2553 Protection of Income

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Protection of Income

Effective Date:

December 2022

Chapter:

2550

Policy Number:

2553

Previous Policy Number(s):

MT 58

Updated or Reviewed in MT:

MT-68

Requirements

All or part of the recipient’s income is protected for the month of admission to or discharge from a nursing home (NH), Institutionalized Hospice, CCSP/EDWP, ICWP or NOW/COMP.

Basic Considerations

Income is protected for the month in which any of the following situations occurs:

  • The recipient enters a NH, Institutionalized Hospice, CCSP/EDWP, ICWP or NOW/COMP from LA-A or B.

  • The recipient leaves a NH, Institutionalized Hospice, CCSP/EDWP, ICWP or NOW/COMP and enters LA-A or B.

  • The recipient has CCSP/EDWP, ICWP or NOW/COMP waivered services and case management is terminated.

  • The recipient is admitted to and leaves a NH, Institutionalized Hospice, CCSP/EDWP, ICWP or NOW/COMP in the same month.

  • The recipient is admitted to a NH, Institutionalized Hospice, CCSP/EDWP, ICWP or NOW/COMP and dies in the same month.

  • The recipient enters a NH, Institutionalized Hospice, CCSP/EDWP, ICWP or NOW/COMP in the same month in which s/he was admitted to a hospital or other LA-D from LA-A or B.

  • Goes directly from NH to CCSP/EDWP or CCSP/EDWP to NH.

In the above situation, use the date of admission to the first LA-D as the admission date for determining the amount of protected income.

  • For Institutionalized Hospice use the date of election of Hospice services.

  • For CCSP/EDWP, ICWP, or NOW/COMP cases, use the date case management begins. Third party vendor payment supplements are not protected. VA Aid and Attendance are not counted in the Patient Liability/Cost Share (PL/CS) budget. Refer to 2418 VA Income.

Allow the protected income deduction when calculating the PL/CS.

Use the following chart to determine the amount of the recipient’s income to protect based on when the recipient entered and/or left LA-D. If an A/R enters and leaves a facility/facilities more than once during the same month, or if the A/R dies during the month of admission, the total number of days spent in the facility/facilities for the entire month is considered in determining protected income. Refer to the following chart.

  • Count the day of admission towards the total stay.

  • Do not count the day of discharge or death towards the total stay.

CHART 2553.1 – PROTECTION OF INCOME
IF the applicant/recipient THEN Protect

enters the 1st through the 10th day of the month from LA-A, B, or C

one half income

enters the 11th through 31st day of the month from LA-A, B, or C

ALL income

enters/leaves (leaves/enters) or dies in the same month

AND

the total stay is 10 days or less

ALL income

enters/leaves (leaves/enters) or dies in the same month

AND

the total stay is 11 days or more

one half income

leaves the 1st through 10th day of the month to LA-A, B, or C

ALL income

leaves the 11th through 31st day of the month to LA-A, B, or C

one half income

dies in a NH, Institutionalized Hospice, CCSP/EDWP, ICWP, or NOW/COMP in any month after the month of admission

NO income

Leaves CCSP/EDWP and enters a NH on the same day

ALL income in the month of admission to NH

Leaves NH and enters CCSP/EDWP Case Management on the same day

ALL income for the CCSP/EDWP CS for month of entry.

NH PL will have a PNA of the FBR in month of discharge to CCSP/EDWP.

is admitted to an LA-D directly from another LA-D and has been continuously residing in the first LA-D since prior to the first day of the month of entry to the second LA-D (except for NH to CCSP/EDWP or CCSP/EDWP to NH)

NO income