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50 TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE Request documentation of the sale (i.e., settlement sheet, photocopy of the check) for the case record when resources are sold. The recipient is ineligible in the month proceeds are received. This information is important should the individual re-apply in the future claiming all resources have been depleted. When an individual has received 9 months of conditional benefits but has not been able to sell real property despite reasonable efforts to do so, you may continue Medicaid coverage if the Medicaid recipient continues to make reasonable efforts to sell the resource and doesn't refuse a valid offer to buy the resource/property. 1. Notification to the Client Inform the recipient or responsible party that: a) Client or family member is responsible to inform Medicaid promptly of any sale of property. b) Medicaid will continue to exclude the value of the property for so long as reasonable efforts to sell continue but are not successful; c) Medicaid will continue to make periodic follow-up contacts and to request evidence of continued reasonable efforts to sell; d) The individual is still responsible for informing Medicaid promptly of any offers to buy and for showing that any offer refused was not reasonable; and e) Total resources, including the real property in question, do not fall within the applicable resource limit. 2. Follow up Contacts Contact the owner or his representative (by phone, if possible) at 90 day intervals following the end of the conditional benefits period. EXCEPTION - contact may be at 6 month intervals if: The individual does not have a spouse and equity in the property to be sold is $2,000 or less; or The individual has a spouse and equity in the property to be sold is $3,000 or less. NOTE: This exception recognizes the possibility that an individual may have spent down other resources and become eligible without benefit of the real property exclusion. Use these follow up contacts for the same purposes as described above. Evaluate efforts to sell (and good cause, if appropriate) as above. 20360.6 Annual Renewals for Individuals Open with Conditional Medicaid Coverage Individuals who are open in conditional Medicaid coverage while disposing of excess resources that received a "conditional exclusion" and were not counted during the conditional benefit period are not eligible for the streamlined renewal process that waives the resource test at annual renewal. Individuals who receive conditional Medicaid coverage must complete a full annual renewal. 20370 LTC Retroactivity Any individual or couple who applied for Medicaid may also be eligible for Medicaid coverage of any unpaid medical bills incurred in any of the three months prior to the month in which they applied. However, certain requirements must be met in order for these bills to be paid under Medicaid. Applications for Medicaid, even if denied, qualify for a determination of retroactive eligibility. a) Individual must document that for time period in which bill was incurred, all medical and financial conditions of the Long Term Care Program have been met. For individuals whose income is between the SSI standard and 250% of the SSI standard, retroactive payment is only possible if the individual has been institutionalized 30 consecutive days. The assumption used for initial nursing facility eligibility determination, that the applicant will remain institutionalized for 30 consecutive days, does not apply for retroactive coverage when it is obvious the 30 day criteria has not been met. b) Individual must supply documentation of the unpaid bill. In some circumstances, bills may have been paid by someone other than the applicant and they have requested a refund. Documentation of provider reimbursement and unpaid balance must be provided. Acceptable documentation would be a copy of the provider reimbursement check written to someone other than the applicant. Credit to a patient's account is not acceptable. If part of the 30 day consecutive period was hospitalization no documentation of unpaid hospital bills are required. 20400 Trusts BACKGROUND