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(d) changes beyond the control of the individual such as change in the policy of the issuer.

(4) If the annuity is a countable resource, the a/b will likely be ineligible for Medicaid due to excess resources. In this case no transfer of assets sanction can be applied.

b. The following requirements apply to annuities not determined to be a resource:

(1) Assets of an a/b used to purchase or change an existing annuity after November 1, 2007, will not be considered as a transfer of assets if, in addition to North Carolina’s Medicaid program named as a beneficiary, the annuity meets the following conditions: (Note: This requirement does not apply to an annuity held by the a/b’s spouse). The annuity was sold by a bank, insurance company, or other person engaged in the business of the sale of commercial annuities and (a) The annuity is considered either:

1) An individual retirement annuity, or

2) A deemed Individual Retirement Account (IRA) under a qualified employer plan. or

(b) The annuity is purchased with proceeds from one of the following: 1) A traditional IRA; or

2) Certain accounts or trusts which are treated as traditional IRAs; or

3) A simplified retirement account; or 4) A simplified employee pension account; or 5) A Roth IRA.

Note: To determine if an annuity is established under any of the provisions in a. and b. above, rely on verification from the financial institution, employer, or employer association that issued the annuity. It is the responsibility of the a/b, or the a/b’s representative to produce this documentation. OR

(c) The annuity meets all the following requirements:

1) The annuity is irrevocable and does not allow the policy holder to assign or transfer the ownership or income of the