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IMA POLICY MANUAL
PART VI: FINANCIAL ELIGIBILITY REQUIREMENTS
CHAPTER 1: Determining Countable Assets
Temporary Absence from Home 1.24.6
| MA |
Exclude a home the person formerly lived in if the absence is due to care in a hospital or LTC facility and the person intends to return to the home. Also exclude a home a person formerly lived in if the person is temporarily absent (see Section 1.15: Temporary Absence in Part IV).
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| TANF |
Exclude the home that a person formerly lived in if the person is 'temporarily absent' from that home (see Section 1.15: Temporary Absence in Part IV).
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| GC |
See TANF.
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| FS |
Exclude a home the person formerly lived in if the absence is for one of the following:
- Vocational rehabilitation training;
- Inability to live at home due to a verified health condition;
- Migratory farm worker with the intent to return to the home; or
- Employment, training for future employment, illness, casualty (such as fire), or natural disaster. The group must intend to return.
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Rent Payments Withheld 1.25
| ALL |
Rental payments withheld for a rent strike and given to a third party such as the Landlord Tenant Court or Neighborhood Legal Service are excluded.
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MA
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Exclude also rental payments that are withheld due to a rent strike but remain in the possession of the group.
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TANF
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See MA
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GC
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See MA
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FS
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Count rental payments that are withheld due to a rent strike but remain in the possession of the group.
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| ALL |
Exclude the cash value of all retirement plans for all group members, including the following:
- Individual Retirement Accounts (IRAs);
- Keogh accounts;
- 401(k), 403(b), and 457 accounts; and
- All other pension and retirement funds as long as the funds remain in the retirement plan.
Any funds removed or disbursed from a retirement plan shall be treated as income in the month withdrawn and countable as a cash asset thereafter.
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SSI and TANF Benefits 1.27
| MA |
The assets of an SSI recipient, including assets from sources other than SSI benefits, are never considered when determining the eligibility of other family members.
| Mr. Kelly, a 19-year-old, lives with his disabled mother who receives SSI. Mr. Kelly is applying for MA under the Medically Needy (AR) standard. When determining Mr. Kelly's eligibility, none of his mother's assets are deemed to him. | |
| TANF |
See MA
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| GC |
See MA
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| FS |
Exclude the assets of a group member who receives SSI or TANF benefits.
| A household consists of a mother (Ms. Munoz), her two children, and the children's disabled grandmother receiving SSI (the grandmother is under age 60 and purchases and prepares food with the rest of the family). Ms. Munoz works and does not receive TANF but applies for FS. Ms. Munoz and her two children have $1,500 in countable assets. The grandmother, who receives SSI, has $1,000 in countable assets. When determining whether the household meets the asset limit, the grandmother's $1,000 in assets is not included because she receives SSI. Thus, the household has countable assets of $1,500 and is below the $2,000 asset limit. | |
| MA |
AR The assets of the group are determined at the point of application. Assets transferred prior to application are not considered.
AX: See AR.
AZ: Elderly and Physically Disabled Home-And-Community-Based Services Waiver
Persons who transfer assets for less than full market value may be subject to a penalty period. During this period, they are not eligible for Medicaid reimbursement for the following services:
· Home health services;
· Home and community care for functionally disabled and elderly adults;
· Personal care services provided to persons who are not inpatients in medical institutions; and
· Any other long-term care services for which Medicaid payment may be withheld by law.
The penalty period is the lesser of the following:
- thirty months, or
- the number of months obtained by dividing the uncompensated full market value of the transferred assets by the average monthly cost of nursing facility services in the District of Columbia. The penalty period shall include partial months that result from this calculation.
The average monthly costs of nursing home care in DC is $7,149.
The date of the transfer is used to determine the penalty period:
- Transfers before February 8, 2006 are used to determine a penalty period if they occurred during or after the 36th month preceding the first month for which the person was determined to be eligible for Medicaid. In this situation, the penalty period begins on the first day of the month in which the asset was transferred, even when this month is prior to the month of application for Medicaid.
- Transfers on or after February 8, 2006 are used to determine a penalty period if they occurred during or after the 60th month preceding the first month for which the person was determined to be eligible for Medicaid. In this situation, the penalty period begins on the first day of whichever of these months is later:
- the month during which the transfer took place, or
- the first month for which the person was determined to be eligible for Medicaid.
When multiple assets are transferred for less than full market value on different dates, contact the IMA Policy Unit for instructions.
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Mr. Jones owns a parcel of land that has a full market value of $40,000. On January 10, 2006, he sells the parcel of land to his son for $2,000. He applies for Medicaid on September 15, 2006 under the Community Based Care Waiver program and is determined eligible effective September 1, 2006. If the average cost of private-pay nursing facility care in DC is $3,000 per month, the penalty period is determined as follows:
Full Market Value of Transferred Asset $40,000
minus Compensation Received - $2,000
Uncompensated Value of Transferred Asset $38,000
Uncompensated Value $38,000
divided by Monthly Private-Pay Nursing Cost ÷ $3,000
Penalty Period 12 and 2/3 months
Mr. Jones is subject to a penalty period of twelve and 2/3 months that begins on January 1, 2006 and ends on in January, 2007. Therefore he is subject to restricted Medicaid reimbursement for the period September 1, 2006 into January, 2007. If the transfer had occurred on or after February 8, 2006, the penalty period would start on September 1, 2006 and end in September, 2007. |
If a spouse transfers a countable asset for less than market value, the penalty period will be divided in half and equally apportioned to the spouses, if both spouses are eligible for Medicaid. If the status of one spouse changes and he/she is no longer subject to a penalty period, the remaining full penalty period must be served by the remaining spouse.
Penalties due to transfers of income streams will be handled as follows:
- For lump sum transfers, the lump sum value will be used to determine the penalty period;
- For transfers of individual payments from an income stream, separate penalties will be imposed for each payment, including partial months; and
- For transfers of the right to an income stream, the actuarial value of all payments transferred will be used to calculate the penalty period.
Transfers of assets or income streams between spouses are not subject to these penalties and should be handled under the provisions in Chapter 2: Impoverished Spouse in this Part.
Notification of Penalty Period and Undue Hardship Determination
When a person is subject to a penalty period of restricted Medicaid reimbursement, IMA will notify the applicant/recipient in writing.
The notice of the penalty period will also inform the individual of his/her opportunity to claim that the penalty would result in undue hardship and to present evidence backing that claim. The agency will determine that an undue hardship exists if:
- The individual has been threatened with eviction from a long term care facility or other medical institution and has exhausted all legal methods to prevent the eviction, or the individual’s medical provider has threatened to terminate home and community-based services based on a waiver; and
- The transferee is no longer in possession of the transferred asset, has no other assets of comparable value with which to pay the cost of care, and there is no organization, family member, or other individual able and willing to provide care.
Penalty periods will not be imposed if it creates undue hardship to the individual.
SR (excluding SSI Recipients): See AR. For individuals in LTC facilities, however, the rules differ. See AZ: Elderly and Physically Disabled Home-And-Community-Based Services Waiver above and Section 2.13: Transfer of Assets Before and After MA Eligibility Determination in Part VII.
QM: See AR.
MC: For both the 50-64 Demonstration Program and the DC HealthCare Alliance, assets are determined at the point of application. Transfers prior to the date of application are not considered.
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| TANF |
Assets are determined at the point of application. Transfers prior to the date of application are not considered.
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| GC |
See TANF.
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| FS |
At the time of application, the applicant household must provide information regarding any resources which any group member (or ineligible alien or disqualified person whose assets are being considered available to the group; see Chapter 2: Whose Assets are Counted in this Part) had transferred within the three-month period immediately preceding the date of application.
Eligibility for the program will not be affected by a transfer of assets if:
- The transfer would not otherwise affect eligibility (for example, excluded personal property such as furniture or money that when added to other non-exempt resources was less than allowable limits at the time of the transfer);
- Assets sold or traded at, or near, fair market value do not result in disqualification;
- Assets are transferred between members of the same group (including ineligible aliens or disqualified persons whose assets are being considered available to the group); or
- Assets are transferred for reasons other than for qualifying or attempting to qualify for FS benefits such as, a parent placing funds in an inaccessible educational trust fund.
Groups which have transferred assets knowingly for the purpose of qualifying or attempting to qualify for FS are disqualified from participation in the program for up to one year from the date of the discovery of the transfer. This disqualification period will be applied if the assets are transferred knowingly in the three-month period prior to application or if they are transferred knowingly after the group is determined eligible for benefits. An example of the latter would be assets which the group acquires after being certified for benefits which are then transferred to prevent the group from exceeding the maximum asset limit.
The length of the disqualification period is based on the amount by which the transferred resources, when added to other countable assets, exceed the allowable asset limits. The following table shows the period of disqualification by excess amount:
| $0.00 - $249.99 |
1 month |
| $250.00 - $999.99 |
3 months |
| $1,000.00 - $2,999.99 |
6 months |
| $3,000.00 - $4,999.99 |
9 months |
| $5,000.00 and higher |
12 months |
In the event the SSR established that the applicant group knowingly transferred assets for the purpose of qualifying or attempting to qualify for FS, the SSR will send the group a notice of denial explaining the reason for and length of the disqualification. The period of disqualification will begin in the month of application. If the group is participating at the time of the discovery of the transfer, the SSR will send the recipient Form F713: Disqualification which explains the reason for and length of the disqualification. The period of disqualification is effective with the first allotment issued after the adverse notice period has expired unless the group requested a fair hearing and continued benefits. |
| ALL |
A trust is a right of property created by one or more persons for the benefit of themselves or another person(s).
The grantor is the person(s) who creates the trust, and the beneficiary is the person(s) for whose benefit the trust is created.
The trustee is the person(s) to whom the grantor transfers the asset. The trustee has legal title to the asset and is responsible for managing the trust for the benefit of the beneficiary.
The assets in the trust are the principal, which may be real property (such as a house, furniture, or land) or personal property (such as stocks, bonds, life insurance policies, or savings accounts).
Divestment might result when the client (or, for MA, a client's spouse) uses his/her own assets to establish a trust in order to qualify for, remain eligible for, or increase the amount of program benefits.
When a trust established by an asset group member is determined to be irrevocable, it is excluded. Irrevocable trusts and any funds in a trust or transferred to a trust are excluded from resources if they are inaccessible to the household.
Excluded assets placed in a revocable trust are excluded. If an applicant placed assets, including a home, in a revocable trust, the value of the property in trust is excluded. The value of any non-excluded assets in the revocable trust is countable for the grantor.
Any funds in a trust (including income produced by the trust) or funds transferred to a trust are considered unavailable if all of the following conditions apply:
- The trust arrangement is not likely to end during the benefit period;
- No asset group member has the power to revoke the trust or change the name of the beneficiary during the benefit period;
- The trustee administering the funds is;
- a court or an institution, corporation, or organization not under the direction or ownership of any asset group member, or
- an individual appointed by the court who is restricted by the court to use the funds solely for the benefit of the beneficiary; and
- Investments made on behalf of the trust do not directly involve or benefit any business or corporation under the control or direction of an asset group member. the funds in the irrevocable trust are;
- established from the asset group's own funds and the trustee uses the funds solely to make investments on behalf of the trust or to pay the educational or medical expenses of the beneficiary, or
- established from funds of a person who is not a member of the asset group.
If a determination can be made that assets in a trust are totally available, the trust is a countable asset. If a determination of availability cannot be made by examining the trust document(s) or talking with the trustee, proceed as follows.
- If the trust is administered by Probate Court, the asset group must petition the court to make the trust available. The court decides availability.
- Otherwise, refer the trust to the Office of the General Counsel to decide on availability.
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