0415.000.00 PAYMENT AND AMOUNT OF GRANT

0415.005.05 SAB Claimant in a Nursing Home

IM-#4 January 15, 2015IM-#109 December 11, 2013IM-#97 December 3, 2012IM-#77 December 21, 2011

If the SAB claimant is in a nursing home and not eligible for vendor payments, use the computation most beneficial to the claimant:

  1. Complete an SAB need determination. If there is need, subtract from the SAB maximum any SSI amount the claimant receives. Or
  2. To determine need, subtract the income from the basic nursing home charge. NOTE: SSI income is counted in this need determination.
  3. If there is need, the amount of grant is the deficit up to the appropriate maximum from the following list:

MAXIMUM PAYMENTS

Residential Facility I $156.00
Residential Facility II $292.00
Intermediate
(Claimant’s Medical Necessity is substantiated by Level of Care Determination)
$390.00
Skilled-Ineligible for Medicaid
Nursing Care Benefits
(Claimant’s Medical Necessity is not substantiated by Level of Care Determination)
$292.00

Any person receiving a cash nursing home payment, except DMH alternate care placements, is eligible for a Personal Expense Allowance of $50. The Personal Expense Allowance is issued as a separate check.

If the SAB claimant does not meet the exceptions previously described, complete an SAB need determination. If there is need, determine the amount of grant by subtracting any SSI payment the claimant receives from the current BP maximum.