Adult Medicaid Manual MA-2240 TRANSFER OF ASSETS

IiI. DEFINITION OF TERMS RELATED TO TRANSFER POLICY

Actuarially Sound – A promissory note, annuity, mortgage or loan established to pay off the entire asset value over the actual or expected lifetime of the annuitant/lender is actuarially sound. The annuitant/lender is expected to live long enough to receive an amount that is equal to or greater than the amount originally invested. The total amount of proceeds must be designed to be paid out in equal regular payments during the term of the agreement, with no deferral and no balloon payments.

Annuity - An annuity is a type of trust. An individual pays an entity a lump sum of money in return for the right to receive fixed, periodic payments, either for life or a term of years. This includes the investment portion of a single premium pure endowment life insurance policy.

Annuitant – An annuitant is the person who receives the income payments of an annuity policy at maturity date for life or for a specified period. The annuitant may or may not be the same as the owner.

Annuitize – Converting a principal of an annuity into a series of payments.

Asset – For purposes of transfer of assets is resources and income.

Beneficiary of an annuity – The beneficiary is the person who receives any benefit that is paid upon death of the annuitant prior to the maturity date of the annuity.

Compensation - Something received as payment for an asset. Payment is usually considered to be cash, but other forms of payment include in-kind income, real or personal property, support and maintenance, services, or assumption of a legal debt.

REVISED 02/01/08 – CHANGE NO. 07-08

(III.)

Cost of Care - The amount of money charged to an individual for NF or ICF-MR level of care, a swing bed, or inappropriate level of care bed in a hospital, waiver services for the Community Alternatives Program or Program of All-Inclusive Care for the Elderly (PACE).

Current Market Value - The value of an asset if sold on the open market. For real and personal property it is the tax assessed value of the property, unless that value is rebutted and a different value established. Refer to MA-2230, Financial Resources, for instructions on establishing and rebutting the tax value.

Demonstrated Hardship – The a/r, spouse or personal representative proves through the greater weight of evidence that a denial of institutional services due to excess home equity value will cause the a/r a demonstrated hardship.

Equity – The equity of real or personal property is the current market value (see definition above) less any encumbrances (mortgages, liens, or judgments) on the property.

Greater Weight of the Evidence – Refers to the quality and convincing force of the evidence rather than to the quantity of the evidence.

Homesite - When applying the transfer policy the homesite is defined as any property in which the a/r or financially responsible person has an ownership interest and

• Which is currently used (or during the lookback period was used) as his principal place of residence, or to which he intends (or intended) to return, or
• Which is currently used (or during the lookback period was used), as the principal place of residence of his spouse or his dependent relative.

It includes the land the home sits on and all buildings and land contiguous to the home.

See MA-2230, Financial Resources, for the definition of homesite when determining resource eligibility.

In-Home Health Services and Supplies – Medically necessary services provided to an applicant/recipient (a/r) by a Medicaid certified provider can be sanctioned due to a transfer of assets. These services include the following:

• Durable Medical Equipment (DME) and related medical supplies such as wheelchairs, walkers, canes, hospital beds, oxygen and oxygen equipment, needed to maintain or improve a recipient’s medical, physical, or functional level.
• Home Health Services covers home health aide services, skilled nursing, physical therapy, speech pathology and audiology, and occupational therapy provided by a Medicaid certified home health agency to help restore, rehabilitate or maintain a recipient in the home.

REVISED 02/01/08 – CHANGE NO. 07-08

(III.)

Home Health Supplies include items such as adult diapers, disposable bed pads, catheter and ostomy supplies provided by a Home Health or Private Duty Nursing (PDN) agency. PDN services are not provided to individuals in an Adult Care Home (ACH).

Home Infusion Therapy (HIT) covers self-administered therapies such as nutrition therapy (tube feeding), drug therapy including chemotherapy for cancer treatments, antibiotic therapy and pain management therapy.

• Personal Care Services (PCS) are personal care activities such as bathing, toileting, monitoring vital signs, housekeeping and home management tasks essential for maintaining the recipient’s health performed by an in-home aide in a private residence.

PCS services provided to individuals in an ACH are not subject to this policy.

Institutional Services - These services include services provided in a nursing facility (NF), intermediate care facility for the mentally retarded (ICF-MR), swing bed or inappropriate level of care bed, services provided through the Community Alternatives Program (CAP), or Program of All-Inclusive Care for the Elderly (PACE). These services can be sanctioned due to a transfer of assets. This does not include acute hospital care regardless of length of stay.

Institutionalized for Transfer of Assets – As defined for a transfer of assets review, institutionalized is an individual receiving institutional services in a nursing facility (NF), intermediate care facility for the mentally retarded (ICF-MR), swing bed or inappropriate level of care bed in a hospital, services provided through the Community Alternatives Program (CAP) or Program of All-Inclusive Care for the Elderly (PACE). This is different from the definition of institutionalized for long term care budgeting or institutional living arrangement when determining state/county residency.

Legal Representative - A person acting for and legally authorized to execute a contract for the a/r, such as but not limited to a general guardian, guardian of the estate, parent of a minor child, power of attorney, fiduciary (agent), conservator or any trustee managing the a/r’s resources. Legal authorization requires a separate legal document except for parents of minor children.

Lookback Date - The earliest date a transfer can occur and be evaluated for a transfer of assets for less than fair market value. The lookback date varies depending on when an individual applies for Medicaid, is admitted to a NF or ICF/MR or requests CAP or PACE services. Sanctions can be determined for transfers that take place on or after the lookback date.

Rebuttal – The process by which an a/r, the a/r’s spouse or legal representative proves through a greater weight of evidence factors that eliminate or decrease a sanction period.

Remainder Beneficiary-The person(s) entitled to an annuity’s principal, possibly including income that has been accumulated and added to principal, after the death of the annuitant.

REISSUED 11/01/11 – CHANGE NO. 17-11

(III.)

Sanction Period - The period of time in which an a/r is ineligible for Medicaid payment of institutional services and in-home health services. In order to sanction in-home health services, the sanction period must have begun during a period the individual received institutional services and continues when the individual goes to PLA living arrangement. The sanction period is also referred to as a penalty period.

Transfer - To change ownership or title from one person(s) to another. A transfer also occurs when an individual takes action to waive or renounce assets or an inheritance to which he is entitled or when an individual takes any action that eliminates his ownership or reduces his control of an asset. For example, changing fee simple property to tenancy-in-common property or adding an additional owner to a savings account is considered a transfer.

Transfer Date for Real Property or Interest in Real Property - The date of transfer for real property is the day the deed is signed by the grantor, delivered, and accepted by the grantee. Unless fraud is suspected, it is presumed this is the date recorded on the front of the deed. The deed does not have to be notarized or registered in order to be a valid title transfer. However, a deed of gift must be registered within 2 years to remain valid.

Uncompensated Value - The difference between the market value less encumbrances (the equity) of the asset at the time of the transfer and any payment or compensation received. The uncompensated value is the amount upon which the sanction is based.

Undue Hardship – The application of the sanction period would deprive the individual of medical care, such that the individual’s health or life would be endangered; or of food, clothing, shelter, or other necessities of life.

Undue Hardship Waiver- An individual who incurs a sanction for transfer of assets and is denied or terminated from Medicaid payment of institutional services may request this sanction be waived and can demonstrate the sanction will cause the a/r an undue hardship.