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State of Maryland Medical Assistance Manual Revised April 2014

husband and wife have the same lawyer, the institutionalized spouse cannot be protected by the assignment of support provision. Actions that constitute assisting in making an asset inaccessible include but are not limited to removal of the institutionalized person’s name from an asset, placing any asset in which the institutionalized person has an ownership interest into a trust, converting any ownership interest of the institutionalized spouse from fee simple to life interest, transferring assets to the community spouse and adding a joint owner or trustee to an asset owned solely or in part by the institutionalized spouse. The LDSS must determine if any of these actions have taken place within 60 months prior to the month of application or anytime during or after the month of application. If an institutionalized spouse has taken any of the actions described above but can demonstrate, to the Department’s satisfaction, that there was no intent to make assets inaccessible that the action was for a purpose unrelated to Medical Assistance eligibility and that denial of eligibility would result in undue hardship then the institutionalized spouse will not be considered to have assisted in making the asset inaccessible. The LDSS must refer all requests for such consideration to the Division of Eligibility Services and the decision to grant to request may only come from this office. Factors that will be considered in determining if there was intent or anticipated need for Medical Assistance will include the persons’ health, age and financial status at the time for the action, and whether or not the action was typical or routine for persons not applying for Medical Assistance. For example, a man and a woman, both 45 years old, marry. She places his name on her accounts soon after the wedding. One year later, she is disabled in an auto accident and is institutionalized. He withdraws all of the funds and places them in an account in his name only and refuses to make the funds available to his wife. In this example, placing her husband’s name on her bank accounts was a typical action, given the circumstances. Her age, health and financial status at the time she took this action did not suggest the need for long term care or Medical Assistance. Because of this she will not be considered to have assisted in making the assets inaccessible. The 30 month look period for assistance in making assets in accessible is not be confused with 60 month look back period for disposal of assets, meaning that while some of these actions do not constitute a disposal of assets (eg. Inter-spousal transfers), they would preclude protection of eligibility under the assignment of support provision. Furthermore, while the look back period for disposals is limited to 60 months, the 30 month figure used in this provision is provided as a reasonable guideline, meaning that, while the LDSS is not required to investigate beyond this period, it may do so if there is reason to believe such action has taken place at an earlier time in anticipation of incurring LTC expenses; for example if there is an unusual distribution of the spouses’ ownership interest (90%/10%. 100%/0) or any other circumstance that may indicate that the inaccessibility was consented to by the institutionalized spouse.