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3. Service(s) provided is charged at a rate higher than Fair Market Value (FMV). a. FMV is determined by using the US Bureau of Labor Statistics Occupational Outlook Handbook (www.bls.gov) 4. Agreement/Contract is not actuarially sound in accordance to the life expectancy table in ABD-016 5. There is no repayment agreement to Montana Medicaid.

Legal Authority: Deficit Reduction Act of 2006

The uncompensated value is the asset’s FMV less any compensation received per the above policy. A stream of income’s FMV is the total annual payments multiplied by the life expectancy of the person on whose lifetime payments are based. EXAMPLE: Anthony, who is 85 years old, is entitled to $300 per month in annuity payments for the remainder of his life. The value of this ‘stream of income’ is $300/month X 12 months X 6.00 (Anthony’s life expectancy per ABD 016 Life Expectancy Table), or $21,600.

NOTIFICATION: The client must be notified that a disqualifying transfer penalty has been identified before eligibility is approved or denied. The notice must: 1. Notify the client an uncompensated asset transfer is identified; 2. Provide the transferred resource’s value; and 3. Explain the client’s right to rebut the presumption that the transfer was made to qualify for Medicaid. If the client fails to respond within 15 days, it is assumed that no rebuttal will be received. The asset transfer penalty is established and applied to the case.

TRANSFER REBUTTAL STATEMENT: All asset transfers are presumed to have been made in order to qualify for Medicaid. When the client rebuts the presumption that a transfer occurred to qualify for Medicaid, the client is responsible to provide proof the transfer occurred exclusively for another reason. The rebuttal statement must include: 1. The reason(s) the asset was transferred; 2. Documentation of attempts to sell the asset at fair market value; 3. Documentation that fair market value was received or the reason for accepting less than fair market value; 4. Proof the client had sufficient means to support themselves after the transfer; and 5. The client’s relationship to the individual who received the asset in transfer.

CONVINCING EVIDENCE: Factors that may indicate a transfer was not made to qualify for assistance include: · One of the following occurs after the asset is transferred: