rate (10/1/20) $10,526
Monthly State NF Rate (10/1/20) $7,149
MEDICARE SAVINGS PROGRAM – Alternate financial eligibility standards 4/1/2020
People in the Household 1 2 3 4 5 6 7 8 9 10 11+
QMB Income – 100% FPL (S03) 1,064 1,437 1,810 2,184 2,557 2,930 3,304 3,677 4,050 4,424 374
SLMB Income – 120% FPL (S05) 1,276 1,724 2,172 2,620 3,068 3,516 3,964 4,412 4,860 5,308 448
QI-1 Income - 135% FPL (S06) 1,436 1,940 2,444 2,948 3,452 3,956 4,460 4,964 5,468 5,972 504
QMB, SLMB, QI-1 Resources 7,860 11,800, if two spouses
QDWI - 200% FPL (S04) 2,172 2,874 3,620 4,367 5,114 5,860 6,607 7,354 8,100 8,847 747
QDWI Resources 4,000 6,000, if two spouses
Note: Internal staff use the charted dollar amounts that reflect net income after deductions allowed under each program. For MAGI programs (N groups), gross income limits are 5% more and maybe higher after allowed deductions. For non-MAGI (classic) programs, gross income is reduced by $20, in addition to other allowed deductions. For example, after adding the $20 to be deducted for MSP, gross income limits are for QMB: $1,084 and $1,457; for SLMB: $1,296 and $1,744; for QI-1: $1,456 and $1,960; and for QDWI: $2,192 and $2,894.
SSI/CNIL STANDARDS (1/1/21)
Single Eligible
Eligible Couple
CNIL INCOME 794 1,191
FBR (SSI Standard) 794 1,191
1/2 FBR 397 --
SHARED LIVING FBR 530 794
SSI RESOURCES 2,000 3,000
MEDICARE SAVINGS PROGRAMS (4/1/2020) People
1 2 QMB Income – 100% FPL (S03) 1,064 1,437
SLMB Income – 120% FPL (S05) 1,276 1,724
QI-1 (ESLMB) Income - 135% FPL (S06) 1,436 1,940
QDWI - 200% FPL (S04) Must be employed for eligibility 2,127 2,874
QMB, SLMB, QI-1 Resources (1/1/20) QDWI Resources
7,860 4,000
11,800 6,000
MEDICARE STANDARDS 1/1/2021 Part A Premium: 40+ work quarters = Free Part A; <40 but >29 work quarters = $259; <30 work quarters = $471
Part B Premium
$148.50
Part A Deductible: Inpatient Hospital = $1,484 per benefit period
Part B Deductible $203
Part A coinsurance for Inpatient hospital $371 per day for 61st - 90th day; $742 per day for over 90 days
Part A coinsurance for NF $185.50 per day for 21st - 100th day
Substantial Gainful Activity (SGA) 1/1/21
Non-Blind Blind
$1,310 $2,190
January 1 2021 Cost
of Living Adjustment (COLA) and Requirement for Manual Case Updates.pdf
Page 1Page 2
COLA Attachments A
B.pdf
Page 1Page 2
Medicaid Programs -
LTSS Chart.doc
Desk Aid – Medical Coverage Groups Used in LTSS
Program Category and what agency usually maintains the program
ACES
Description
Scope
HCB Waiver
CFC
MPC
MAC d
TSOA e
NF short stay b
(If not managed care or Medicare days).
Institutional b
30 days or more
SSI and SSI-related
(non-institutional)
Aged/Blind/Disabled (ABD) category
Disability is determined by SSA, or by NGMA referral to DDDS
CSD financial staff manage S track cases unless the client is receiving LTSS through DDA or HCS.
See below for S08/HWD
S01
SSI Recipients Categorically Needy (CN)
CN
a
a
x
x
S02
SSI-related
CN
a
a
x
x
S03
QMB Medicare Savings Program (MSP).
Medicare premiums, copayments, coinsurance, deductibles.
MSP
Pays Medicare co-insurance days as a claim if QMB eligible. No application required for NF if medicare co-insurance days only, on QMB & no other service is needed. No NFLOC is needed to submit a claim for Medicare days in a NF. If on QMB only, must have an application for NF coverage.
S04
Qualified disabled working individual (QDWI).
Medicare Part A premiums.
MSP
S05
Specific low-income Medicare beneficiary (SLMB).
Medicare Part B premiums.
MSP
S06
Qualified individual (QI-1).
Medicare Part B premiums.
MSP
S07
SSI-related Alien Emergency Medical (AEM).
Emergency Related Service Only (ERSO).
ERSO
Hospital, cancer, or end stage renal
S95
SSI-related Medically Needy (MN) no spenddown.
MN
x
S99
SSI-related with spenddown.
MN
If SD met and shows active.
SSI-related
(non-institutional)
Living in an alternate living facility (ALF) - AFH, AL or DDA group home.
G03 Maintained by HCS or DDA LTC staff.
G03
Income under the special income level (SIL) & under state rate x 31 days + $38.84.
Only used for MPC and BHO placements.
CN
a
x
G95
ALF private pay no spenddown.
Income under the SIL, and under the private rate.
MN
x
G99
ALF private pay with spenddown.
Income under the SIL, but over the private rate.
MN
If SD met
SSI-related/ABD
(non-institutional)
Healthcare for Workers with Disabilities (HWD)
Maintained by HCS if on HCS services or DDA LTC team if not on HCS services.
S08
Premium based program. Substantial Gainful Activity (SGA) not a factor in disability determination.
CN
x
x
x
x
x
HCB Waiver (institutional)
SSI or SSI-related 1915(c) waivers authorized by HCS or DDA
Aged/Blind/Disabled (ABD) category
Disability is determined by SSA, or by NGMA referral to DDDS
HCS/DDA LTC financial staff maintain L track cases.
L21
SSI recipients
CN
x
x
x
L22
SSI-related.
DDA – income at or below SIL
HCS – income < effective MNIL (182-515-1508)
CN
x
x
x
L24
Undocumented Alien / Non-Citizen LTC.
Must be preapproved by HCS ([email protected] ).
State-funded CN (SFCN) scope.
Community component of SFCN program.
SFCN
State-funded personal care based on NFLOC criteria. Financial Eligibility based on HCB Waiver rules. In home or state funded services in an ALF.
If in NF 30 days or more, change to L04 program.
WAC 182-507-0125. Natalie Lehl must pre approve the state funded long-term care for non-citizen program. NGMA IS NEEDED IF NOT AGED/BLIND
SSI and SSI-related
(non-institutional) PACE, or Hospice
HCS/DDA LTC financial staff maintain L track cases.
L31
SSI recipient on PACE; or
SSI recipient in institution on hospice (do not change S01 to L31 for hospice outside of an institution).
CN
NF services included in PACE.
Hospice services provided in institutions.
L32
SSI-related PACE or hospice as a program.
PACE is managed care (no CFC or HCB waiver with PACE).
CFC or HCB waiver with hospice only.
Hospice + HCB waiver will trickle to L22 as priority program.
CN
x
x
x hospice only
NF services included in PACE
Hospice services provided in institutions.
SSI and SSI-related Roads to Community Living (RCL)
HCS/DDA LTC financial staff maintain L track cases.
L41
SSI recipient on RCL.
CN
x
L42
SSI-related RCL.
365 day medical upon approval by social services.
Must be receiving Medicaid on day of institutional discharge.
CN
x
SSI and SSI-related Community First Choice (CFC)
HCS/DDA LTC financial staff maintain L track cases.
L51
SSI recipient on CFC or MPC
CN
x
x
x
L52
SSI-related CFC or MPC. L52 includes S02 and G03 eligibility rules with and without spousal impoverishment.
CN
x
x
x
SSI and SSI-related (institutional)
In a medical institution for 30 days or more.
Aged/Blind/Disabled (ABD) category
Disability is determined by SSA, or by NGMA referral to DDDS
HCS/DDA LTC financial staff maintain L track cases.
L01
SSI recipient
CN
x
L02
SSI-related.
Income under the SIL.
CN
x
L04
Undocumented Alien / Non-Citizen LTC.
Must be preapproved by HCS ([email protected] )
State-funded CN (SFCN) scope.
Institutional component of SFCN program.
SFCN
x
NGMA IS NEEDED IF NOT AGED/BLIND
L95
SSI-related no spenddown
Income over the SIL, but less than the state rate.
MN
x
L99
SSI-related with spenddown
Income over the state rate, but under the private rate.
Client participation locked to state rate.
MN
Eligible for services, but client pays all cost of care
MAGI (institutional)
Only used for individuals not eligible under non-institutional MAGI through the HPF.
Maintained by HCA
K01
Categorically Needy Family in Medical Institution
CN
x
K03
AEM in Medical Institution.
ERSO
Hospital, cancer or end stage renal.
K95
LTC Medically Needy no Spenddown in Medical Institution
MN
x
K99
LTC Medically Needy with Spenddown in Medical Institution
MN
If SD met
Pregnancy/Family Planning
Maintained by HCA
P02
Pregnant 185% FPL & Postpartum Extension
CN
P04
Undocumented Alien Pregnant Woman
CN
P05
Family Planning (FP) Service
FP
P06
Take Charge
FP
P99
Pregnant Women & Postpartum Extension
MN
If SD met
Refugee Medical Assistance (RMA)
R03
Refugee medical is referred by HCA to CSD if the client is not eligible for a MAGI program due to income
CN
X
X
X
X
Foster Care/JRA
Maintained by HCA
D01
SSI Recipient FC/AS/JRA Categorically Needy
CN
x
x
x
x
D02
FC/AS/JRA Categorically Needy
CN
x*
x
x
x
D26
Title IV-E federal foster care – under 26
CN
x*
x
x
x
MAGI
Maintained by HPF/HCA
N01
Parent / caretaker
CN
x
x
x
Pays as a claim (no award letter). Instructions in NF billing guide.
N02
12 month transitional parent / caretaker
CN
x
x
x
N03
Pregnancy
CN
x
x
x
N05
Adult alternative benefits plan (ABP) (age 19-64)
ABP
x
x
x
N10
Newborn medical birth to one year
CN
x
x
N11
Children's (age under 19)
CN
x
x
N13
Children's Health Insurance Program (CHIP) (age under 19)
CN
c
c
N21
AEM parent / caretaker
ERSO
Hospital, cancer or end stage renal
N23
Pregnancy; not lawfully present – CHIP funded. Covers personal care through the end of the pregnancy
CN
***
No
Yes
No
Pays as a claim (no award letter)
N25
AEM (age 19-64)
ERSO
Hospital, cancer or end stage renal
N31
Non-citizen children's (age under 19)
SFCN
x**
x**
Pays as a claim (no award letter)
N33
Non-citizen CHIP (age under 19)
SFCN
x**
x**
Medical Care Services (MCS)
Medical eligibility through eligibility for HEN or ABD Cash
Maintained by CSD unless client is on HCS LTSS. HCS takes over cases when in a NF 30 days or more or if in state funded residential.
A01
ABD legally admitted persons in their 5-year bar or otherwise ineligible due to their immigration status. LTSS include state-funded residential and NF.
MCS
x**
x
x
A05
Incapacitated legally admitted persons in their 5-year bar or otherwise ineligible due to their immigration status. LTSS include state-funded residential and NF.
MCS
x**
x
x
Breast and Cervical Cancer
Program
HCA maintains
S30
Breast and Cervical Cancer (Health Department approval)
CN
x
x
x
X
Tailored Supports for Older Adults (TSOA)
HCS maintains TSOA cases.
T02
Pre-Medicaid benefit for the caregiver of a person 55 or older to support the caregiver. For those not eligible for a CN or ABP Medicaid program and not needing or eligible for other LTSS services because of resources. Must meet NFLOC. No Medicaid service card is issued with TSOA. Program is effective 7/1/2017
x
This is a desk tool used by Aging and Long Term Supports Administration (ALTSA) field staff that has all the medical coverage groups/programs in Washington and what Home and Community Service can be authorized under that medical program if functionally eligible.
x – Service covered under the medical coverage group. Be sure to look at notes and comments.
a – This is provided under L51 for SSI recipients or L52 for SSI-related recipients. S01 and S02 clients are financially eligible for CFC or MPVC; and once financial is notified services have opened under CFC or MPC, the FSS will change the case to a L51 or L52. In addition, G03 rules are built into L52.
b – All NF admissions for skilled or rehabilitation are the responsibility of the managed care entity if enrolled and must be pre-approved by the managed care plan
c – CHIP is Title XXI, and not eligible for Title XIX CFC/MPC, or MAC due to age. There is a CFC/MPC “look-alike” service for Title XXI eligible individuals
d – MAC is Medicaid Alternative Care to provide supports for an unpaid caregiver. The financial requirement of this program are similar to MPC in that the client must be eligible for a CN or ABP medical program. A person cannot get MPC, CFC or HCB Waiver and MAC at the same time. A CN client can be on a MSP and receive MAC. The client must be age 55 or older.
e – Although TSOA is a separate coverage group – “T02” – a person can be MN/non-full scope Medicaid and receive T02. For example, S03 and T02 or S99 and T02. A client on CN or ABP can be considered for MAC if the client is not interested in CFC/MPC. The client must be age 55 or older.
* Must have disability, resource, and income determination for HCB Waiver services. (HCB Waiver services can be used for individuals on cash assistance or foster care as long as a disability determination has been established and the financial worker must keep the assistance unit (AU) as a foster care AU. Until cash assistance is de-linked from the medical assistance, the cash AU must be used in ACES.
** State funded program, not technically CFC/MPC, but does provider similar levels of personal care and services.
*** N23 is a pregnancy medical program paid for under CHIP dollars for the unborn child and currently is not included in the inclusion table for CFC or MAC. 10/2019 clarification from HCA indicates N23 covers MPC but not MAC or CFC.
Acronym
Definition
ABP
Alternative Benefits Plan – Scope of care for the N05/Expanded adult group
AH
Apple Health. Washington Apple Health. General term for all medical coverage including MAGI, Classic Medicaid, MCS, Institutional and HCB Waiver medical
Classic
Medicaid programs that are not determined by the Health Benefit Exchange. These programs did not change with the Affordable Care Act (ACA). Classic programs are those who are age 65 or older and those under age 65 who are disabled or blind and not on Medicare. It also includes foster care medical, institutional, Home and Community Based (HCB) Waiver and state funded Medical Care Services (MCS).
CN
Categorically Needy
ERSO
Emergency Related Services Only for Alien Emergency Medical (AEM)
FP
Family planning service
MAC
Medicaid Alternative Care Provide for unpaid caregivers who support a person on CN or ABP medicaid eligible but who do not currently access traditional LTSS services, (like MPC or CFC). Although the financial eligibility is the same as MPC, a person can’t get both MPC and MAC at the same time. There is no state funded caregiver support program in ACES like there is for in P1/CARE for MPC. For someone who is not eligible for TSOA or MAC, refer to the AAA offices for the state funded program. The state funded caregiver support program is not in ACES or CARE. This program is effective 7/1/2017
MAGI
Modified Adjusted Gross Income. This is a methodology used by the Health Benefit Exchange
MCO
Managed Care Organization
MCS
Medical Care Services (state-funded medical assistance)
MN
Medically Needy
MPC
Medicaid Personal Care
MSP
Medicare Savings Program
NF
Nursing Facility
RMA
Refugee Medical Assistance
SD
Spenddown
SF
State-funded
SFCN
State-funded with state funded CN scope of care
TSOA
Tailored supports for older adults. This is a pre-medicaid CN/ABP medicaid benefit. A person cannot be on CN/ABP medicaid and get TSOA (we could considered MAC for those on CN/ABP). Medicaid coverage is not included in the TSOA medicaid package, although a person could be on a MSP or MN program and receive TSOA benefits. If not financially eligible for TSOA, there is a state funded program through the AAA offices. This program is effective 7/1/2017
Revision 5/2020
The current version of this chart is on the financial eligibility and policy (FEP) SharePoint under “for the field” https://teamshare.dshs.wa.gov/sites/hcs/FP/SitePages/default.aspx
5/2020
MAGI & A01-A05
Client Responsibility Calculator 2021.xlsx
MAGICLIENT RESPONSIBILITYMAGI
Enter Data in the Shaded Cells
Client NameMonthCase Manager Name
Full Month
Earned Income$0.00Allowable DeductionsUnearned IncomePayee$0.00Balance$0.00Guardianship fees$0.00PNA (Standard)$71.12Court Costs$0.00Balance$0.00Medical Expenses$0.00Deductions$0.00Total$0.00Balance$0.00Room & Board$0.00Total Client Responsibility$0.00
Partial Month - Pro-Rated
Participation Paid$0.00Room & Board Paid$0.00Total Client Responsibility Paid$0.00Number of days in facility0Daily Room & Board Rate$23.43Total Pro-Rated Cost$0.00Pro-Rated Client Responsibility$0.00Amount Reimbursed to the client$0.00NOTES
ABD CashCLIENT RESPONSIBILITYGO3 CALCULATOR
Enter Data in the Shaded Cells
Client NameMonthCase Manager Name
Full MonthAllowable DeductionsPayee$0.00Earned Income$0.00Guardianship fees$0.00Unearned Income$197.00Court Costs$0.00Balance$197.00Total$0.00PNA ($62.79)$38.84Balance$158.16Participation$0.00Room and Board rate$672.21Deductions$0.00Room and Board payment$158.16Total Client Responsibility$158.16
Partial Month - Pro-Rated
Client Responsibility Paid$158.16Number of days in facility0Client Daily Rate$0.00Total Pro-Rated Cost$0.00Pro-Rated Client Responsibility$0.00Amount Reimbursed to the client$158.16NOTES
AO1-AO5CLIENT RESPONSIBILITYABD Income CALCULATOR
Enter Data in the Shaded Cells
Client NameMonthCase Manager Name
Full MonthEarned Income$0.00Allowable DeductionsUnearned Income$0.00Payee$0.00Balance$0.00Guardianship Fees$0.00PNA$38.84Court Costs$0.00Balance$0.00Medical Expenses$0.00Deductions$0.00Total$0.00Balance$0.00Room & Board Pmt$0.00Balance$0.00 $0.00$0.00Participation Pmt$0.00Total Client Responsibility$0.00
Partial Month - Pro-Rated
Participation Paid$0.00Room & Board Paid$0.00Total Client Responsibility Paid$0.00Number of days in facility0Client Daily Rate$0.00Total Pro-Rated Cost$0.00Pro-Rated Client Responsibility$0.00Amount Reimbursed to the client$0.00NOTES
Change logClient Responsibility Worksheet (for Program Manager use only)Step 1Unearned IncomeAmountSSASSDIDACVAOtherTotalStep 2DeductionsAmountPNA + $20 (starting 1/1/20 increase total PNA to $70.00 w/ no $20)70Payee/GuardianUncovered MedicalOther Guardianship CostsTotalStep 3Countable Unearned IncomeAmountSubtract Step 2 from Step 1Step 4Earned IncomeAmountTotalSubtract$65BalanceDivide Balance by 2Step 5Retained IncomeSubtract the calculated amount from the total income. This is the Retained Income
Room and Board CalculationCountable Unearned Income (from Step 3)Earned Income (total)Step 6Income Available for R&B (sum of Earned and Countable Unearned)Room and BoardAmountEnter Monthly R&B rate713if Income Available is greater than the monthly R&B rate, client pays total R&B to the providerIf Income Available is less than the monthly R&B rate, client pays Income Available to the providerParticipation CalculationStep 7Total IncomeAmountEarned IncomeUnearned IncomeTotalMinus DeductionsBalanceMinus R&B PaidBalanceMinus Retained IncomeBalanceIf this amount is 0 or less, no participation is due. If this amount is greater than 0, this amount is paid to the provider for participation (in addition to the Room and Board amount.)
Step 8Total Client Responsibility (Room & Board and Participation)
2008 Changes and Corrections - 11/20/07SSI = 637HCS PNA = 60.78R&B = 576.22Corrected SSI worksheet to allow $20 disregard for both earned or unearned - linked to total income over SSI standard.2008 Changes - 7/1/2008HCS PNA = 62.78R&B = 574.22DDD PNA = 41.44GO3 PNA = 41.44 + 202009 Changes - 1/1/2009SSI increase to $674HCS PNA = 62.79R&B = 611.21DDD PNA (combined w/ $20 to match HCS) = 62.79GO3 PNA = 62.79NOTES box expands to allow needed comments2012 Changes - 1/1/2012SSI increase to $698R&B = 635.212013 Changes - 1/1/2013SSI increase to $710R&B = 647.212014 Changes - 1/1/2014SSI increase to $721R&B = 658.21corrected G03 calculator2015 Changes - 1/1/2015BKSSI increase to $733R&B = 670.212017 Changes - 1/1/2017BKSSI increase to $735R&B = 672.212018 Changes - 1/1/2018BKSSI increase to $750R&B = 685.952019 Changes - 1/1/2019BKSSI increase to $771R&B = 701.002019 Changes - 12/19/18Updated calculator for current rulesLK2020 Changes 12/9/2019AASSI increase to $783R&B = 713.002021 Changes 12/1/2020AASSI increase to $794R&B=722.88PNA= 71.12