Long Term Care Screening Procedures & Application Process

If you are someone in your family needs nursing facility care or personal care in the home and cannot afford the cost, you should apply for Medicaid at your local Department of Social Services.

Eligiblity Determination

An individual’s gross monthly income must be less than the private rate for care in a nursing facility or for personal care. The person’s resources (cash, bank accounts, stocks, bonds, etc.) cannot exceed $2000. Applicants with spouses have different income and resource rules and determinations than single individuals.

Prescreening

Prescreening is the preauthorization of Medicaid payment for covered Long Term Care services. A nurse from the local Health Department and an adult service worker visit the patient at home to assess the level of care that the patient needs. This information is given to the local Health Department director and a decision is made as to whether or not long term care is necessary and cost efficient. The prescreening process may be completed by a hospital screening committee if the person is in an acute care hospital at the time the placement is needed.

Medicaid Provider

The nursing facility or personal care provider must be a Medicaid provider. If the individual is in a nursing home, he or she must be in a Medicaid certified bed. (Go to the DMAS Web site for a listing of Medicaid providers).

Patient Pay

The patient will have to pay a portion of the cost for his or her nursing facility care or personal care. The amount is based on their total monthly income with some allowances made for expenses such as personal needs ($30 for nursing home residents; $1028 for personal care recipients as of 01/01/2007), the cost of secondary medical insurance, and the amount needed for the maintenance needs of a spouse or minor dependent child in the community.

Steps in the Screening Process

  • Request a screening for nursing home, personal care, adult day care, etc. by calling Service Intake at 501-7346.
  • A Henrico County DSS social worker will coordinate an appointment time with a nurse from the Health Department. The social worker will contact the family to confirm the appointment time to visit and complete the screening.
  • After the screenining and the visit are completed, the original screening forms will be forwarded to the Henrico County Health Department.
  • If approved, you will choose a provider from the “Medicaid approved Providers” list. Contact agencies on the list to determine who can best meet your needs. The will then discuss whether or not an aide is available, how many hours they can provide, etc.
  • After choosing an agency, contact the Health Department at 501-4648 and have them forward the original screening forms to the nursing home, personal care agency, or adult daycare of their choice.