A Word about the PAS (Part 2)

Last week I wrote about the medical part of Medicaid eligibility.  The preadmission screening (PAS) process requires the state to  certify that the applicant needs nursing home level care.  Nursing home level care means needing assistance with at least 3 of the activities of daily living.  Those activities are transferring (eg. in and out of bed or chair), dressing, bathing, toileting, eating and incontinence.  

Before COVID in the case of an applicant for Medicaid benefits at home, the State would send out a nurse to the applicant’s home to do the evaluation.  Now, however, these evaluations are being done by teleconference but expect delays.  Additionally, we have seen many instances where the PAS request is not being processed until the actual application has been filed.

This is problematic for a number of reasons.  Since both financial and medical eligibility are required for approval, any delay in obtaining the medical PAS will obviously delay the receipt of benefits.  While the PAS can be issued retroactively in the case of nursing home Medicaid (ie. approval back to the date of the request), this is not the case for the community Medicaid programs so timing is critical.

This creates another potential problem for married couples where one spouse is applying for Medicaid benefits.  The healthy spouse is entitled to keep a part of the couple’s countable assets based on a calculation called the Community Spouse Resource Allowance (CSRA).   Medicaid divides those assets in half and the community spouse can keep 1/2 up to a limit of $128,640(in 2020).  Since the value of assets changes from month to month, a snapshot is taken as of the first day of the first month of continuous institutionalization.

When does that occur when the applicant is at home?  The PAS approval tell us when the standard has been reached.  If, however, the PAS is delayed the snapshot is delayed and the spend down of the applicant’s half of the assets to meet the financial eligibility requirement is also delayed.  

One more thing to keep in mind.  The PAS is issued for 1 year and must be renewed.  Some applicants who intended to move to a facility but applied for the PAS while still at home, were unable or unwilling to make that move after COVID.

If they do not move into the facility within 1 year a new PAS will need to be ordered.  So if you are in this situation don’t wait too long to request a renewal of the PAS.