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2. Annuities that are purchased or changed during the lookback period, that do not meet the criteria below are considered an uncompensated transfer. Determine a sanction period for the purchase amount plus any additions to the annuity.

a. The following requirements apply to all annuities whether they are determined to be a resource or not: (1) North Carolina Medicaid must be named remainder beneficiary in the first position for all annuities created or changed on or after November 1, 2007, when the a/b is applying for or receiving institutional services, CAP services, or PACE services. This requirement also applies to annuities held by the a/b’s spouse. Use the information obtained from the DHB-5111, Annuity Verification Form.

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2. Annuities that are purchased or changed during the lookback period, that do not meet the criteria below are considered an uncompensated transfer. Determine a sanction period for the purchase amount plus any additions to the annuity.

a. The following requirements apply to all annuities whether they are determined to be a resource or not: (1) North Carolina Medicaid must be named remainder beneficiary in the first position for all annuities created or changed on or after November 1, 2007, when the a/b is applying for or receiving institutional services, CAP services, or PACE services. This requirement also applies to annuities held by the a/b’s spouse. Use the information obtained from the DHB-5111, Annuity Verification Form.

(a)If there is a community spouse and/or any child under…#

(a) If there is a community spouse and/or any child under age 21 or a disabled child of any age when the purchase or change takes place, North Carolina Medicaid may be named in the next position after those individuals.

(b)If North Carolina Medicaid is not named as a remainder…#

(b) If North Carolina Medicaid is not named as a remainder beneficiary or not named in the correct position within the time frames for providing necessary information, the purchase, or change to the annuity is a transfer of assets for the original full purchase price plus any additions. The amount North Carolina Medicaid can receive, as a beneficiary, is limited to the amount that Medicaid paid on behalf of the Medicaid beneficiary.

(2) Changes include any action(s) taken by an individual that changes the course of payment of the annuity or that changes the treatment of the income or principal of the annuity. Changes include but are not limited to: (a) Additions to principal

(b) Elective withdrawals

(c)Requests to change the distribution of the annuity#

(c) Requests to change the distribution of the annuity

(d)Elections to annuitize the contract- (convert into a…#

(d) Elections to annuitize the contract- (convert into a series of payments)

(3) Changes do not include:

(a) address changes,

(b) death or divorce of a remainder beneficiary,

(c) child turning 21, or