Adult Medicaid Manual MA-2230 FINANCIAL RESOURCES

II. FINANCIAL RESOURCE PROCEDURES

The following information contains procedures for verifying and counting resources. Detailed information about various topics in this section is referenced for convenience.

A. Determine Whose Resources Are Counted

The a/r’s available resources are always counted when determining eligibility. In addition, if the a/r is married or is under age 18, a spouse or parent(s) may be financially responsible for the a/r. The spouse’s or parent’s resources must be evaluated when determining eligibility. See III. below for information on how to determine whose resources are counted.

B. Determine Availability of Resources

Even though an a/r, spouse or parent has financial assets, the assets may not be an available resource to the a/r under certain circumstances. Item IV. below provides information on how to determine availability of resources.

C. Request and Verify Resources

1. Liquid Assets - First Moment Balance

Always verify liquid assets as of the “first moment” of the month of verification. For all Medicaid classifications:

a. Request the closing balance/value on the last working day of the month pre-ceding the verification month.

REISSUED 01/01/2011 – CHANGE NO. 02-11

(II.C.1.)

b. The closing balance/value on the last business day of the preceding month is the “first moment” balance/value of the verification month.

2. Personal and Real Property Assets

The value of personal property and real property changes only when re-evaluated for tax purposes. Verify the value at any time during the month.

D. Resource Verification Month

1. Applications

The month to verify resources is:

a. Ongoing Certification Period - The month of application, or, if there are excess resources, the month resources are reduced.

b. Retroactive Certification Period - Each month of any 1, 2, or 3 month period.

2. Redeterminations

For eligibility reviews, there is some flexibility as long as the “verification month” is:

a. No earlier than the month in which the review process (verifications, appointment letter, etc.) is started, and

b. No later than the first month of the new certification period

3. Change In Situation

Verify resources for the month of change. If countable resources exceed the allowable limit:

a. Notify the recipient via the DMA-5097 or DMA-5097S of excess resources and the opportunity to rebut or reduce the value of resources. Allow 12 calendar days to provide proof of rebuttal or reduction of resources.

b. If, at the end of 12 calendar days, proof of rebuttal or reduction of resources is not received, send a timely notice of termination.

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(II.D.3.)

c. The recipient must provide proof that resources have been reduced no later than the effective date of termination.

d. If proof is submitted by the termination effective date, continue eligibility.

4. Appeal Reversals

Verify resources as of the first month of each certification period (c.p.). Begin with the retroactive 1-3 months and go forward by c.p.’s of 6 months. Verify any reported increases in resources during a c.p.

E. Calculate Countable Resources

1. Add the value of all countable real property assets. Include equity value based on tax value at this point. Rebuttal of current market value is only necessary if there are excess resources. See VII. below to determine how to count real property.

2. Add the value of all countable personal property assets. Include the equity value of excess vehicles. Rebuttal of personal property value is only necessary if there are excess resources. See VIII. to determine how to count personal property.

3. Add the value of all countable liquid assets. See X.-XII below to determine how to count trust funds, life insurance and other liquid assets.

4. Total all countable assets available to the a/r and financially responsible persons. See MA-2260, Financial Eligibility Regulations-PLA, for resource limits and parental deeming of resources. Refer to MA-2231, Community Spouse Resource Protection, when the a/r is institutionalized and has a spouse in the community. See XII.D below for instructions on how to apply a resource disregard for individuals with a qualified Long Term Care Partnership policy.

F. Compare Countable Resources to Resource Limit

1. Private Living Arrangement

The PLA a/r meets resource eligibility criteria if total countable resources are equal to or less than the resource limit for the a/r (individual or couple limit) on the first moment of the verification month.

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(II.F.)

2. Long Term Care

a. A single (unmarried or widowed) a/r in LTC meets resource criteria if total countable resources are equal to or less than the resource limit for one person.

b. Married LTC a/r with a spouse in the community –

Subtract the Community Spouse Resource Allowance (CSRA) from total countable resources of the couple. The a/r meets resource criteria if the remaining resources are equal to or less than the limit for one person. Rules and procedures for determining the amount of the CSRA are found in MA-2231, Community Spouse Resource Protection.

3. See G. - J. below if resources exceed allowable limits

G. Rebuttal of Real/Personal Property Value or Promissory Note

The a/r may rebut the value of real or personal property (including partial interest) or promissory note when countable resources exceed allowable limits. Rebuttal requirements are listed in items VII. and VIII. Refer also to instructions in MA-2303, Verification Requirements For Applications. When the a/r successfully rebuts the value of an asset, use the lesser value for all months for which eligibility is being determined, including retroactive months.

1. Rebuttal Requirements for Applications

When total countable resources exceed the allowable limit and the total includes equity in real property, personal property or a promissory note, notify the applicant in writing on the DMA-5097, Request for Information (or DMA-5097S), of the right to rebut.

a. Indicate the current value of countable resources and inform the applicant of the right to rebut the value and show that the asset has lesser value. State the latest date the rebuttal can be provided.

b. Refer to MA-2304, Processing The Application, for information concerning processing time frames for applications.

REISSUED 11/01/08 – CHANGE NO. 22-08

(II.G.)

2. Rebuttal Requirements for Ongoing Cases

a. When total countable resources exceed the allowable limit and the total includes equity in real property, personal property or a promissory note, notify the recipient in writing on the DMA-5097, Request for Information, (or DMA-5097S) of the right to rebut the value of these resources.

Indicate the current value of countable resources and inform the recipient of the right to rebut the value and show that the asset has lesser value. Allow 12 calendar days to provide proof of rebuttal of the value of the resource(s).

b. If proof of rebuttal or reduction is not received within 12 calendar days, send a timely notice proposing termination for excess resources. Terminate the case unless, the value of resources are rebutted or resources are reduced prior to the effective date of termination.

H. Burial Exclusion

Up to $1,500 of countable liquid assets for the a/r, spouse and financially responsible parent may be excluded for burial purposes. Using the burial exclusion is one method of reducing total countable resources which exceed the limit. See XIII. below.

I. Approving/Denying the Application for Resources

Refer to MA-2260, Financial Eligibility Regulations – PLA, to determine if countable resources, as determined in this section, are within allowable limits.

1. Countable Resources are Within Limits

Approve the application effective with the month that countable resources are equal to or below the allowable limit and all other eligibility criteria are met.

2. Countable Resources Exceed Limits

a. Medically Needy - M

If resources are reduced to allowable limits within the application processing time, authorize Medicaid as of the day that both resource and deductible requirements are met, whichever occurs last and all other requirements are met.

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(II.I.2.)

b. Categorically Needy - N, Q, B, E, and MWD.

If resources are reduced to allowable limits within the application processing time, authorize Medicaid the month that resources are below the limit as of the first moment and all other requirements are met.

J. Eligibility Redeterminations/Change in Situation

1. Countable Resources Are Within Limits

The a/r is eligible if countable resources are equal to or below the appropriate limit as of the first moment of the verification month and all other eligibility requirements are met.

2. Countable Resources Exceed Limits

If the recipient has excess resources at redetermination or change in situation, he must reduce resources to the allowable limit prior to the effective date of termination.

a. Send a DMA-5097, Request for Information, (or DMA-5097S) notifying the recipient of excess resources including the resource limit and options for rebuttal of resources (whose value can be rebutted), burial exclusion, or other reduction of resources, that are applicable to the types of resources he owns. Allow 12 calendar days for him to provide proof of rebuttal or reduction of resources.

b. If the recipient does not provide proof of rebuttal or reduction of resources within 12 calendar days, send a timely notice proposing termination for excess resources. Terminate the case unless the values of the resources are rebutted or resources are reduced prior to the effective date of termination.