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2. Evaluate each situation on a case-by-case basis. The evaluation may be done as part of the application process, recertification, change in circumstances, or appeal.

3. For a sanction to apply, the transfer must have occurred on or after a specific date known as the lookback date. 4. Treat a transfer that was completed in the lookback period by a financially responsible spouse or the a/b’s or spouse’s legal representative as though it were completed by the a/b. 5. The total cumulative value of all uncompensated transfers made within the lookback period is treated as a single transfer and a single sanction period is calculated.

6. An a/b or their authorized representative is provided with the opportunity to show evidence that the transfer was made for a reason other than to establish eligibility for NC Medicaid. They may also rebut the value of the transferred assets, or the value of compensation received. Refer to XII below. 7. Do not apply a transfer sanction when the a/b has been granted a waiver for undue hardship. Refer to MA-2245, Undue Hardship Waiver for Transfer of Assets, for procedures to determine if an undue hardship exists.

III. TRANSFER OF ASSET RULES

This section explains to whom transfer rules apply and what assets are considered in determining whether there is a transfer. All assets are considered whether they are owned jointly by the a/b and their spouse, the assets are owned individually by each spouse, or the assets were owned by one spouse prior to marriage.

A. Apply transfer rules to a/bs requesting or receiving assistance with any of the following:

1. Cost of care for institutional services under MAGI or non-MAGI rules in a:

a. Nursing facility (NF),

b. Intermediate care facility for individuals with intellectual disabilities (ICF- IID), or

c. Nursing facility level of care: (1) in a Swing bed or (2) in an acute care hospital bed, 2. Home and Community Based Services under MAABD rules:

a. Community Alternatives Program (CAP) waiver programs, or