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 09012019 Background This section provides information for processing applications for MediCal for LTC and incompetent individuals The reformatting to this section included removing duplicate application processing information and adding the relevant MPG cites A DefinitionsTerms The definition of terms used for individuals who act on behalf of LTCIncompetent persons are found in MPG 0402 B Notices of Action NOA The requirement for mailing notices and correspondence has been moved to MPG 040208 C Who May Apply Whether or not the LTC patient is incompetent 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 040205 for who may complete the MediCal State of Facts SOF D Roles and Responsibilities of PublicPrivate Conservators Roles and responsibilities of PublicPrivate Conservators has been included in MPG 040208 E Reporting Responsibilities of Public Guardian Conservators or Representatives Reporting Responsibilities of Public Guardian Conservators or Representatives has been included in MPG 040208 F Required Forms Refer to MPG 040208 for the required forms G Methods to Determine a LTC Patients Incompetency Refer to MPG 040208 for actions taken to determine incompetency H Diligent Search Refer to MPG 0409 for diligent search procedures I NonCooperation of the Acting Individual Refer to MPG 040205 for required actions J LTC Patients Income andor Property Are Exploited Refer to MPG 040205 for required actions 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 Questions and Answers Question 1 When a nursing facility or other medical provider provides 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 hisher own affairs if another individual family member friend etc can get access to the property then it must be regarded as available Many elderly persons 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 does heshe 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 AR An AR form would not be appropriate in these instances No written authorization is required for an individual to assist an incompetent person to apply for benefits Question 3 If an LTC patient is competent does heshe have to complete and sign the AR form Answer Yes if the applicant designates someone other than a family member to act on hisher 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 worker when it is found out that the representative has failed to report changes to HHSA Answer Request all information necessary to determine the applicantsbeneficiarys eligibilitycontinued eligibility andor SOC from the representative as the worker otherwise would do with any other applicantsbeneficiaries If the representative refuses or fails to provide the requested information by the due date heshe shall be considered noncooperative Procedures None 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 Program Impacts None References ACWDL 9462 MEM PROC 133 Probation Code 2401 SDHS Letter dated 101995 Sunset Date This policy will be reviewed for continuance by 09302022 Approval for Release Rick Wanne Director Eligibility Operation