REVISED 01/01/14 – CHANGE NO. 11-13
When an individual, legal representative, or financially responsible spouse transfers any real property, personal property or any other assets, including assets counted or excluded in determining Medicaid eligibility, for less than current market value, a transfer of assets sanction may be imposed. If a sanction is imposed the individual is ineligible for certain Medicaid covered services.
Transfer of asset regulations do not apply to all Medicaid covered services. Therefore, an individual under a transfer of assets sanction may be eligible for other services covered by the North Carolina Medicaid program.
The services that can be sanctioned are: Institutional services which are provided to individuals who are in a nursing facility (NF), intermediate care facility for the mentally retarded (ICF-MR), swing bed or inappropriate level of care bed, Community Alternatives Program (CAP), or the Program of All-Inclusive Care for the Elderly (PACE). Additionally certain non-institutional services may be sanctioned. These are in-home health services and supplies after the individual has been sanctioned for institutional services.
This section contains the policy and procedures for determining the following:
Individuals subject to the transfer of assets regulations,
Medicaid covered services subject to the transfer of assets regulations,
Assets subject to the transfer of assets regulations,
The lookback date,
When a non-allowable transfer has occurred,
When to impose a transfer of assets sanction,
How to determine the sanction period,
Applicant/beneficiary (a/b) notification procedures.
Refer to MA-2242, Home Equity Value and Eligibility for Institutional Services, for policy when determining eligibility for institutional services when an a/b has home equity in excess of $543,000. Refer to MA-2245, Undue Hardship Waiver for Transfer of Assets, for policy and procedures when an a/b alleges an application of a transfer of asset sanction would cause an undue hardship.
REISSUED 01/01/14 – CHANGE NO. 11-13
A transfer of asset evaluation involves many dates that are important to both the current evaluation and possible future evaluations. Always retain these dates in a sub-folder or file in the a/b’s permanent record using the DMA-5162, Transfer of Assets Dates Documentation. Update at each review as needed. At the initial evaluation and at each subsequent update retain the original in the case file and send a copy of the DMA-5162, Transfer of Assets Dates Documentation, to the Medicaid Program Representative.
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.