Page 45

45

c. The a/b, or the a/b’s spouse must provide convincing evidence that may include but is not limited to a report to law enforcement officials.

5. The transfer of assets occurred as part of a regular, in frequency and amount, pattern of giving. The convincing evidence must include written records that clearly document the pattern of giving. Records include but are not limited to bank account records and property transfer records. 6. In situations other than those noted in XII.C. 1. through 5. above, when an a/b or an a/b’s spouse alleges that the transfer of assets was made solely for a reason other than to become eligible for Medicaid, evaluate the evidence presented. The evidence might establish another reason for the transfer. However, if establishing Medicaid eligibility for institutional services or in-home health services and supplies after receiving institutional services was also considered, the transfer was not exclusively for a purpose other than to establish or retain Medicaid eligibility.

In making the determination, consider the following:

a. The a/b’s or the a/b’s spouses’ age, general health, living arrangement, and amount of assets retained to meet future needs at the time of the transfer.

b. How the a/b expected to meet their medical and other living expenses without the transferred asset. c. Whether the case record documents any inquiry by the a/b, the a/b’s spouse, representative, or other interested party about asset limits for Medicaid, or other eligibility requirements for Medicaid.

d. Whether the a/b, or the a/b’s, spouse, legal representative, or other interested party consulted or hired an attorney for estate planning purposes. e. Whether the individuals who provided the knowledgeable statements concerning the circumstances of the transfer stand to gain in any way from the transfer. Whether the transfer is a one-time gift by the a/b, or the a/b’s spouse to a charity, religious organization, or family member made when the a/b, or the a/b’s spouse did not anticipate needing long-term medical care.

f. Whether a traumatic event (e.g., traffic accident) of disability or blindness happened causing the need for a healthy individual to need institutional services • Example: An a/b, age 40, was in good health when they gave their vacation cottage to their nephew. The next day the a/b was in an automobile accident. Their injuries require long-term care. The transfer was not made to become eligible for Medicaid because they could not anticipate their need for LTC services. 7. Document the response provided to the considerations listed in XIII.C.6. a. above. The a/b or the a/b’s spouse or the a/b’s or the a/b’s spouse’s legal representative must also provide a complete written accounting of the transfer, including all