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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 29 a. If the individual's QLTCP disregard plus resource limit equals or exceeds the individual's countable resources plus the value of the transferred resource, no penalty period applies. The disregarded value of the transferred resource is considered part of the individual's QLTCP disregard. b. If the individual's QLTCP disregard plus resource limit is less than the individual's countable resources plus the value of the transferred resource: i. Determine the individual’s available QLTCP disregard by adding the individual's QLTCP disregard to the individual's resource limit, then subtracting the individual's current countable resources and any amounts that have previously been transferred without a restricted Medicaid coverage period as a result of a QLTCP disregard. ii. Subtract the individual’ available QLTCP disregard from the amount that would otherwise have been considered improperly transferred. The remainder is the amount improperly transferred; a restricted Medicaid coverage period is calculated for the remainder. 8. Reciprocity with other states. DMMA will accept partnership policies issued in other States with qualified long-term care insurance partnership programs. 9. Exhaustion of Benefits. An individual who owns a Qualified State Long-Term Care Insurance Partnership policy can apply for Medicaid before exhausting policy benefits. The partnership policy is treated as a third party liability and Medicaid will pay for services not covered. Medicaid will be payor of last resort. 10. Verification of the Partnership policy. A Qualified State Long-Term Care Insurance Partnership policy must meet all relevant requirements of federal and state law. Qualified partnership policies are certified by the Delaware Department of Insurance (DOI). 15 DE Reg. 1014 (01/01/12) 20350 Transfer of Assets Transfer of assets occurs when an institutionalized individual, or the individual's spouse, has sold, given away (including establishment of a trust or contribution to a charity) or otherwise transferred any asset. Assets transferred by a parent, guardian, court or administrative body, or anyone acting in place of or on behalf of or at the request or direction of the individual or spouse, are considered to be transferred by the individual or spouse. Medicaid law provides for a period of ineligibility when an institutionalized individual or the individual's spouse disposes of assets for less than fair market value (FMV) on or after a specified look-back date. Section 13611 of the Omnibus Budget Reconciliation Act of 1993 (P. L. 103-66) enacted 8/10/93, revised the rules on Transfer of Assets. The new rules are effective for long term care applications filed on or after 10/1/93 and assets transferred on or after 8/11/93. The new rules do not apply to assets transferred on or before 8/10/93. 20350.1 Definitions 20350.1.1 Institutionalized Individual 20350.1.2 Spouse 20350.1.3 Assets 20350.1.1 Institutionalized Individual An institutionalized individual is an individual who is: - an inpatient in a nursing facility, or - an inpatient in a medical institution with respect to whose eligibility is based on an appropriate level of care for that medical institution, or - a home and community-based services recipient described in section 1902(a)(10)(A)(ii)(VI). 20350.1.2 Spouse This is a person who is considered legally married to an individual under the laws of the State in which the individual is applying for or receiving Medicaid. 20350.1.3 Assets Assets include all income and resources of the individual or the individual's spouse. NOTE: PRIOR TO OBRA 93 THE DEFINITION OF ASSETS DID NOT INCLUDE INCOME. Assets would also include assets that the individual or spouse is entitled to receive but does not because of an action taken by: - the individual, or - the individual's spouse, or a person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or spouse, or - any person, including a court or administrative body, acting at the direction of or upon the request of the individual or such individual's spouse.