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Chapter 3 - Determining Asset Eligibility

Introduction 3.1

At application, use the assets available on the date of application, unless the applicant's assets change before application disposition. Assets are available if an individual has both legal authority and actual ability to use them for self support. When an individual owns an asset in whole or in part, presume the asset is wholly available unless the individual proves it is not (see Chapter 1: Determining Countable Assets in this Part). If excess assets exist at application, deny the application.

In on-going cases, use the assets the group expects to have in the payment month. The case should be closed for the month of ineligibility.

To be eligible for MA under some eligibility categories, groups must have countable assets below a specified level. Some categories do not, however, impose an asset test. Specifically, children and pregnant women who meet the non-financial and income-eligibility criteria under 'Poverty Level Families and Children' within the AR program type and children, parents, and caretaker relatives eligible under the categories within the AX program type do not have to meet an asset test (see Section 2.2.2: ACEDS MA Program Types in Part I). Also, FS and MA groups which are categorically eligible do not have to meet an asset test (see Chapter 12: Categorical Eligibility in Part IV).

This chapter relates only to the treatment of assets for programs or eligibility groups within programs that impose an asset test on applicants and recipients. Thus, in this chapter when the term 'ALL' is used to indicate the programs to which a particular policy apply, the term only includes those programs and eligibility categories within programs that apply an asset test. Similarly, in this chapter, the term 'MA' only includes those eligibility categories within Medicaid and D.C. Medical Charities that impose an asset test. For clarity, when MA is broken into subgroups in this chapter, a notation will be made to indicate that the asset-related discussion does not apply to certain categories.

Legal Authority 3.2

AREA/TOPIC DISTRICT FEDERAL
Determining Asset Eligibility

D.C. Code 3-205.10-11; 3-217.5

GC: See TANF and D.C. Code 3-205.5a.

MA: 42 USC 1396a(l), 1396a(r)(2); 1396u-1; 42 CFR 435.601, 435.840-.845

TANF: 45 CFR 265.10

FS: 7 USC 2014(a),(g),(j);7 CFR 273.8

Asset Limits 3.3

ALL

 

ALL A group is ineligible when the total value of its countable assets exceeds the asset limit for the pertinent program.

Exhibit VI-1: Asset Limits shows the asset limits for each program by ACEDS program type and group.

Determining Asset Eligibility/Asset Budgeting 3.4

MA

Groups which are categorically eligible do not have to meet the asset limits listed in Exhibit VI-1: Asset Limits. A group is categorically eligible if all eligible MA group members receive or are authorized to receive TANF, GC, and/or SSI benefits (see Section 12.3: Who is Categorically Eligible in Part IV).

For groups subject to an asset test, asset eligibility exists when the group's countable assets are below the applicable MA asset limit for at least one day during the month being tested.

TANF Determine asset eligibility using the group's assets for the payment month. The group is ineligible if its assets exceed the applicable limit during any day of the month (see Exhibit VI-1: Asset Limits).
Example

A group receiving TANF exceeded the asset limit on July 8 and reported it on July 15. The group verifies it no longer had excess assets on July 19. Recoup July TANF benefits. Continue August benefits because the group's assets are within the asset limit for that month. If the group had also been receiving MA, there would have been no break in MA coverage for the group.

GC

See TANF.

FS

Groups which are categorically eligible do not have to meet the asset limits listed in Exhibit VI-1: Asset Limits. A group is categorically eligible (see Section 12.3: Who is Categorically Eligible in Part IV) if:

  • All eligible FS group members receive or are authorized to receive TANF and/or SSI benefits.
  • No group member is disqualified for FS because of an IPV.

For all other applicant groups, use the asset group's countable assets on the interview date to determine the initial eligibility of the group.

For on-going cases, if the asset limit is exceeded at any point during the month, the group is ineligible for that month (see Sections 6.3-6.4.4 in Part VIII for rules for when an overpayment should be charged and benefits recouped). The group may reapply and be determined eligible if the assets are again below the limit.

Determining Retroactive Eligibility 3.5

MA

AR: When a person applies for Medicaid, s/he can also apply for three months of retroactive eligibility. In order to determine retroactive eligibility, consider the applicant's resources during each month of the three-month period and compare it to the appropriate standard in Exhibit VI-1: Asset Limits.

AX: N/A.

SR: See AR.

QM: QMBs, Q1-1s and Q1-2s are not eligible for retroactive eligibility. For SLIMBs and QDWIs, see

AR.

MC: N/A

TANF

N/A

GC

N/A

FS

N/A

Verification 3.6

Requirements 3.6.1

MA

AR – TANF Standard: If the applicant is categorically eligible, no verification is required. Otherwise, verify assets.

AR – Foster Care/Department Ward/Adoption Assistance Recipient: All individuals in this group are categorically eligible for MA. Thus, assets do not need to be verified.

AR – Medically Needy Standard: Do not require verification when assets exceed the limit based on the client's statement of value.

Otherwise, require verification of the value of countable assets at application, redetermination, or when a change in assets is reported. Require verification of the ownership of all assets at application and when a change is reported.

AR – Poverty Level Families and Children: N/A

AX: N/A

SR – SSI Recipients: If the applicant receives SSI, no verification is required.

SR – Aged/Disabled: See AR – Medically Needy Standard.

QM: See AR – Medically Needy Standard.

MC: See AR – Medically Needy Standard.

TANF See AR – Medically Needy Standard.
GC

See AR – Medically Needy Standard.

FS

Require verification only if the information provided would affect group eligibility and is questionable (i.e., unclear, inconsistent, or incomplete).

Sources 3.6.2

ALL

The following prove ownership and/or value of assets. The SSR must assist a client unable to obtain proof.

Items verified by telephone contact must be documented in the case record.

The following types of assets must be verified with one of the stated sources or its equivalent:

  • Burial Plots:
    • right of burial certificate written statement from cemetery.
  • Checking (or Credit Union Draft) Account:
    • monthly statement (examination of checkbook is not sufficient verification)
    • current credit union statement
    • if necessary, telephone contact with the institution to verify the current balance
  • Funeral Contract:
    • copy of contract
    • contact with the funeral home
  • Insurance:
    • policy document
    • written statement from insurance company or agent
  • Money Held By Another Person:
    • written statement from the person holding the money
  • Other Property:
    • written statement from an individual or agency in a position to know the value of the type of property
    • the client's records verifying ownership and/or current value
  • Real Estate:
    • deed, mortgage, purchase agreement, or contract
    • property tax record
    • attorney or court records
    • city records
    • written statement from real estate agent or financial institution
    • telephone contact with real estate agent or financial institution to verify property as non-saleable
  • Retroactive SSDI or SSI Payments:
    • SSDI/SSI award letter
  • Savings (or Credit Union Share) Account:
    • passbook with entry posted within the last 30 days
    • current (30 days) quarterly credit union statement
    • Christmas Club coupon book
    • written statement from financial institution
    • if necessary, telephone contact with the institution to verify the current balance
  • Savings Certificate:
    • certificate itself
    • written statement from financial institution
  • Stocks or Saving Bonds:
    • certificate or bonds themselves
    • written statement from the broker or company
    • information from local brokerage firms, banks, or newspapers about the current value of stock/bonds
  • Temporary Illness and Ability to Return to Work:
    • written statement from a M.D. or D.O. indicating the nature of the illness or whether the person will likely be able to return to a type of work for which the excluded asset is essential
  • Trust Fund:
    • information from the administrator or trustee of the estate or LTC facility
    • court or attorney records
  • Vehicle:
    • DMV inquiry
    • vehicle title, registration, or proof of insurance
    • blue book or NADA book wholesale (trade-in) value
    • written statement from one auto dealer (or junk dealer if appropriate)
    • loan statement
    • payment book (only to verify ownership and not value)

Exhibit VI-1 Asset Limits

Policy Category Eligibility Criteria

Group

Size

Limit

MA AR - TANF Standard Families receiving TANF

All

None - Categorically Eligible

   

Families with children who meet TANF payment standard but do not receive TANF (categorically needy standards)

All

None, effective July 1, 2005

 

AR – Poverty Level Families and Children

Pregnant women and children

All

None

  AR - Medically Needy Families and Children

Parents, caretaker relatives, and children (including 19 and 20-year-old children)

All

None, effective July 1, 2005

  Foster Care/Dependent Ward/Adoption Assistance Recipient  

All

None - Categorically Eligible

  AX

Pregnant women, parents, caretaker relatives, and children

All

None

  SR

Individuals eligible based on age or disability (SSI recipients are categorically eligible)

1
2

$4,000
$6,000

  QM

QMB, SLIMB

QWDI

1

2

1

2

None, effective November 1, 2008

$4,000

$6,000

  MC

DC HealthCare Alliance

Childless Adult Medicaid

1

2

$4,000

$6,000

No resource test

TANF  

Parents, caretakers, and children – no elderly household member

Parents, caretakers, and children – at least one elderly group member

All

All

$2,000

$3,000

GC

 

See TANF

 

   

FS

 

 

 

 

Household with Categorical Eligibility or Expanded Categorical Eligibility

Other households with no elderly or disabled member

Other households that include an elderly or disabled member

All

All

All

None, effective March 1, 2010

$2,000

$3,250, effective October 1, 2011