County of San Diego Health and Human Services Agency HHSA MediCal Program Guide LongTerm Care LTC and Incompetent Applicants Number Page 041901 1 of 3 Revision Date 11012020 BackgroundThis section provides information for processing applications for MediCal for LongTerm Care LTC and individuals who have been deemed incompetent PurposeThe reformatting to this section included removing duplicate application processing information and adding the relevant MPG cites Policy041901A DefinitionsTerms The definitions of terms used for individuals who act on behalf of LTCIncompetent applicants are found in MPG 040208A 041901B Notices of Action NOA The requirement for mailing notices and correspondence has been moved to MPG 040208E 041901C Who May Apply Whether or not an LTC patient is competent anyone who knows of an individuals need may apply for MediCal on that individuals behalf by completing and filing the SAWS 1 initial application form Refer to MPG 040205A for who may complete the MediCal Statement of Facts SOF 041901D Roles and Responsibilities of PublicPrivate Conservators Roles and responsibilities of PublicPrivate Conservators has been included in MPG 040208B 041901E Reporting Responsibilities of Public GuardianConservators or Representatives Reporting responsibilities of Public GuardianConservators or Representatives has been included in MPG 040208C 041901F Required Forms Refer to MPG 040208D for the required forms to be provided to Public Guardian Conservator or Representative acting on behalf of the applicant who has been deemed incompetent 041901G Methods to Determine an LTC Patients Competency Refer to MPG 040205B for steps to taken when determining competency 041901H Diligent Search Refer to MPG 040901 for diligent search procedures 041901I NonCooperation of the Acting Individual Refer to MPG 040205H for required actions when there is a noncooperation from acting individuals County of San Diego Health and Human Services Agency HHSA MediCal Program Guide LongTerm Care LTC and Incompetent Applicants Number Page 041901 2 of 3 041901J LTC Patients Income andor Property Are Exploited Refer to MPG 040205I for required actions when an LTC patients income andor property are being exploited Questions and Answers Question 1 When a nursing facility or other medical provider provides Health and Human Services Agency HHSA with documentation to substantiate mental incompetency may HHSA regard all resources such as bank accounts etc as unavailable Answer No The availability of property must be determined separately from the incompetency issue Even if the applicant is regarded as incompetent this includes individuals in a comatose or unconscious state and unable to handle their own affairs if another individual family member friend etc can get access to the property then it must be regarded as available Many elderly people have friends or relatives listed on bank accounts and this joint access situation should be determined If the incompetent individual is the only person who has access the account will be regarded as unavailable Question 2 After an LTC applicant has been determined to be incompetent do they have to complete and sign an Appointment of Representative form Answer No A MediCal applicant who is incompetent is presumably incapable of demonstrating the required knowledge and ability necessary to designate an Authorized Representative AR An AR form would not be appropriate in these instances No written authorization is required for an individual to assist an incompetent applicant to apply for benefits Question 3 If an LTC patient is competent do they have to complete and sign the AR form Answer Yes if the applicant designates someone other than a family member to act on their behalf the applicant must complete and sign an AR form In this situation the applicant must be given the same rights and responsibilities under the law and MediCal regulations to participate in the application process Question 4 What would be the best course for the Human Services Specialist HSS when it is found out that the representative has failed to report changes to HHSA Answer Request all information necessary to determine the customers eligibility continued eligibility andor Share of Cost SOC from the representative as the HSS otherwise would do with any other customers If the representative refuses or fails to provide the requested information by the due date they shall be considered noncooperative County of San Diego Health and Human Services Agency HHSA MediCal Program Guide LongTerm Care LTC and Incompetent Applicants Number Page 041901 3 of 3 Question 5 When is the DHCS 7068 Responsibilities of Public GuardiansConservators form necessary Answer The DHCS 7068 form is required when an applicant whether in a nursing facility or not has a public guardian conservator or a representative due to incompetence The form sets forth the responsibilities of those individuals to the incompetent customer as court appointed or volunteer representative to report information regarding changes The form does not convey any authorization to release information to the representative see MPG 040208 The form should be given to the representative at application and redetermination Procedures None Program ImpactsNone References ACWDL 9462 MEM PROC 133 Probation Code 2401 SDHS Letter dated 101995 Sunset Date This policy will be reviewed for continuance by 11302023 Rick Wanne Director Eligibility Operation