524 MEDICAID EXCEPT TO RESOURCE

524 MEDICAID EXCEPTIONS TO APA Adult Public Assistance RESOURCE POLICY

The value and count-ability of resources is determined according to the criteria of the APA Adult Public Assistance program, except as provided below.

524 A. REASONABLE COMPATIBILITY

Reasonable compatibility refers to the standard used to address discrepancy between the client stated resources and information from an electronic data source.

Information from an electronic data source (in this case, AVS Asset Verification System in IEVS Instant Eligibility Verification System ) is reasonably compatible if is results in the same eligibility outcome as the client stated information.

This policy change does not alter other program requirements for which resources must be verified or how resources are counted for program eligibility.

Note: Actual resource information must be used for Long Term Care cases and Medicaid cases that use a Medicaid qualifying trust.

Actions:

Both the client stated countable resources and electronic data are at or below the resource limit. Take client statement and authorize Medicaid.

Both the client stated countable resources and the electronic data are above the resource limit. Take client statement and deny the Medicaid.

Client stated countable resources are above the resource limit and the amount verified using the electronic data is at or below the resource limit. Accept client statement and deny Medicaid.

Client stated countable resources are at or below the resource limit and the amount verified using electronic data is above the resource limit. Further verification is required.

The reasonable compatibility test will only be applied to resources that have not otherwise been verified (for example, if a recipient submits bank statements as part of their renewal or if the resource has been verified by another program). It can only be applied when resource information is available through AVS Asset Verification System .

Example 1:

Shania is due for her Medicaid renewal and previously reported the following countable resources:

Savings account: $5 (A)

AVS Asset Verification System returns the following information:

Savings account: $200 (match with A)

Undisclosed checking account: $800 (new)

Reasonable Compatibility Determination:

Medicaid Resource Limit: $2,000

Total client stated resources: $5

Total AVS Asset Verification System and client stated resources: $200 + $800 = $1,000

Result: reasonably compatible because the sum of both calculations is less than the resource limit. No further verification is requested from Shania. Client statement is used to determine resource eligibility.

Example 2:

Johnny is due for his Medicaid renewal and previously reported the following countable resources:

Checking account: $500 (A)

Savings account: $700 (B)

Savings bond: $300 (B)

AVS Asset Verification System returns the following information:

Checking account: $800 (matched with A)

Savings account: $400 (matched with B)

Undisclosed checking account: $900 (new)

Reasonable compatibility determination:

Medicaid Resource Limit: $2,000

Total client stated resources: $500 + $700 + $300 = $1,300

Total AVS and client stated resources: $800 + $700 + $900 + $300 = $2,700

Result: not reasonably compatible because the sum of countable resources from AVS Asset Verification System is above the Medicaid resource limit. In this case, the $700 savings account amount is used when calculating the total countable resources as it is the higher amount when comparing the client stated and AVS Asset Verification System information. Verification of countable resources is required.

Example 3:

Dolly is due for Medicaid renewal and previously reported the following countable resources:

Checking account: $1000 (A)

Savings account: $500 (B)

AVS Asset Verification System Returns the following information:

Checking account: $2000 (match with A)

savings account: $2500 (match with B)

Reasonable compatibility determination:

Medicaid Resource Limit: $2,000

Total client stated countable resources: $1,000 + $500 = $1,500

Total AVS Asset Verification System and / or client stated resources: $2,000 + $2,500 = $4,500

Result: not reasonably compatible because the sum of countable resources from AVS Asset Verification System is above the Medicaid resource limit. Verification of countable resources is required.

524 B. COMMUNITY SPOUSE RESOURCE ALLOWANCE

Resources may be transferred from the Long Term Care spouse to his or her community spouse to meet the eligibility resource limit (see Addendum 1 for current year allowance amount) to qualify for Medicaid under the Special Long Term Care eligibility category. See Section 553 .

524 C. CONDITIONAL BENEFITS

The APA Adult Public Assistance policy regarding conditional benefits at APA Manual Section 433-2 does not apply. Medicaid does not provide conditional benefits.

524 D. PROPERTY FOR SALE

The APA Adult Public Assistance policy regarding property up for sale at APA Manual Sections 432-1D and 433-2 does not apply in Medicaid-only determinations. Medicaid has no exemption for property up for sale.

524 E. TRANSFER OF RESOURCES

The APA Adult Public Assistance policy regarding transfer of resources at APA Manual Section 433-1 does not apply to Medicaid-only determinations. See Section 554 for Medicaid transfer of asset policy for institutional or waiver applicants and recipients. Federal income tax returns are not subject to Medicaid transfer of asset penalty provisions for 12 months from the date the payments are received. However, payments given away after the exempt period are subject to Medicaid transfer of asset penalty provisions.

524 F. INSTITUTIONAL ALLOTMENT OF RESOURCES

The APA Adult Public Assistance policy regarding financial responsibility of spouses who no longer live together at APA Manual Section 460-2(A) does not apply to institutional or waiver applicants. See Section 553-D for resource eligibility determination and allotment of resources policy.

524 g. INSTITUTIONALIZED INDIVIDUALS WITH SUBSTANTIAL HOME EQUITY

The APA Adult Public Assistance policy regarding exemption of an individual’s home, regardless of its value, APA Manual Section 432-1 , does not apply to institutional or waiver applicants for payment of long-term care services. See Section 553-C for resource eligibility determination and allotment of resources policy.

524 H. PROMISSORY NOTES, LOANS, AND PROPERTY AGREEMENTS

For transfer of asset purposes only, the APA Adult Public Assistance policy regarding promissory notes, loans, and property agreements. APA Manual Section 431-2(I) does not apply to institutional or waiver applicants. See Section 554-H for purchase of promissory notes, land, or mortgages policy.

524 I. LIFE ESTATES

For transfer of asset purposes only, the APA Adult Public Assistance policy regarding life estates. APA Manual Section 431-1(B)(6) does not apply to institutional or waiver applicants. See Section 554-J for purchase of life estates policy.

524 J. RESOURCE LIMIT FOR THE WORKING DISABLED BUY-IN CATEGORY

The APA Adult Public Assistance policy regarding the resource limit at APA Manual Section 430-2 does not apply to the Working Disabled Buy-In category. See Section 534-B for the resource limit.

524 K. INDIVIDUAL INDIAN MONEY ACCOUNTS

Funds deposited or held in an Individual Indian Money ( IIM Individual Indian Money ) account are excluded. However, once funds are removed from an IIM Individual Indian Money account, they become a countable resource.

IIM Individual Indian Money accounts primarily contain money collected by the federal government from farming and grazing leases, timber sales, mining, oil and gas production, and other activities on trust land, as well as certain per capita distributions. The funds in IIM Individual Indian Money accounts are held in trust by the federal government for the benefit of individual Indians.

524 L. ALASKA NATIVE AND AMERICAN INDIAN REAL PROPERTY RESOURCE EXCLUDED

All real property in Alaska owned by an Alaska Native or American Indian is excluded from being a countable resource or as a potential transfer of asset penalty. This includes land and any structures built on the land. The real property does not need to be Native restricted land for this exclusion to apply.

If real property has been determined to be excluded as a resource using the policy described above, it should not be counted as a resource for any other household members' Medicaid eligibility.

Note: Alaska Native property shall remain exempt if it passes from AN/AI Alaska Native / American Indian to one or more relatives, such as a spouse or a child. even if the relatives are not AN/AI Alaska Native / American Indian .

When property owned by an Alaska Native or American Indian is sold, the proceeds are no longer exempt. See conversion of resources in APA MS 440-3(C) .

524 M. DINGELL ACT LANDS

Certain Alaska Native Americans who served in the Armed Forces during the period between August 5, 1964, and December 31, 1971 and haven't received a Native Allotment may receive up to 160 acres in Alaska from the Dingell Act. This land is an exempt resource.

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