A Word about the PAS

When talking to clients about achieving Medicaid eligibility, we spend most of our time focused on the financial requirements.  That includes an asset test and an income test and transfers that are potentially subject to a Medicaid penalty.  However, I always tell families that we can’t forget about the medical test.

If we do everything right on the financial side of the equation but the applicant fails to meet the medical test – as determined by Medicaid by way of an exam and reflected on a form called a Preadmissions Screening or PAS, then the application will fail. Because there are 3 distinct Medicaid programs that cover nursing home level care – in a nursing home, in an assisted living facility and at home – the rules of each are not exactly the same.

If the applicant is in a nursing home or an assisted living facility and applying for Medicaid, the facility makes the request for the PAS.  This triggers an evaluation by Medicaid to determine if the applicant meets the test of needing assistance with at least 3 of the activities of daily living.  Once the facility is informed of the intention of the applicant to file a Medicaid application, it is the facility’s responsibility to order the PAS.

If the applicant, however, files an application for nursing home benefits while still at home the facility will not be responsible to order the PAS.  The applicant’s family must arrange for it by calling the county Aging and Disability Resource Center (ADRC) office.  Note that it can take some time for the State to do the screening and this is especially true since the COVID pandemic.  Again, if financial eligibility is reached but the PAS has not yet been issued, then eligibility will only be granted as of the date of the PAS.

For home based Medicaid benefits, ordering the PAS can be trickier.  We’ll go over that next week as well as what has been happening since COVID.