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See MA-2230, Financial Resources, for the definition of homesite when determining resource eligibility.

In-Home Health Services and Supplies – Medically necessary services provided to an applicant/beneficiary (a/b) by a Medicaid certified provider can be sanctioned due to a transfer of assets. These services include the following: • Durable Medical Equipment (DME) and related medical supplies such as wheelchairs, walkers, canes, hospital beds, oxygen and oxygen equipment. • Home Health Services covers home health aide services, skilled nursing, physical therapy, speech pathology and audiology, and occupational therapy provided by a Medicaid certified home health agency. • Personal Care Services (PCS) are personal care activities such as bathing, toileting, monitoring vital signs, housekeeping and home management tasks.

Institutional Services - These services include services provided in a nursing facility (NF), intermediate care facility for individuals with intellectual disabilities (ICF-IID), nursing facility level of care in a Swing bed or in acute care hospital bed, services provided through the Community Alternatives Program (CAP), or Program of All-Inclusive Care for the Elderly (PACE). These services can be sanctioned due to a transfer of assets. This does not include acute hospital care regardless of length of stay. Institutionalized for Transfer of Assets – As defined for a transfer of assets review, institutionalized is an individual receiving institutional services in a nursing facility (NF), intermediate care facility for individuals with intellectual disabilities (ICF-IID), nursing facility level of care in a Swing bed or in acute care hospital bed, services provided through the Community Alternatives Program (CAP) or Program of All-Inclusive Care for the Elderly (PACE). This is different from the definition of institutionalized for long-term care budgeting or institutional living arrangement when determining state/county residency.

Irrevocable Trust- A type of living trust, that details an individual’s assets and how the individual would like them to be distributed to their beneficiaries. However, unlike a revocable trust, irrevocable trusts are pretty much set in stone. Some exceptions allow for changes if all the beneficiaries agree to them, but the proposed updates must go through a lengthy approval process, which can include going before a judge. Legal Representative - A person acting for and legally authorized to execute a contract for the a/b, such as but not limited to a general guardian, guardian of the estate, parent of a minor child, power of attorney, fiduciary (agent), conservator or any trustee managing the a/b’s resources. Legal authorization requires a separate legal document except for parents of minor children.

Lookback Date - The beginning of the lookback period and the earliest date transfers of assets are reviewed when evaluating an a/b for institutional services. The lookback date depends on when an individual applies for Medicaid and is admitted to a NF or ICF/IID or requests CAP or PACE services. Lookback Period- The period that is reviewed for transfer of assets. It begins with the