Claimants who plan to enter or currently reside in a nursing facility, IMR, or State Mental Hospital may be eligible for MA or BP vendor payments made to the facility on their behalf.
When a BP recipient or blind applicant is residing is in or plans to enter a nursing facility, IMR, or MHC, eligibility for vendor must first be explored under MA. If ineligible under MA, BP vendor eligibility will be explored if the claimant is in a nursing facility or MHC. IMR coverage is not available under BP state only medical assistance.
Refer to Medical Assistance policy for information on determining eligibility and transferring a case to vendor payments. If eligible for MA vendor, close the BP case and open the MA case on the same day. If the BP claimant cannot meet MA eligibility, change the BP case from cash to vendor for claimants certified for NF or MHC level of care. The process for determining vendor eligibility and level of care under BP is the same as the process for MA vendor, except:
- If a BP cash payment is more advantageous than vendor, the cash payment would be continued.
- Until the BP grant is stopped, it is counted in the surplus determination for BP or MA vendor.
- When a BP claimant leaves one living arrangement for another, always explore eligibility under the program that is most beneficial to the claimant. The BP claimant will always at least be eligible for a BP cash grant, UNLESS the claimant is under age 65 and residing in a State Mental Hospital or is residing in an IMR. If this occurs, the BP (cash and medical) case must be closed.
- When a BP claimant age 65 or older enters a State Mental Hospital, first explore MA vendor, then BP vendor and finally BP cash.