Page 54

Chapter: 1600 Assets Program: MSSI, SFP 50

institutionalized individual. The institutionalized individual's eligibility depends on whether or not these remaining assets are within program standards.

After approval of Medicaid nursing home services, assets which are attributed to the community spouse but remain in the institutionalized spouse's name are not considered available to the institutionalized spouse if the assets are transferred to the community spouse before the next scheduled complete redetermination. The FLORIDA system generates an alert for the eligibility specialist to check on the transfer 90 days following approval.

At the time of approval, the couple and the legally authorized representative must be advised of the need to transfer assets remaining in the institutionalized spouse's name (which are part of the community spouse's asset allowance) to the community spouse. Such transfers are allowed and no penalty can be imposed.

Partial reviews must be scheduled on a quarterly basis to check on the status of the transfers and to remind the couple or the legally authorized representative of the necessity to transfer excess assets (over the applicable program limits) to the community spouse. All necessary transfers should be completed as soon as possible after approval to assure such assets will not cause the individual to become ineligible for Medicaid assistance at the time of the annual review.

Failure to transfer assets to the community spouse before the next scheduled redetermination must not be reported as overpayment. 1640.0611 Transfers by Community Spouse (MSSI) Transfer of assets between spouses does not affect eligibility. Transfer of assets to a third party by the spouse of the individual applying for nursing facility services prior to the approval of the institutional spouse's eligibility are subject to the transfer of assets penalty. However, if the third party intends to use the funds for the sole benefit of the community spouse, it is not counted as a transfer (refer to 1640.0609.06), but may or may not continue to count as an available asset.

After the individual has been determined eligible for Medicaid nursing facility, institutional Hospice, HCBS or PACE services, transfers of assets owned by the community spouse (or ineligible spouse) will not affect eligibility of the institutionalized spouse provided included assets were within the applicable limit at the time of application disposition. 1640.0612 Assets Transferred Due to Court Ordered Support (MSSI) For ICP, institutionalized MEDS-AD, institutionalized Hospice, HCBS, or PACE when a court has entered an order against an institutional spouse for the support of the community spouse or family member, there will be no penalty imposed due to assets transferred to comply with the court order. 1640.0613 Processing Transfer Cases (MSSI) Evaluate all transfers of assets or income that occur within the look-back period to determine the following if the:

1. transfer is legally binding; and 2. individual has any remaining ownership in the asset; and 3. individual received fair compensation.

If the individual would have been eligible if the asset was kept, you may assume the he did not transfer the asset(s) to become eligible. In other words, if the total countable resources, including the transferred amount, were below the program limits after considering all applicable exclusions and asset allocations at the time of transfer, no transfer penalty may be imposed.