loading…
loading…
loading…
302.01 Introduction 108
302.02 Resource Limit 108
302.02A Resource Reduction Period 108
302.03 Resource Definitions 110
302.04 Resources vs. Income 112
302.05 Liberalized Resource Policy 113
302.06 Whose Resources to Count 113
302.07 Unknown Assets 114
302.08 Ownership Interest 114
302.08.01 Sole Ownership 114
302.08.02 Shared Ownership 114
302.08.03 Equitable Ownership 115
302.08.04 Property Rights with No Ownership 117
302.09 Factors That Make Property a Resource 118
302.10 Access to Resources 118
302.10.01 Individual Declared Legally Incompetent 118
302.10.02 Types of Access 119
302.11 Retirement Funds 120
302.12 Loans, Promissory Notes and Property Agreements 121
302.13 Inheritances and Un-Probated Estates 122
302.14 Resource Exclusions 123
302.14.01 Home Property 123
302.14.02 Home Replacement Funds 125
302.14.03 Installment Sales Contract 125
302.14.04 Jointly Owned Property 126
302.14.05 Bona fide Effort to Sell 126
302.15 Resource Exclusions for Tribal Members 128
302.16 Automobiles 129
302.16.01 Rebuttals 132
302.17 Life Insurance 133
302.17.01 Development of Countable Life Insurance 135
302.17.02 Estimated Cash Surrender Value Table 139
302.17.03 Accelerated Life Insurance Payments 139
302.18 Death Benefits for Last Illness and Burial Expenses 140
302.19 Burial-Related Resources 142
302.19.01 Burial Spaces 142
302.19.02 Burial Space Exclusion 143
302.19.03 Burial Funds 143
302.19.04 Burial Fund Exclusion 144
302.19.05 Burial Fund Penalty 145
302.19.06 Burial Fund Exclusion and Re-Determination 145
302.20 Pre-Need Burial Contracts 146
302.20.01 Pre-Need Burial Contracts Including Burial Spaces and Burial Funds 146
302.20.02 Revocable Pre-Need Burial Contracts 147
302.20.03 Irrevocable Pre-Need Burial Contracts 148
302.20.04 Life Insurance Funded Burial Contracts 149
302.20.04A Effect of the Assignment of Ownership on Burial Exclusion 149
302.20.04B Effect of the Assignment of Proceeds on Burial Exclusion 149
302.21 Property Essential to Self Support 149
302.21.01 Essential Property Excluded – Regardless of Value or Rate of Return 150
302.21.02 Essential Property Excluded – Up to $6,000 Equity – Regardless of Rate of Return 151
302.21.03 Essential Property Excluded – Up to $6,000 Equity – If It Produces a 6% Rate of Return 151
302.22 Resources Set Aside as Part of Plan for Achieving Self-Support 153
302.23 Retained Cash Payments 153
302.23.01 Retroactive Supplemental Security Income (SSI) and Retirement, Survivors, and Disability Insurance (RSDI) 153
302.23.02 Dedicated Accounts for Past-Due Benefits Due to Individuals Under Age 18 Who Have a Representative Payee 153
302.23.03 Cash Received for the Repair or Replacement of Lost, Damaged, or Stolen Excluded Resources 154
302.23.04 Disaster Assistance 155
302.23.04A COVID-19 Economic Impact Payments (EIPs) 155
302.23.05 Presidentially Declared Major Disasters 157
302.23.06 Netherlands WUV Payments to Victims of Persecution 157
302.23.07 German Reparations Payments 158
302.23.08 Austrian Social Insurance Payments 158
302.23.09 Benefits Excluded from Both Income and Resources by a Federal Statute Other Than Title XVI 158
302.23.09A Agent Orange Settlement Payments 158
302.23.09B Victims Compensation 159
302.23.09C Relocation Assistance Payments 159
302.23.09D Tax Advances and Refunds Related to Earned Income Tax Credits 159
302.23.09E Radiation Exposure Compensation Trust Fund Payments 160
302.24 Gifts of Domestic Travel Tickets 160
302.25 Identifying Excluded Funds That Have Been Co-mingled with Non-Excluded Funds 160
302.26 Countable Resources 160
302.26.01 Cash 161
302.26.02 Checking/Savings Accounts 161
302.26.03 Joint Checking/Savings Accounts 163
302.26.03A Rebuttal of Joint Checking/Savings Accounts 163
302.26.04 Time Deposits 164
302.26.05 Conservator Account 164
302.26.06 Stocks 165
302.26.07 Mutual Fund Shares 165
302.26.08 US Savings Bonds 166
302.26.09 Municipal, Government, or Corporate Bonds 166
302.26.10 Other US Government Securities 166
302.26.11 Contents of a Safety Deposit Box 166
302.26.12 Non-Home Real Property 167
302.26.13 529 Plan 167
302.26.14 Direct Express Account 168
302.27 Cash to Purchase Medical or Social Services 168
302.28 Retroactive In-Home Supportive Services 168
302.29 Encumbrance 169
302.30 Trust Property 172
302.30.01 Trust Terms and Definitions 172
302.30.02 Instruments Similar to Trusts 173
302.30.03 Use of Trust Funds 175
302.30.04 Trust Revocability and Its Effect on the Status as a Resource 175
302.30.05 Disbursements from Trusts 176
302.30.06 Special Needs Trusts 177
302.30.07 Pooled Trusts 179
302.30.08 Achieving a Better Life Experience (ABLE) Accounts 180
302.30.08A Designated Beneficiary of ABLE Account 180
302.30.08B Excluded ABLE account contributions, balances, earnings, and distributions 181
302.30.08C Countable ABLE account balances and distributions 183
302.31 Uniform Gifts to Minors Act 183
302.31.01 UGMA and Sources 184
302.31.02 While Donee Remains a Minor 184
302.31.02 When the Donee Reaches Age 18 184
302 Appendix A Excluded Resources 186
302 Appendix B Verification Procedures 189
302 Appendix C Knowledgeable Source Statements 190
302 Appendix D Rebuttal Of Ownership of Assets Other Than Joint Bank Accounts 191
302 Appendix E Stocks, Bonds, Mutual Funds 192
302 Appendix F Life Estate and Remainder Interest Tables 195
302 Appendix G Asset Verification System (AVS) 198
302.01 Introduction
(Eff. 10/01/05)
Medicaid uses the value of a person’s resources as a factor in determining eligibility for Supplemental Security Income (SSI)-related programs. It is generally expected that individuals or couples whose resources exceed the limit will use the excess to meet their needs before becoming eligible for Medicaid.
This chapter will describe the treatment of resources when determining eligibility for the SSI-related Medicaid programs using modified SSI resource policy (such as ABD, SLMB, QWDI, and Institutional). Each program has an established resource limit. If countable resources exceed the limit, eligibility cannot be established. The applicable limits will be discussed in the program specific chapters of this manual.
SSI policy is used as the basis of determining financial eligibility for Medicaid for the adult categories of assistance. SSI policy is explained in the Program Operations Manual System (POMS). This manual provides references to sections in the POMS for more detailed explanations of policy and procedures. Sometimes, Medicaid policy is different from SSI, especially if an individual is institutionalized. The differences will be discussed in the institutional chapter.
Note Not everything a person owns is a resource. Not all resources count against the limit. The Social Security Act and other Federal laws require certain types and amounts of resources to be excluded. If a resource is not specifically excluded, it is considered countable. In certain situations, Federal law requires other people to share financial responsibility. In those situations, their resource(s) are considered along with those of the applicant/ beneficiary. If countable resources exceed the limit, an individual or couple is not eligible.
Table of Contents
302.02 Resource Limit
(Eff. 10/01/05)
(POMS SI 01110.003)
Federal law establishes a limit on the value of resources an individual or couple may own and still be eligible for Medicaid. The resource limit for adults follows the Supplemental Security Income (SSI) rules except in certain situations. The limits for each program will be explored in the program specific chapters.
302.02A Resource Reduction Period
(Eff. 04/01/25)
A resource reduction period is defined as the process of reducing excess resources below the maximum allowable resource limits. A resource reduction differs from an encumbrance because excess resources are not used to accommodate prior medical bills. If an applicant/ beneficiary’s combined resources exceed the resource limit, the Eligibility Specialist must allow up to 45 days from the application received date for the applicant to spend down the resources for Non-MAGI programs. Encumbrance (MPPM 302.29) must be explored for all liberalized Non-MAGI and Long-Term Care categories before a resource reduction is requested.
For individuals applying for Nursing Home and Waiver Services, refer to 304.05.02A.
A resource reduction may occur when:
An applicant purchases a preneed burial contract during the month of application or in a month after applying for Medicaid
An applicant purchases personal items during the month of application or in a month after applying for coverage
An applicant no longer has the funds during the month of application or in the month after applying. (Non-MAGI does not request verification of how the money was used. Long-Term Care does request verification of how the money was spent.)
If an applicant applying for Non-MAGI or General Hospital coverage is over the resource limit after the Eligibility Specialist determines the individual is otherwise eligible, it must be determined if the resources can be reduced below the limit within 45 days of the application date. If the applicant has excess resources, they must be reduced within 45 days; however, a minimum 15-day notice must be given. The Eligibility Specialist must contact the applicant or authorized representative via collateral call, explain the available options to reduce the excess resources, and follow-up in writing with a DHHS Form 1233.
The Eligibility Specialist must contact the applicant or AR via collateral call to inform the applicant they are over the resource limit, explain what options are available for reducing the excess resources within 45 days from the application date and follow-up in writing with a DHHS Form 1233.
If the applicant indicates that the resources cannot be reduced within 45 days of the application date, deny the application.
If the applicant indicates that the resources can be reduced within 45 days of the application date:
The applicant will be required to contact the agency within 45 days to report if they are under the limit
If the applicant reports that they are over the limit, deny the application for excess resources
If the applicant reports they are under the limit, the Eligibility Specialist must verify the current value of the resources
If countable value is under the limit, determine eligibility
If countable value is over the limit, deny for excess resources
If the applicant fails to contact the agency, the application is denied for excess resources.
Resource Reduction Procedure If the applicant has alleged that the resource is no longer available to them, the Eligibility Specialist must request updated records indicating that the applicant no longer has the resource(s). Examples of verifications include any combination of the following: Bank Statements, Teller Receipts, Receipts showing dates funds were spent, and/or AVS Results (only as a last resort) Letter from a life insurance company showing a loan against the cash surrender value, life insurance policy showing a change in ownership, etc. Account closure letters for annuities Document showing that an individual no longer owns real or personal property or showing there is a bona fide effort to sell This verification must be obtained before allowing a reduced equity value for resources. Once the verification is received, the equity value of the resources can be established for the month the resources were spent down. IMPORTANT: While a resource reduction is beneficial for both Non-MAGI and Long-Term Care, a Non-MAGI applicant must keep in mind the following: If Long-Term Care services are needed within the next 5 years, any resources gifted to someone other than a spouse during a resource reduction could result in a transfer of assets for less than Fair Market Value. Verification that the applicant is no longer the owner of a resource is required for Non-MAGI. For Long-Term Care, verification of how a resource was spent is also required.
302.03 Resource Definitions
(Eff. 10/01/05)
Type | Definitions | Examples | POMS Conserved Funds | Funds or property being held for an individual by another person | Daughter has $30,000 in a bank account in her name, but it is actually her parents’ money. She uses it exclusively for their needs. Countable Resources | Resources remaining after all exclusions are applied. **The current or fair market value of resources must be verified and the equity value considered. Current or Fair Market Value (CMV or DHHS Form V) | The amount a resource can be expected to sell for on the open market or the sales price, if sold for a higher amount. Equity Value | The current market value minus any legal debt (payoff amount) | House has a market value of $150,000. The mortgage payoff is $80,000. The equity value is $70,000. Exclusion | A resource, or part of a resource’s value, that is not considered in the eligibility determination | (Refer to list in MPPM 302.14 .) General Definition | All assets, including real and personal property, which an individual or couple: Owns Can apply toward basic needs of food, clothing, and shelter – either directly or by conversion Is not legally restricted from use for support and maintenance | Home Land Bank Accounts Burial Assets Life Insurance Automobiles Investments | SI 01110.100 Liquid Resources | Cash or items that are readily converted to cash (within 20 days) | Stocks, bonds and mutual fund shares Checking and savings accounts, time deposits, CDs US Savings Bonds, treasury bills, notes Mortgages and promissory notes | SI 01110.305 Non-Liquid Resources | Are not cash and are not readily convertible to cash | Building, land, and other real property rights Vehicles Farm machinery and livestock Household goods and personal effects Non-cash business property | SI 01110.310 Reasonable Compatibility | Refers to an allowable difference or discrepancy between the resource an applicant self-attests and the amount of resource reported by an electronic data source. The Reasonable Compatibility check is performed on Non-MAGI and Long-Term Care categories that considers resources. | Asset Verification System (AVS) | § 435.952
Table of Contents
302.04 Resources vs. Income
(Eff. 10/01/05)
It is important to distinguish between resources and income to know which rules to use for any given month. An item is not subject to both income and resource rules in the same month.
Income
Items received in cash or in-kind during a month are evaluated under the income rules.
Resources
Items evaluated under the resource rules include any income retained for use in the month after it is received and all other items not defined as income.
Converted Resources
If an individual sells, exchanges, or replaces a resource, what he receives in return is a resource that has been converted from one type of resource to another.
Examples of converted resources:
A lot with equity value of $5,000 is sold, and the money is deposited into a money market account.
A life insurance policy is cashed in, and the proceeds are used to purchase a pre-need burial contract.
An individual sells a piece of property for $25,000. The $25,000 is a resource.
Note: When a resource changes form, it may change: (1) from an excluded resource to a countable one, (2) from a countable resource to an excluded one, or (3) to something that is not considered a resource for Medicaid purposes.
Example #1 An excluded vehicle is sold, and the proceeds are deposited into a checking account. The money received then becomes countable. Example #2 A life insurance policy with a face value of $15,000 and a cash value of $9,500 is cashed in, and the proceeds are used to purchase a paid-in-full cemetery plot for the applicant/beneficiary (excluded) and an irrevocable pre-need burial contract (not a resource after 30 days).
Table of Contents
302.05 Liberalized Resource Policy
(Rev. 10/01/07)
The Social Security Act allows states the option of using more liberal resource criteria than SSI in certain instances. South Carolina has received approval to use the following liberalized policies for the ABD, QMB, SLMB, Working Disabled, QDWI, Institutional, and Home and Community-Based Services programs.
Liberalized policies include the following:
Eligibility may be established effective the first day of the month, if the countable resources fall below the limit at any time during the month.
The value of one vehicle is automatically excluded.
The value of life estate interest in real property is excluded. (Refer to MPPM 302.08.03.)
Real property may be located in another state.
The individual may have more than one life estate – all are excluded.
The value of household goods and personal effects is excluded.
The value of undivided interest in real property is excluded.
The value of an un-probated estate is excluded. (Refer to MPPM 302.13)
The cash value of life insurance is excluded, if the combined face value of all policies is $10,000 or less.
The burial fund exclusion is not offset by the face values of life insurance.
302.06 Whose Resources to Count
(Rev. 10/01/10)
POMS SI 01110.530
When eligibility is determined or re-determined, the resources of the following must be considered:
Applicant/beneficiary
Spouse (legal or common law) of the applicant/beneficiary
If they live in the same household
Even if they are not applying or are ineligible (Exception: Institutionalized individuals discussed in MPPM Chapter 304).
Parent(s) of an applicant/beneficiary who is a child under age 18 if living in the same household.
Funds or property being held or conserved for an individual by another person are considered as a resource for the individual, even if the individual’s name does not appear on the title of the resource. The policy in effect for the type of resource must be used to make the eligibility determination for the individual. For example, a daughter has a bank account only in her name, but the money is being held for her father and his Social Security checks are being deposited into the account; the account is considered a resource for the father.
302.07 Unknown Assets
(Eff. 10/01/05)
POMS SI 01110.117
An individual may be unaware of his ownership of an asset. The asset is not a resource for the period during which the individual is unaware of his ownership.
Once discovered, the value, including any monies accumulated on it through the month of discovery, must be treated as follows:
Month of discovery – treated as income
Month after the month of discovery – any remaining value is a resource
302.08 Ownership Interest
(Eff. 10/01/05)
POMS SI 01110.510
The type and form of ownership may affect the value of property and its status as a resource.
302.08.01 Sole Ownership
(Eff. 10/01/05)
Type of Ownership | What it Means Sole Ownership | Only one person owns the property and may sell, transfer or dispose of the property.
302.08.02 Shared Ownership
(Eff. 10/01/05)
Type of Ownership | What it Means Shared Ownership | Two or more people own it together Tenancy-in-common | Two or more people have an undivided fractional interest in the whole property. Interest may not be equal. One may dispose of his share without permission of the other owner(s). When one owner dies, his interest passes to his heirs or estate. No automatic right to survivorship Joint Tenancy | Each person has an undivided interest in the whole property. In effect, each owns all of the property. Right to survivorship applies to the other owner(s). Tenancy by the entirety | Exists only with married couples While married, property can only be disposed if both give consent. Right to survivorship applies. If divorced, they become tenants-in-common and each can sell without the other’s consent. Procedure: Assume each owner owns only his fractional interest unless there is evidence otherwise. Divide the total value among the owners to match their percentage of ownership. If each of two owners owns ½ interest, divide by two. DHHS Form V $50,000 – each has a resource worth $25,000. If there are two owners, one owns 1/3 and the other 2/3. DHHS Form V $90,000 DHHS Form V ($90,000) ¸ 3 = $30,000, the value for the first owner. $30,000 x 2 = $60,000, the value for the second owner. Exception #1 Joint bank accounts or time deposits (Jim Smith or Eve Thomas). All of the funds belong to the individual in equal shares if there is more than one applicant/beneficiary. If only one account holder is an applicant/beneficiary, the entire account is counted as his. Exception #2 For an institutionalized individual with a joint bank account or time deposit (Jim Smith or Eve Thomas), assume all of the funds belong to him.
Table of Contents
302.08.03 Equitable Ownership
(Eff. 02/01/06)
An equitable ownership interest exists without legal title to property. It can exist despite another party’s having legal title or no one having it. A court of equity determines the existence of an equitable ownership interest. However, under certain circumstances, the eligibility worker can conclude that an equitable ownership exists and make a resource determination accordingly.
Type of Ownership | What it Means Exists without legal title to property. Legal title may belong to another or to no one. Examples: Person allows someone, such as a child, to purchase a car in his or her name due to insurance or credit problems. The child makes the payments on the vehicle, but it is in the parent’s name. A person may gain equitable ownership in a home by making mortgage payments or paying for improvements.
Procedure: If equitable ownership is alleged, obtain corroborating evidence to support the allegation such as: Property – Cancelled checks showing the other person is making/made the payments Bank Accounts – Verification such as whose money was used to establish the account, or verification of who makes the deposits and withdrawals. Statements from both parties as to why the resource is showing in the applicant/beneficiary’s or their spouse’s name. If equitable ownership is verified, do not count as a resource for the applicant/beneficiary.
Type of Ownership | What it Means Life Estate Interest | Individual has certain property rights during his life or someone else’s life. May be conditional ( Example: surviving spouse has the right to live in the home until remarriage). Legal document is required (such as a will or deed). Unless the legal document restricts rights, the life estate owner has the right to possess, use, and obtain profits from the property (such as rents). Life estate interest can be sold. Procedure: A life estate is excluded. This exclusion is not limited to property located in South Carolina . In addition, if an individual has a life estate interest in more than one piece of property, all are excluded. If a life estate is transferred or sold, eligibility for vendor payment or HCBS may be affected, refer to MPPM 304.08.
Type of Ownership | What it Means Remainder Interest | Remainderman inherits property upon the death of the life estate holder. No right to possess or use the property until the life estate terminates Remainder interest may be sold before the termination of the life estate unless the document establishing it restricts this right. Procedure: A remainder interest is excluded. If a remainder interest is transferred or sold, eligibility for vendor payment or HCBS may be affected, refer to MPPM 304.08. When the life estate holder dies, the remainderman attains ownership of the resource, which must then be evaluated under the appropriate resource policy.
Table of Contents
Type of Ownership | What it Means Un-probated estate | An individual may have an equitable ownership in an un-probated estate if he: Is an heir or relative of the deceased Receives income from the property Acquires rights through intestacy laws Note: An un-probated estate is excluded.
Type of Ownership | What it Means Trusts | Trustee holds legal title. Beneficiary has equitable ownership. Procedure: All trust documents must be sent to Policy and Process Management for review and for clearance on how the trust affects eligibility.
Type of Ownership | What it Means Fee simple | Absolute, unconditional ownership of real property At owner’s death, property passes to his heirs. Can apply to solely- or jointly owned property.
Table of Contents
302.08.04 Property Rights with No Ownership
(Eff. 10/01/05)
Type of Ownership | What it Means Leasehold | Individual has use and possession of property for a specific time period and usually for a specified rent. Procedure: A “lease for life” must be sent to Policy and Process Management.
Type of Ownership | What it Means Incorporeal Interests | No ownership of the physical property Applies to: Mineral Rights, Timber Rights and Easements Mineral Rights | Ownership in natural resources such as coal or oil, coming from the property. Timber Rights | Permits one party to cut and remove trees from property owned by another. Water Rights | Gives owner of river or shore front property the right to access and use the adjacent water. Procedure to Determine the Value of Incorporeal Rights: The value of Incorporeal Rights must be verified by a knowledgeable source. The knowledgeable source must be familiar with values of such incorporeal rights in the area. The knowledgeable source must not be related to the applicant/beneficiary or to a member of his or her immediate family. Examples of Knowledgeable Sources: Local office of the Farmer's Home Administration or Agricultural Stabilization and Conservation Service for rural land County Agricultural Extension Service The knowledgeable source statements must contain the following information: A description of the property to which the individual has the incorporeal right; The estimated value; The period of time to which the estimate applies; and The name and business address of the person providing the estimate. If the validity of the estimate is doubtful, obtain a second knowledgeable source statement.
302.09 Factors That Make Property a Resource
(Eff. 10/01/05)
POMS SI 01120.010
Property of any kind, including cash, is a resource only if it meets all criteria listed below.
Resource Ownership Interest An individual must have some form of ownership interest in property in order for the property to be considered a resource. The fact that an individual has access to property, or has a legal right to use it, does not make it a resource if there is no ownership interest. Legal right to access (spend or convert) property An individual must have a legal right to access property. Even with ownership interest, property cannot be a resource if the owner lacks the legal ability to access funds for spending or convert non-cash property into cash. The fact that an owner does not have physical possession of property does not mean it is not his resource. It is a resource if the owner still has legal ability to spend it or convert it into cash. An individual has free access to, and unrestricted use of, property even when he can take actions only through an agent (such as a representative payee or conservator) Legal ability to use for personal support and maintenance Even with ownership interest and legal ability to access property, a legal restriction against the property’s use for the owner’s own support and maintenance means the property is not a resource.
302.10 Access to Resources
(Rev. 04/01/24)
S.C. Code Ann. § 62-5-100
Unless there is a court order signed by a judge stating an individual has been declared incapacitated, he is capable of managing his own affairs under state law and his resources are countable for Medicaid eligibility purposes. (Note: Competency does not affect consideration of resources.)
302.10.01 Individual Declared Legally Incompetent
(Eff. 10/01/05)
Court has appointed Guardian or Conservator | Court has not appointed Guardian or Conservator Resources owned by the individual are considered available resources. Individual may not dispose of property but the conservator can with court approval (in South Carolina ). Seeking Court approval Is NOT a legal restriction to the sale or disposal of property Does NOT change the property’s status as a countable resource to the individual | Resources owned by the individual are NOT considered available. Individual does NOT have access to the resource until a guardian or conservator is appointed.
Table of Contents
302.10.02 Types of Access
(Eff. 10/01/05)
Resources are accessible through an agent, litigation, or a petition-conservatorship account. Listed below is more information on these three types of access to resources.
Access Via an Agent POMS SI 01120.020
An individual is considered to have free access to, and unrestricted use of, property even when he can take those actions only through an agent (such as a representative payee or guardian)
Example Jean Simmons receives Social Security benefits. Her mother, Laura Simmons, is her representative payee and has Power of Attorney. The check goes to a bank account named “Laura Simmons for Jean Simmons.” The bank account is a countable resource because Jean has unlimited use through her mother.
Access Only Via Litigation
If there is a legal restriction, or a bar, to the sale or use of property (such as a co-owner legally blocks the sale of jointly-owned property), an individual is not required to undertake litigation in order to accomplish the sale or access. The property is not a resource under such circumstances in a month if a legal bar exists as of the first moment of that month.
Example #1 Cindy Lorrick and her sister, Sallie Comer, co-own a piece of property inherited from their parents. Last year, Sallie took legal action to prevent Cindy from selling. Cindy is not required to enter into litigation to gain the ability to sell, so the property is not a resource. Example #2 Stella Black applied for ABD in March. She co-owns a piece of property with her sister valued at $25,000. She wanted to sell it, but a legal restriction placed on it on April 5 prevents this. Since the restriction was not in place until April, the property is countable in March and excluded in April.
Access Via Petition - Conservatorship Account POMS SI 01140.215
Petitioning a court is different from undergoing litigation. Seeking court approval is not a legal restriction against use. Although the individual does not have access to the asset, the conservator does. Therefore, it is available for the individual's support and maintenance and is, therefore, that individual's resource. This is true despite the fact that the individual or his agent is required to petition the court to withdraw funds for the individual's support and maintenance.
Table of Contents
302.11 Retirement Funds
(Eff. 10/01/05)
POMS SI 01120.210
Retirement funds are annuities or work-related plans that are designed to provide income when work ends. Listed below are some examples:
Pensions, disability, or retirement plans administered by an employer or union
401K
IRA
Keogh or Roth plans
Some profit sharing plans
Procedure – Retirement Fund Value of the Fund: The resource value of the fund is the amount that can currently be withdrawn after deducting certain expenses The amount of a penalty is deducted when determining a value. The amount of any taxes due is NOT deducted. When is a Retirement Fund a Resource? When the individual has the option of withdrawing a lump sum even if he is not eligible for periodic payments If the individual applies for period payments and is denied, the value becomes a countable resource the month after the month periodic payments are denied. A delay in payment beyond the individual’s control makes it a non-liquid resource. When is it Not a Resource? When a person must terminate employment to obtain payment. When a person is eligible for and is receiving periodic payments. Note: Periodic Payments An individual must apply for them if eligible. If he has a choice of a lump sum or periodic payments, he must take the payments. The periodic payments are counted as income. Ineligible spouses Any retirement funds owned by an ineligible spouse are excluded as a resource. Periodic payments are counted as the spouse’s income. Previously unavailable funds are a countable resource the month after the month it becomes available. Types of Verification: Pension or annuity statements Letter from plan manager Check stubs
Table of Contents
302.12 Loans, Promissory Notes and Property Agreements
(Eff. 10/01/05)
POMS SI 01120.220
POMS SI 01140.300
This section involves the principal amounts of these items. The interest paid is ALWAYS considered unearned income. All promissory notes must be sent to the Bureau of Eligibility Administration for evaluation and approval.
Bona Fide Agreement — legally valid and made in good faith
May be written or oral
Oral agreement is bona fide if it is legally binding and includes:
Borrower’s acknowledgement of his obligation to repay
A schedule and plan for repayment
Borrower’s intent to repay from income or property
Negotiable Agreement—legal title to the agreement or the amount of the agreement can be transferred to another party
Loan—One party gives money to another party who promises to repay it in full.
It may or may not include paying interest.
It must be written (promissory note) and enforceable under State law.
Promissory Note—Written agreement where one person promises to pay another party a specific amount at a specific time. It can be repayment of money or a payment for services or goods.
Property Agreement—a piece of property is used to secure payment of a debt or performance of services. Other names for property agreements include:
Mortgage
Land contract
Contract for deed
A person holding a contract for the sale of real estate owns two things until the agreement is settled: (1) the real estate and (2) the value of the agreement. (Note: The real estate is not a resource because it cannot be sold.)
A contract must be evaluated to determine if it is a resource and, if so, how it should be treated.
Procedure – Individual is the Seller or Creditor Bona Fide, Negotiable Agreement: The agreement is a resource. The goods or money represented in the agreement are not a resource because they are not accessible – the agreement replaces them as a resource. Debtor’s payments against the principal are a conversion of a resource, not income. Example Debtor pays $500 per month–$350 toward principal and $150 in interest. The $350 is a converted resource and the $150 is unearned income.) Non-Bona Fide, Non-Negotiable Agreement: The agreement is not a resource. Payments are income, not a converted resource. The goods or money represented in the agreement may be a resource if the seller/creditor has access for his own use. Types of Verification: Copy of Agreement Courthouse checks: online or via DHHS Form 1255 ME , Verification of Real and Personal Property
302.13 Inheritances and Un-Probated Estates
(Eff. 10/01/05)
POMS SI 01120.215
Un-probated estates are excluded from resources until probate is completed. The eligibility worker must evaluate the status of the un-probated estate at annual review.
An inheritance is a not a resource until the month following the month in which it meets the definition of income. Thereafter, if retained, the property is evaluated as a resource. (Refer to MPPM 304.09 for information about transfer of assets in Nursing Home and other institutional categories.)
Procedure Obtain copies of the will and/or probate records either from the beneficiary/authorized representative or through the probate court (via DHHS Form 1255 ME , Verification of Real and Personal Property). If the probate is complete, there should be a discharge order in the court records, but the status can be verified through the court staff. An individual’s relationship to a deceased person may be verified by: Court records Birth certificates Marriage license
Table of Contents
302.14 Resource Exclusions
(Eff. 10/01/05)
The value of the resources in this section may be excluded, in part or in whole, when determining eligibility.
302.14.01 Home Property
(Rev. 04/01/24)
POMS SI 01130.100
An individual’s home is property he has ownership interest in and is his principal place of residence. It may include:
The shelter he lives in.
The land on which the shelter is located.
All buildings on the land.
Procedure – Home Property: A principal place of residence is the dwelling that an individual considers his principal home and to which he intends to return. It may be: Real or personal property Fixed or mobile Located on land or on water ( Example: If a person who owns and resides in a houseboat on the lake, the boat may qualify as home property.) Even though it will be excluded, ownership of homestead property must be verified. If a person owns land and intends to reside on it, it may be considered home property if there is no other principal place of residence. If a person owns the land but not the shelter, the land is considered the residence. ( Example: A person owns the land he lives on but lives in a mobile home owned by his parents.) If a person owns the shelter but not the land, the shelter is the residence. ( Example: A person owns the mobile home but rents the lot on which the home is located.) Treatment An individual’s home, regardless of value, is an excluded resource for Medicaid eligibility if the individual: Resides in the home; or Intends to return to the home. ( Example: An individual is residing with his children due to illness but intends to go home when health permits. The intent is based entirely on the person’s desire to return home.) The intent to return must be documented in the case record by one of the following: Answering “Yes” to the intent to return question on the DHHS Form 3401 , Healthy Connections Application for Institutional/Waiver/OSS or DHHS Form 3400-B , Healthy Connections Additional Information for Institutional/Waiver Services. Completing and signing a DHHS Form 1277 , Statement of Intent to Return Home Note If the individual has returned home during the process of making an eligibility determination, the intent to return is assumed and a DHHS Form 1277 is not needed. The home exclusion applies to: The shelter in which he lives. All buildings on the excluded property. The land on which the shelter is located AND any land adjoining it as long as it is not separated by land that neither the individual nor his spouse has ownership interest in. Example: Property would be considered adjoining if the road were not there. Things such as easements, roads, and utility lines do not separate land.
Table of Contents
If an individual leaves the home and does not intend to return to it, it is no longer considered the principal place of residence. The home exclusion no longer applies as of the date the individual leaves with the intent not to return or the date he no longer intends to return. The month after there is no intent to return, the property will then be considered a countable resource unless another exclusion develops.
Procedure: A home can be excluded without an intent to return, if: A spouse or dependent relative of an i nstitutionalized individual resides in the home. Dependency may be financial or medical. Verification includes: tax returns, cancelled checks Relatives may include: Child, stepchild , grandchild Parent, stepparent , grandparent Sibling, stepsibling , half sibling Aunt, uncle, cousin, niece, nephew In-law Verification includes birth certificates, marriage license, family records, court orders Sale of the home would cause an undue hardship to a co-owner due to loss of housing. ( Note: Co-ownership would need to be verified with a copy of the deed or title and DHHS Form 1255 , Verification of Real and Personal Property.) If the individual has returned home during the process of making an eligibility determination, the intent to return is assumed and a DHHS Form 1277 is not needed.
Table of Contents
302.14.02 Home Replacement Funds
(Eff. 10/01/05)
POMS SI 01130.110
If an individual sells an excluded home, the proceeds may be excluded if he:
Plans to buy another excluded home.
Buys the home within 3 full calendar months of receiving the proceeds.
302.14.03 Installment Sales Contract
(Eff. 10/01/05)
POMS SI 01130.110
If the proceeds from the sale of an excluded home are received under an installment sales contract, the contract is excluded if the individual:
Plans to use the entire down payment and the entire principal portion of the payment to buy another excludable home.
Purchases the new home within 3 calendar months of receiving the down payment or installment.
Procedure The case record must contain a signed statement from the individual/authorized representative that he intends to purchase a new home. What is considered a proceed from the sale? Lump Sum – The net amount the seller receives at closing/settlement Installments – Down payment and/or principal portion of any installment payment Verification: Copy of closing/settlement papers Copy of installment contract and amortization schedule Proceeds may be used for the following expenses when buying another excludable home: Down payment Closing/settlement costs Loan processing fees and points Moving expenses Necessary repairs or replacement of the new home’s structures or fixtures IF identified and documented before the new home is occupied. This may include: Roof; heating and air conditioning; plumbing; built in appliances. Mortgage payments Types of Verifications: Copy of closing statement Copy of loan application Copy of home inspection reports Receipts for moving expenses and/or repairs What happens if the proceeds are not re-invested in a timely manner? Lump Sum – the exclusion is revoked retroactively to the date of receipt. Installment Contract – the exclusion of the contract itself and the unused portion of any installments received are revoked retroactively to the date the unused proceeds were received. The exclusion may be reinstated if a new intent is signed within three (3) full calendar months of receiving an installment. Reinstatement is effective with the date the new intent is signed .
Table of Contents
302.14.04 Jointly Owned Property
(Eff. 10/01/05)
POMS SI 01130.130
If an individual owns property jointly with another person(s), the value of his interest may be countable unless the sale would cause an undue hardship to a co-owner due to loss of housing.
Procedure – Jointly Owned Property Undue hardship would result if the co-owner: Uses the property as his principal place of residence. Would have to move if the property was sold. Has no other readily available housing. Example: Mr. Allen and his son jointly own a piece of land. The son and his family live on the property and have no other place to live. Mr. Allen applies for Medicaid. The property is excluded because the sale would cause an undue hardship to his son. However, if the son owned another house nearby which was vacant and inhabitable, there would be other available housing. In this case, undue hardship would not exist. The value of Mr. Allen’s interest would be countable.
Table of Contents
302.14.05 Bona fide Effort to Sell
(Rev. 09/01/25)
POMS SI 01150.201
Real property and automobiles (as defined in MPPM 302.16) may be excluded if an individual is making a reasonable, bona fide effort to sell it. Such efforts include listing it for sale with a real estate agent, media advertisements, and conducting regular open houses. The individual must maintain their effort to sell unless good cause exists. Good cause exists when circumstances beyond an individual's control prevent his taking the required actions to accomplish reasonable efforts to sell. In addition, he must accept a reasonable offer for the property. An offer to buy or sell property is reasonable or legitimate if the offer is at least two-thirds of the estimated Current Market Value (CMV) unless the owner proves otherwise.
In the liberalized resource categories, the resource may be excluded beginning the month it is put up for sale.
Procedure – Bona Fide Effort to Sell Types of Verification: Copy of listing with a realtor Advertisement in newspaper or other media “For Sale ” sign on property Step for Eligibility Specialist : Verification of the continued effort to sell must be documented in the case record. Examples of Good Cause: No offer to buy received. A legitimate offer does not result in a sale. Escrow begins but closing does not take place within the disposal period. Incapacitating illness or injury, such as the individual becomes homebound or hospitalized for a prolonged period due to illness or injury and cannot take the steps necessary to sell the resource or to arrange for someone to sell it on his behalf. Part owner of a resource dies, and administration or probate of the estate delays efforts to sell the resource (assuming that the property continues to be a resource). Example #1 Dale Livingston is a patient at Caring Hearts Nursing Home. He applied for Nursing Home Assistance on July 25 after he listed some non-home property for sale with a realtor on July 14. The eligibility specialist obtains a copy of the sales listing which verifies the date the property was listed for sale. The property is an excludable resource beginning July. Example #2 Samantha Ryan has a piece of property up for sale by owner. The case record contains copies of the following: newspaper advertisement, the receipt paying for 8 weeks of advertisement, and a photograph of the For Sale By Owner sign. Example #3 Gladys Lorick is a Medicaid beneficiary whose property has been excluded due to a bona fide effort to sell. Her daughter (and Power of Attorney) accepted an offer on the property. However, the buyer backed out of the deal at closing. Ms. Lorick immediately started sales efforts again. Good cause exists. Example #4 Rebecca Ford applied for Nursing Home Assistance on September 8 and owns three vehicles and one recreational boat. Two of the vehicles can be excluded because they are used for transportation. The Authorized Representative states they are currently attempting to sell the third vehicle and the boat and submits proof of online advertising through AutoTrader and Boat Trader on September 22. The third vehicle can be excluded with a bona fide effort to sell; however, the boat, which is only used as a recreational vehicle, does not meet the definition of an automobile. The equity value of the recreational vehicle is a resource.
Table of Contents
302.15 Resource Exclusions for Tribal Members
(Eff. 07/01/11)
POMS SI 01130.150
The American Recovery and Reinvestment Act of 2009 (Recovery Act), requires States to exclude certain types of Indian-specific property from being considered as “resources” when determining Medicaid or CHIP eligibility for an individual who is an Indian.
Resources are excluded in two categories:
Property connected to the political relationship between Indian Tribes and the Federal government; and
Property with unique Indian significance
The following resources must be excluded:
Property, including real property and improvements, that is held in trust, subject to Federal restrictions, or otherwise under the supervision of the Secretary of the Interior; located on a reservation, including any federally-recognized Indian Tribe’s reservation, pueblo, or colony, including former reservations in Oklahoma, Alaska Native regions established by the Alaska Native Claims Settlement Act and Indian allotments on or near a reservation as designated and approved by the Bureau of Indian Affairs of the Department of the Interior.
For any federally-recognized Tribe not described in paragraph (1), property located within the most recent boundaries of a prior Federal reservation.
Ownership interests in rents, leases, royalties, or usage rights related to natural resources (including extraction of natural resources or harvesting of timber, other plants and plant products, animals, fish, and shellfish) resulting from the exercise of federally-protected rights.
Ownership interests in or usage rights to items not covered by paragraphs (1) through (3) that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable Tribal law or custom.
302.16 Automobiles
(Rev. 09/01/25)
POMS SI 01130.200
An automobile is any vehicle used for transportation. It can be motorized or animal drawn. All vehicles must be considered in the eligibility process – even those that are unregistered or inoperable.
Examples of Automobiles
Car or truck
Boat
All-terrain vehicle
Horse-drawn wagon
Horse
Medicaid automatically excludes the first vehicle regardless of value. It may be possible to exclude a second vehicle using SSI policy. If an exclusion cannot be developed, verify the current market value and/or equity value of the vehicle.
A second automobile per household is excluded regardless of the value if it is used for transportation of the applicant/beneficiary or a member of the individual’s household.
ASSUMPTION: Assume the automobile is used for transportation, absent evidence to the contrary.
The equity value of any automobile, other than those excluded, is a resource when it:
Is owned by the applicant/ beneficiary; and
Cannot be excluded under another provision (for example, property essential to self-support, plan for achieving self-support, or conditional benefits).
The following vehicles do not meet the definition of an automobile:
A vehicle that has been junked;
A vehicle that is used only as a recreational vehicle (such as a boat used on weekends for pleasure).
The equity value of such a vehicle is a resource.
Procedure – Excluded/Non-Excluded Vehicle(s): Medicaid automatically excludes one vehicle regardless of value. A second vehicle for the individual or a household member may be excluded regardless of value if it is used for transportation. The ownership of all vehicles must be verified. For liberalized categories, attestation can be used to verify ownership for up to two vehicles. Additional verification is not required. If there are three or more vehicles, verification of ownership and value must be completed according to the Vehicle Ownership and Value procedures shown below. The exclusion(s) may be applied in a way that is most advantageous to the applicant/ beneficiary. Apply the exclusion to the automobiles with the greater equity value, If the value of an automobile cannot be excluded, the equity value is countable toward the resource limit. Automobiles may be excluded if an individual is making a reasonable, bona fide effort to sell. (Refer to MPPM 302.14.05 Bona Fide Effort to Sell)
Procedure – Vehicle Ownership and Value Verification: To Determine Ownership of Vehicle Accept self-attestation if one or two vehicles are alleged DHHS Form 1255 ME , Verification of Real or Personal Property Vehicle registration or title Tax receipt Court House records Statement from a knowledgeable source DMV Web Tool – Can be used to view vehicles, boats, and mobile homes that are titled in an individual’s name. This information can be considered as lead information and the eligibility worker must follow-up with the applicant/beneficiary if there is a discrepancy between what was reported on an application or review and the information shown on the DMV Web Tool. To access the DMV Web Tool: Go to https://www.scdmvonline.com/DMVmember/logon.aspx . This is a secure log-in requiring authorization with an agency assigned User ID Select the button next to “Title History” in the “Type of Report” box. Click on the “Name Search” button. Enter first name, last name, and birth date; or Business name and city. Click the “Submit” button. A list of vehicles titled to that individual or business will appear. To Determine Current Market Value of Vehicle Kelley Blue Book ( https://www.kbb.com/ ) NADA ( http://www.nadaguides.com/ ) Prior to determining CMV, the Eligibility Specialist should verify the year, make and model of the vehicle. The Eligibility Specialist should also attempt to verify vehicle attributes including style, number of doors, mileage, color and equipment of the vehicle. If unable to obtain this information, the Eligibility Specialist will use the make, model and style from a public information source, such as a tax receipt. The mileage should be calculated by the Eligibility Specialist using the vehicle’s age and 12,000 miles annually. Assume the vehicle has standard equipment and is white in color. If the tax receipt contains the Vehicle Identification Number (17-digit VIN) the VIN should be used to determine value. Note When using Kelley Blue Book, use the “trade-in” value for Medicaid purposes. These figures are available through the hard copy book or online. If using the book, it must be the current month’s issue. Also, assume the vehicle is in average condition, absent evidence to the contrary. To d etermine the v alue of a Vehicle t hat cannot be verified by using the methods mentioned above Knowledgeable source statement to include the following: Detailed description of the automobile including the year, make, model, equipment, mileage, number of doors Estimated value Business address and telephone number of the source providing the information. Note The source must be a disinterested, unrelated party (such as a used car dealer, automobile insurance company, bank loan officer.) To Determine the Pay-Off Amount of Vehicle Statement of pay off amount from the lender Monthly loan statement/payment voucher, if payoff is indicated Note When money is owed on a vehicle, the equity value of the vehicle must be determined. The equity value of the vehicle is the C MV minus the pay-off amount.
Procedure – Determining Transfer Penalty on Vehicle Sale Verification: Determine if the vehicle was sold on the Open Market or a Private Sale Open Market Sale : If the vehicle was sold on the open market, assume the individual received Current Market Value (CMV) Private Sale: Verify the CMV Assume that the value received on the sale of property is reasonable if that value is at least two-thirds of the CMV. Property sold for less than two-thirds of the CMV is considered a transfer for less than CMV, absent verification of a lower value from a knowledgeable, third-party source. Transfers for less than CMV may be subject to a transfer penalty. (Note: When calculating the penalty, the equity value of the vehicle is the CMV minus any pay-off amount; and if jointly owned, only count the applicant’s share of the equity value) Note The transfer of one vehicle that is otherwise excluded is not subject to the transfer of assets penalty. This includes giving the vehicle away or selling the vehicle for less than two-thirds of the CMV. Example 1 Jennifer Saturn applied for Nursing Home coverage. On the application, Jennifer attested to owning a 2019 Ford Fusion and to giving away a 2000 Ford F150 to her grandson one year ago. The 2000 Ford F150 would not be considered a transfer, and the 2019 Ford Fusion could be excluded if used for transportation. Example 2 Misty Johnson applied for Nursing Home Coverage and attested to owning two vehicles. She also attested that she sold a 1980 Bayliner boat two months ago. The Eligibility Specialist will verify the amount Misty received for the boat and verify the Current Market Value through NADA. The “Average Retail Value” shows as $10,000. Misty submits verification she sold the boat to her neighbor for $7,000. The $7,000 received will become a resource but there will not be a transfer penalty for the $3,000 difference because Misty received $7000 which is more than two-thirds of the CMV value of $10,000.
Table of Contents
302.16.01 Rebuttals
(Eff. 10/01/05)
An individual may indicate that a vehicle does not belong to him even though it is registered in his name. He must provide evidence to rebut ownership.
An individual may disagree with a value of an automobile. He must provide verification of the lesser value.
Procedure – Rebuttal of Ownership: The individual/authorized representative must provide a written statement to include: Description of the automobile Name, address, and telephone number of the alleged owner Explanation of the inconsistencies in ownership records Statement and corroborative evidence from the alleged owner Copy of the bill of sale if records do not show the change of ownership If equitable ownership is claimed, receipts or cancelled checks verifying alleged owner made or is making: Loan payments Tax payments Repairs/expenses Example Son’s vehicle is purchased in the father’s name because of the son’s credit but the son makes the loan and insurance payments. Obtain verification that the son is making the payments. Procedure – Rebuttal of Current Market Value: If the individual disagrees with the value established by the eligibility worker, he must obtain a written appraisal of the value from a knowledgeable source. He is responsible for any cost involved in obtaining the statement.
302.17 Life Insurance
(Rev. 10/01/23)
POMS SI 01130.300
A life insurance policy is a contract. The purchaser (owner) pays premiums to the company (insurer). In return, the insurer agrees to pay a specified sum to a designated person(s), known as beneficiaries, upon the death of the insured person. The owner and the insured may or may not be the same person. The policy should state the owner’s name, if different from the insured.
Below are common terms associated with life insurance. (Refer to MPPM Chapter 104 – Appendix I for definitions of these and other terms.)
Cash Surrender Value | Dividend Accumulations Face Value | Dividend Additions Proceeds | Dividends
Generally, the types of life insurance policies are:
Term Life Insurance
Usually in effect for a specific length of time such as 20 years, or length of employment.
Does not accrue cash value.
Whole Life Insurance
Accrues cash value.
Remains in effect unless the premiums are not paid or the policy matures.
Burial Insurance – The terms of the contract prevent the proceeds from being used on anything other than burial expenses of the insured.
A life insurance policy is a resource if it generates a Cash Surrender Value (CSV). The value of the insurance policy is the cash surrender value.
Unless otherwise indicated, assume that a:
Term policy without a table of CSVs, if it appears otherwise complete, does not generate a CSV;
Life insurance policy that does not generate a CSV also does not pay dividends;
Life insurance policy issued by a nonparticipating or stock company does not pay dividends;
Life insurance policy issued by a participating or mutual company pays dividends.
NOTE: The kind of company issuing the life insurance policy is usually identified by a designation following its name on the face page of the policy (“participating” or “non-participating”).
If bank statements were scanned into OnBase: Eligibility Specialist should review all bank statements turned in for potential information regarding life insurance companies; check for life insurance policy numbers, and any auto drafts from a life insurance company. If life insurance companies are found, the Eligibility Specialist should contact the applicant and/or authorized representative to determine the face value of the policy and make collateral calls to the insurance company if necessary. If the Eligibility Specialist is unable to make contact with the applicant and/or Authorized Representative, a DHHS Form 1233 Request for information along with DHHS Form 1280 (if a signed copy is not already in OnBase) needs to be sent to the applicant/beneficiary to request the needed information. If a DHHS Form 1280 is signed and scanned in OnBase already, then the Eligibility Specialist should send the DHHS Form 1280 to the designated life insurance companies listed on the bank statement.
If the attested total Face Value of policies owned by an individual insuring someone equals $10,000 or less, the life insurance can be excluded without additional verification. If there is a copy of the policy(ies) or other applicant/beneficiary provided verification in the case record, the eligibility specialist will use that information to verify the details of the policy in CGIS. If no copy of the policy or other verification is available, the Eligibility Specialist will indicate that the information is “unknown” and still consider the attested face value of the policies. Reminder: Whether countable or excluded, life insurance policy information, including the Face Values of policies attested to, must be documented on the documentation template and entered into CGIS even if other information is unknown.
If an applicant/beneficiary or his spouse owns life insurance, the policies may require to be verified. The individual/authorized representative should provide a copy of all the life insurance policies and the most recent dividend statement for each one. For all policies that cannot be excluded, verify the following:
Owner
Insured
Face Value
Date the life insurance policy was purchased
Maturity date, if specified
Policy number
Address, phone number, or any contact information for the insurance company
Information regarding whether the life insurance policy pays dividends and, if it does, what option the policy owner selected for their disposition (i.e., accumulations, additions, applied to premiums, paid by check)
Current amount of dividend accumulations, if any.
If a policy is countable, in addition to what is listed above, verify the current CSV. This may be verified either by a statement from the company or by mailing a DHHS Form 1280, Verification of Life Insurance Values, to the company. Make sure to include:
any dividend additions that may increase the value of the policy, and
any loans that may decrease the value.
If the total Face Value of policies owned by an individual insuring someone is greater than $10,000, the life insurance must be verified. If there is a copy of the policy(ies) or other applicant/beneficiary provided verification in the case record, the Medicaid eligibility worker does not have to verify the policy(ies) with the insurance company.
Example: Bill and Jane Baggins are both applying and both own life insurance policies. Bill Baggins owns: Policy One: Bill’s son, Jimmy is the insured and the policy’s FV is $10,000. Policy Two: Bill’s daughter, Jannie is the insured and the policy’s FV is $10,000. Policy Three: Bill’s wife, Jane is the insured and the policy’s FV is $10,000. Policy Four: Bill is the insured and the policy’s FV is $10,000. Jane Baggins owns: Policy One: Jane’s husband, Bill is the insured and the policy’s FV is $10,000. Policy Two: Jane’s daughter, Jannie is the insured and the policy’s FV is $10,000. Policy Three: Jane’s son, Jimmy is the insured and the policy’s FV is $10,000. Policy Four: Jane is the insured and the policy’s FV is $10,000. All policies are excluded except for any dividend accumulations that have occurred.
After exclusions are developed, any remaining cash value must be considered in the eligibility determination. The cash surrender value of any policy that cannot be excluded is countable toward the resource limit.
Table of Contents
302.17.01 Development of Countable Life Insurance
(Rev. 05/01/26)
Consider the resource value of a life insurance policy to be its cash surrender value (CSV), not its face value (FV).
Term life insurance policies do not have cash value and are not included.
Burial insurance policies are not included.
There is a difference between being the insured, the owner, and the beneficiary of the policy.
Insured
The insured is the person on whose life the insurance company issues the policy.
Owner
The owner of a policy is the one who has control of the policy. He may take such actions as:
Cash in a policy
Take a loan against the cash value
Change ownership to another person
Change the beneficiary
An individual may own life insurance on himself or on another person. A life insurance policy can be a resource only to the owner of the policy.
Note The value of any life insurance policies owned by an individual must be considered in the eligibility determination process.
Beneficiary
The beneficiary is the individual(s) who receives the proceeds of the policy at the insured individual’s death.
A person may be both the owner and the beneficiary. (Example: Jim Wright purchases a $10,000 life insurance policy on his mother, Janis Wright, and is the beneficiary upon her death.)
For all policies owned by an individual, separate the policies based on who is insured. Total the FV for each insured person separately. If the total FV for the insured person is less than or equal to $10,000, do not count the policies as a resource for the owner.
The $10,000 FV life insurance exclusion applies for each insured person.
Dividend additions
The insurance companies use surplus company earnings, called dividend additions, to buy more insurance protection for the life insurance policy owner. Dividend additions increase the FV and CSV. If there is no indication that dividend additions are attached to the policy, either through attestation or case history, additional verification should not be requested. If policies on file do not verify whether the policy is participating or non-participating, assume it is non-participating.
Do not include the FV of dividend additions when determining whether a life insurance policy is a countable or excluded resource:
If the life insurance policy is a countable resource, do include the CSV of dividend additions when determining the resource value of the policy.
If the life insurance policy is an excluded resource, do not include the CSV of dividend additions when determining the individual's countable resources.
Dividend accumulations
Dividend accumulations are surplus company earnings, which accrue in an account that the insurance company controls for the policy owner. The policy owner can access these funds without penalty at any time without affecting the FV or CSV. Therefore, dividend accumulations may be countable resources unless they are excluded under a different resource exclusion (e.g., set aside for burial).
Do not exclude dividend accumulations under the life insurance provision, even if you exclude the life insurance policy that pays the accumulations.
Unless the accumulations are excludable under another provision (for example, because they have been set aside for burial), count the accumulations as a resource, even if you exclude the life insurance policy itself because the policy's FV is $10,000 or less.
Note
If the verification cannot be obtained from the insurance company, the cash value tables contained in the policy may be used or the Estimated Cash Surrender Value according to instructions contained in MPPM 302.17.02.
The countable cash surrender values of the policies and accumulations are countable toward the resource limit unless it can be excluded as a burial asset. (Refer to MPPM 302.19.)
Even if a policy is excluded, any accumulated dividends are countable toward the resource limit unless they are excluded under another provision such as the burial exclusion. (Refer to MPPM 302.19 for information on Burial Exclusion.) If there is no indication that dividend accumulations are attached to the policy, either through attestation or case history, the policy should be excluded without requesting additional verification. If policies on file do not verify whether the policy is participating or non-participating, assume it is non-participating.
Example #1 Owner has two policies on himself Mr. Parr, an aged individual, owns two life insurance policies on himself with the following values: $4000 FV with $5000 CSV, $5000 FV with $1000 CSV $5000 FV + $4000 FV = $9000 total FV which is less than $10,000 total FV. The total FV of his policies is less than $10,000, therefore the CSV of the policies are excluded. Example #2 Owner has policies for herself and others Mrs. Hogenson, an aged individual, owns the following policies on herself, her husband and their daughter Edna: Mrs. Hogenson $4000 FV with $5000 CSV, $5000 FV with $1000 CSV Total FV = $9000 which is less than $10,000, therefore the polic i es are excluded Mr. Hogenson $15,000 FV with $2000 CSV Total FV = $15,000 which is greater than $10,000, therefore the CSV is a countable resource for Mrs. Hogenson Edna $7500 FV with $2000 CSV Total FV = $7500 which is less than $10,000, therefore the polic i es are excluded Do not combine the FV of all the policies owned by Mrs. Hogenson because the policies do not all insure the same person. Example #3 Joan Howard has four life insurance policies insuring herself. Two are with Life of Georgia and have Face Values of $1,500 each. She also has two $750 FV policies with Liberty Life. The total Face Value of all the policies is $4,500, so the policies are excluded. Example #4 Tanner Shull applied for ABD. He has three life insurance policies insuring himself with Face Values of $750; $2,500; and $12,000. The total Face Value is $15,250. Since this exceeds $10,000, the eligibility worker must verify the cash values and count them toward the resource limit unless a burial exclusion is developed. Example #5 Amanda Weaver has two life insurance policies insuring herself. One is a whole life policy with a Face Value of $2,500. The other is a term life policy with a Face Value of $10,000. The term life policy has no cash value and is excluded. The whole life policy is excluded because the FV is less than $10,000. Example #6 William Turner, aged 66, applies for ABD. William has attested to two whole life insurance policies insuring himself. One policy is with Insurance of America and has a Face Value of $2,000. The second policy with Prudent Life has a Face Value of $5,000. The applicant does not report dividend accumulations for policies, nor does case history indicate accumulations. Both whole life policies should be excluded without further verification as no dividend accumulations have been reported or found, and the total FV per insured is less than $10,000.
302.17.02 Estimated Cash Surrender Value Table
(Eff. 10/01/05)
# Years Policy has been in Effect | Estimated CSV equals this percentage of FV 20 or more | 60% 15-19 | 50% 11-14 | 45% 6-10 | 30% 4-5 | 20% 3 | 10% 2 | 5% 1 | 0%
Using the Estimated CSV
The eligibility worker is permitted to use the estimated cash surrender value until verification is received. The following guidelines should be followed.
The eligibility determination is otherwise complete, and the resource limit is met using the estimated CSV.
The eligibility worker must:
Approve the application OR complete the annual review; AND
Continue attempts to verify the CSV.
The eligibility determination is complete except for verifying the CSV.
If the resources exceed the limit using the estimated CSV but the other countable resources are below the limit, the eligibility worker must not take action until the CSV is verified.
If the resources would exceed the limit without using the estimated CSV, the eligibility worker is to use the estimated CSV in the resource budget and deny the application or begin closure procedures.
The resource limit is met but other information is needed to complete the eligibility determination.
The eligibility worker must request verification of the CSV.
302.17.03 Accelerated Life Insurance Payments
(Eff. 10/01/05)
Accelerated life insurance payments are proceeds paid to a policyholder before death. Plans vary from company to company; however, all involve early payout of some or all of the proceeds of the policy. Most of the plans fall into three basic types depending on the circumstances that cause the payments to be accelerated.
Basic Plans
Long Term Care Model – allows payments if the policyholder requires an extended stay in a care facility or, in some instances, healthcare services at home.
Dread Disease or Catastrophic Illness Model – allows payments if the policyholder suffers from a specified covered disease or illness (such as cancer or AIDS).
Terminal Illness Model – allows payments following the diagnosis of a terminal illness where death is likely to occur within a specified time frame.
Some companies refer to these payments as “living needs” or “accelerated death” payments. Depending on the plan, the receipt of payments may reduce the FV of the policy by the amount of the payments and may reduce the CSV in a proportionate manner. In other cases, a lien may be attached to the policy in the amount of the payments that results in a proportionate reduction in the CSV.
Table of Contents
Procedure – Accelerated Life Insurance Payments: These payments can be used to meet basic needs of food, clothing, and shelter. This is NOT a conversion of a resource because payments are made from the proceeds of the policy rather than from the cash value. The payments should be treated as follows: Month of receipt – consider as income Any money remaining the following month is considered a resource.
302.18 Death Benefits for Last Illness and Burial Expenses
(Eff. 10/01/05)
POMS SI 01120.115
Death benefits are received because of another person’s death.
Examples include:
Life insurance proceeds
Social Security death benefits
Burial benefits from the Railroad or Veterans Administration
Inheritances
Gifts from relatives, friends, or the community to help with expenses
Note: Recurring survivor benefits from a pension or retirement plan or the Social Security Administration are NOT death benefits.
Procedure –Death Benefits If Death Benefits Are Not Considered Income, then: Month of receipt – Excluded Month after receipt – Excluded 2 nd month following receipt – Countable resource, if retained Exception: If the death benefits are repayment for expenses already paid, they are considered resources the month after receipt, if retained. Verification of paid expenses must be obtained. Paid expenses and examples of verification are listed below. Life Insurance Copy of check Contact with or statement from the company Gifts – statements from the party making the gift Inheritance Will Probate records Other types of money (such as SSA) Copy of check Other written verification Expenses Payment receipts Cancelled checks Example #1 Death Benefits Not Considered a Resource When her uncle passed away, Beth Smith received $4,000 as beneficiary of his life insurance policy. She received it in July and intends to spend the entire amount on his last illness and burial expenses. She has already received bills totaling $900 that she paid. On August 1, she received a funeral bill for $2,900 and a few days later received a cash gift of $500 to be used for last illness and burial expenses. She pays the $2,900 funeral bill in August and intends to use the remainder to pay some hospital expenses. Treatment Neither the $4,000 Ms. Smith received in July nor the $500 she received in August is unearned income. Since she used $900 of the $4,000 life insurance check in July, as of August 1, she had a $3,100 balance that is not a resource for August. During August she paid the $2,900 bill and then had $200 left. However, the $500 she receives in August gives her $700 to use for hospital expenses. She must spend $200 in August for burial or last illness expenses; otherwise, the $200 will count as a resource September 1. Any portion of the $500 remaining as of October 1 will be counted as a resource. Example#2 Death Benefits as a Resource Jane Smith has total countable resources of $1,980 consisting of a $1,000 savings account and $980 checking account. Her brother died in late October. In November, she receives $3,000 as beneficiary of her brother's life insurance policy. She has last illness and burial expenses of $2,750 to pay. There will be no more bills after these. Treatment Of the $3,000 Ms. Smith received, $250 is unearned income in November because last illness and burial expenses are only $2,750. The $2,750 is not considered unearned income and will not be a resource until January 1, if she still has it then. The $250 amount will be a resource on December 1 when added to the money she has in her checking and savings accounts.
Table of Contents
302.19 Burial-Related Resources
(Eff. 10/01/05)
There are two different types of burial related resources: Burial space and burial funds. This section will explain the difference in the two.
302.19.01 Burial Spaces
(Rev. 09/01/14)
POMS SI 01130.400
Burial spaces are used to contain and mark the remains of a deceased person. A burial space is a(n):
Burial plot;
Gravesite;
Crypt;
Mausoleum;
Casket;
Urn;
Niche; or
Other repository customarily and traditionally used for the deceased's bodily remains.
The term also includes necessary and reasonable improvements or additions to such spaces, including but not limited to:
Vaults;
Headstones, markers, or plaques;
Burial containers (e.g., for caskets); and
Arrangements for the opening and closing of the gravesite.
A contract for care and maintenance of the gravesite, sometimes referred to as endowment or perpetual care, can be excluded as a burial space.
Burial Space Verification Procedure Procedure – Burial Spaces To verify the Applicant/Beneficiary’s burial spaces: Obtain copies of the deed, purchase contract or agreement. However, if the applicant alleges a burial plot that would be otherwise excluded, the plot does not have to be verified. Contact the cemetery office to verify current market value of burial space items. Determine that the items have been paid for in full. If not paid for, the amount paid is considered a burial fund rather than a burial space. For more information about burial funds, refer to MPPM 302.19.03. For more information about verification procedures, refer to MPPM 302, Appendix B .
302.19.02 Burial Space Exclusion
(Rev. 09/01/14)
A burial space or agreement, which represents the purchase of a burial space held for the burial of the individual, his or her spouse, or any other member of his or her immediate family, is an excluded resource, regardless of value. No limit exists on the value of the burial space that may be excluded. Taxes paid on burial spaces are also excluded.
A burial space may be excluded if intended for the use of the:
Applicant/Beneficiary,
Applicant/Beneficiary’s spouse, and
Applicant/Beneficiary’s immediate family, including parents, children, siblings, and spouses of these relations.
If an Applicant/Beneficiary attests to owning one burial plot, the plot is excluded. If an Applicant/Beneficiary and his/her spouse attest to owning two burial plots, the plots are excluded. To exclude additional burial spaces the Development of Burial Exclusion, DHHS Form 1766-A ME, must be completed. The form must include the individual’s name and relationship to the Applicant/Beneficiary.
Only one burial item, serving the same purpose, may be excluded for each person. For example, a cemetery plot and a casket may be excluded for the same person, but a casket and an urn may not be excluded.
The burial space exclusion is in addition to, and has no effect on, the burial funds exclusion.
302.19.03 Burial Funds
(Rev. 09/01/14)
POMS SI 01130.410
Burial funds are funds clearly designated for an individual’s burial. Burial funds include:
Revocable burial contracts,
Revocable burial trusts,
Installment sales contracts for burial spaces,
Cash,
Financial accounts such as checking or savings accounts,
Stocks, bonds, certificates of deposits (CDs), and
Life insurance cash value.
These funds must be clearly designated for the individual’s or spouse’s burial, cremation, or other burial-related expenses. Property other than that listed in this definition will not be considered burial funds, and may not be excluded under the burial funds provision. For example, a car, real property, etc. are not burial funds.
Expenses included for burial funds exclusion purposes are generally those related to preparing a body for burial and any services prior to burial. They include transportation of the body, embalming, cremation, flowers, clothing, etc.
Burial Fund Verification Procedure To verify the Applicant/Beneficiary’s burial fund: Obtain copies of a bank statement, brokerage statement, or statement from a funeral home. Obtain verification of the amount already paid, remaining principal balance on cemetery items, and accrued interest on a pre-need burial contract. For more information about verification procedures, refer to MPPM 302, Appendix B .
302.19.04 Burial Fund Exclusion
(Rev. 09/01/14)
An Eligibility Worker may exclude up to $1,500 each in funds set aside for:
The burial expenses of the Applicant/Beneficiary, and
The burial expenses of the individual’s spouse.
Burial fund items are considered resources unless a burial fund exclusion is developed. To develop a burial fund exclusion the Applicant/Beneficiary must complete and sign the Development of Burial Exclusion, DHHS Form 1766-A ME. The form should include the name of the individual for whom the fund is designated and the value designated for burial fund.
The $1,500 maximum exclusion amount must be reduced by any amount held in an irrevocable trust or burial contract that represents burial fund exclusion. Interest accrued on an excluded, designated amount is excluded.
Burial funds may be commingled with burial-related assets, but must be kept separate from nonburial-related assets to be excluded. A burial fund may be excluded retroactively to the date the individual originally designated the funds for burial.
This exclusion is separate from and in addition to the burial space exclusion.
Burial Fund Examples Mr. Brown creates a checking account with a $1,500 balance for burial expenses. The entire amount may be excluded. Mr. Brown creates a checking account with a $2,000 balance for burial expenses. Since $1,500 is the maximum that can be excluded for a burial fund, the remaining $500 is counted toward the resource limit. Mr. Brown applies on May 1, 2014 and signs DHHS Form 1766-A ME , designating a checking account for burial expenses. He created the account two years ago. He is seeking retroactive coverage for February, March, and April 2014. The exclusion may be given for those months. Mr. Brown has a checking account with a balance of $2,000. He plans to use $1,500 for burial expenses and the remaining $500 for non-burial expenses. The burial fund exclusion may not be applied to this bank account because the burial funds are co-mingled with non-burial funds. As a solution, Mr. Brown may want to consider opening another checking account to separate the non-burial expenses. If he does so, he must provide verification of the accounts, and complete Form 1766-A ME.
302.19.05 Burial Fund Penalty
(Rev. 09/01/14)
If a burial fund is used for a purpose other than the burial arrangements of the Applicant/Beneficiary or the Applicant/Beneficiary’s spouse for whom the funds were set aside, a penalty is imposed on the Applicant/Beneficiary. The amount misused is counted as a resource for the month following the discovery of the misused fund.
If the misused fund includes non-excluded burial funds, assume the funds were used in this order:
Non-excluded interest
Non-excluded designated amount
Excluded interest
Excluded designated amounts
The penalty only applies to excluded interest and designated amounts.
If an Applicant/Beneficiary loses eligibility, a new burial fund exclusion must be developed if the individual re-applies at a later date.
302.19.06 Burial Fund Exclusion and Re-Determination
(Rev. 09/01/14)
Burial Fund Exclusion Re-Determination Procedure To continue the Applicant/Beneficiary’s burial fund exclusion at re-determination: Verify the current value of the fund. Verify the exclusion’s requirements are still being met. If the burial fund’s amount has increased, determine the source of the increased amount, i.e. interest. If the burial fund contains excluded and non-excluded amounts, use the formula below to determine the current excludable portion: Amount of Original Exclusion x Present Fund Amount = Current Excluded Portion Total Amount of Original Fund The Burial Fund Excluded Interest Worksheet, DHHS Form 933 is used to calculate excluded and non-excluded interest for burial funds.
302.20 Pre-Need Burial Contracts
(Eff. 10/01/05)
POMS SI 01130.420
A pre-need burial contract is an agreement between an individual and a funeral home where the buyer pays in advance for his, or another person’s, burial arrangements.
302.20.01 Pre-Need Burial Contracts Including Burial Spaces and Burial Funds
(Rev. 07/01/09)
Many pre-need contracts include both burial space and burial fund items. Expenses related to the burial space include: casket, vault, opening/closing costs at the cemetery. Expenses related to the burial fund include: embalming, clothing, visitation room, transportation, flowers.
There are two types of pre-need contracts: revocable and irrevocable. Each is described below, as well as, how they are treated in the eligibility determination.
A pre-need contract must be examined to determine if:
It is revocable or irrevocable.
It is paid for in full.
The value of each item is provided.
Payment for a contract has taken place when an applicant/beneficiary transfers a liquid resource to the funeral provider or when specific life insurance policies have been designated on the pre-need burial contract. A liquid resource designated but not transferred to the funeral provider as payment for a contract is counted as an available resource. A resource cannot be designated for future payment of a pre-need contract and that resource be excluded as a resource.
If an applicant’s resources exceed the allowable limit, he is allowed to establish a pre-need contract to reduce his resource below the limit.
Table of Contents
302.20.02 Revocable Pre-Need Burial Contracts
(Rev. 10/01/13)
Revocable contracts may be sold or the money may be refunded. They are considered resources. However, a full or partial exclusion may be developed.
Contracts that are paid in full:
If the value of all the items IS provided, both the burial space and burial fund exclusion may be developed.
If the value of the burial space items IS NOT provided, only the burial fund exclusion may be developed.
Contracts that are not paid in full:
Only the burial fund exclusion may be developed UNLESS the contract verifies the burial space items are paid for and the burial funds items are being paid on.
Procedure – Revocable Pre-Need Burial Contracts Verification Needed: Copy of the contract Statement from the provider of service Treatment: Revocable pre-needs are considered a resource. A burial exclusion may be developed. A DHHS Form 1766-A ME must be completed and signed. If the contract is paid in full: Any portion of the contract clearly representing burial spaces may be excluded entirely, regardless of value. Up to $1,500 of the remaining portion of the contract may be excluded as a burial fund. If the contract is not paid in full, it should be treated as a burial fund unless it is verified that the burial spaces themselves are paid in full and considered “held for” the individual. All calculations must be shown on the workbook. Example: Mrs. Olsen applies for Medicaid. She just purchased a revocable contract at Landon’s Funeral Home. The contract verifies it is paid in full and includes the following: $1,500 Casket $1,000 Vault $1,000 Headstone $500 Opening/closing costs $200 Embalming $300 Visitation room $1,000 Funeral service $5,500 Total value Because the contract is paid in full, the burial space items may be excluded. The first four items are burial space items and may be excluded under the burial space exclusion. The remaining $1,500 may be excluded under the burial fund exclusion. A DHHS Form 1766-A ME must be completed to designate the contract and apply the exclusion.
Table of Contents
302.20.03 Irrevocable Pre-Need Burial Contracts
(Rev. 07/01/26)
Some contracts are irrevocable. The money cannot be refunded or the contract sold without significant hardship. South Carolina law requires that all contracts be revocable for the first 30 days. At the end of the 30 days, the contract becomes irrevocable unless the owner specifies otherwise. Only the amount of funds paid or specific life insurance policies designated for a pre-need burial contract may be considered for exclusion.
Procedure – Irrevocable Pre-Need Burial Contracts Verification Needed: Copy of the contract Contact with the service provider Treatment: If the contract remains revocable after the 30 days, it is treated as described in the Revocable Contract section above. If the contract becomes irrevocable: It is not a resource to the individual. It is not considered a resource retroactive to the date it was purchased. The portion that represents burial funds offsets the $1500 burial fund exclusion. If the contract is not paid in full, the portion paid represents burial funds and is excluded. Example Mr. Allen applies for Medicaid under the ABD program on March 10. He has a savings account worth $ 10 ,000. He also has a life insurance policy with a Face Value of $15,000 and a CSV of $800 that he designates for his burial. Since his resources exceed the $ 9 , 950 limit, he uses $4,500 of his savings to purchase an irrevocable pre-need contract on March 15. A copy of the contract verifies he paid $1,500 for the casket, $1,000 for the vault, $500 for the opening and closing costs at the cemetery, and $1,500 for other services. On the 30 th day, Mr. Allen decides to have the contract remain revocable. It is considered a resource. He signs a DHHS Form 1766-A ME designating the contract for his burial. The $3,000 paid for the casket, vault, and opening and closing costs are excluded as burial space items. The remaining $1,500 is excluded as a burial fund. If Mr. Allen decides to allow the contract to become irrevocable, it becomes so on April 14. It is not a resource and not countable effective March. That portion of the irrevocable burial contract that represents burial fund items, which is $1500, offsets the $1500 Burial Fund Exclusion. The $800 Cash Value of the life insurance that was previously designated for burial then becomes a countable resource. His countable resources would be: savings $ 5 , 5 00 ($ 10 , 0 00 - $4,500) + $800 CSV = $ 6 , 3 00 which is below the ABD resource limit. Assuming all other criteria are met, Medicaid can begin effective March 1.
302.20.04 Life Insurance Funded Burial Contracts
(Eff. 10/01/05)
POMS SI 01130.425
This is not considered burial insurance. A person purchases life insurance and assigns either the proceeds or ownership of the policy to the funeral service provider. This assignment may be revocable or irrevocable.
302.20.04A Effect of the Assignment of Ownership on Burial Exclusion
(Eff. 10/01/05)
Revocable Assignment
The burial space exclusion does not apply because the items are not paid for until the death of the individual.
The burial fund exclusion may apply. The cash surrender value of the life insurance policy is the resource value.
Irrevocable Assignment
The burial space exclusion may apply IF the values of the items are provided.
The life insurance policy is not a resource because the individual no longer owns it.
The contract is not a resource.
The value of the burial fund items offsets the value of any other burial fund items.
Table of Contents
302.20.04B Effect of the Assignment of Proceeds on Burial Exclusion
(Eff. 10/01/06)
The burial space exclusion does not apply because:
The provider will not be paid until the death of the individual.
Spaces are not being “held for” the individual.
The resource value of the contract is the cash surrender value of the life insurance policy.
Procedure – Cash Surrender Value: If the Face Value of all life insurance policies for the individual total $10,000 or less, exclude the Cash Surrender Value under the life insurance exclusion. If the Face Values total more than $10,000, verify and count the Cash Surrender Value toward the limit. The $1,500 burial fund exclusion may apply.
302.21 Property Essential to Self Support
(Eff. 10/01/05)
POMS SI 01130.500
The exclusion may apply to real or personal property. All property described below must be in current use or, if not in use for reasons beyond the individual's control, there must be a reasonable expectation that the required use will resume.
Resources excluded under this provision generally fall into three categories:
Essential Property Excluded – Regardless of Value or Rate of Return
Essential Property Excluded – Up to $6,000 Equity – Regardless of Rate of Return
Essential Property Excluded – Up to $6,000 Equity – If It Produces a 6% Rate of Return
302.21.01 Essential Property Excluded – Regardless of Value or Rate of Return
(Eff. 10/01/05)
POMS SI 01130.501
Property essential to self-support used in a trade or business
Procedure – Property Essential to Self Support Used in a Trade or Business Verification Needed: Obtain a statement regarding: Description of the trade or business Description of the assets of the trade or business The number of years the business has been operated Names of any co-owners Estimated gross and net earnings of the trade or business for the current tax year. Obtain a copy of the latest tax return available.
Government permits granting authority to engage in income producing activity
Procedure Examples of Income Producing Activities Needing Government Authorization: Commercial fishing Tobacco crops Verification Needed: Individual’s signed statement as to: Type of license, permit or other property Name of issuing agency If license is required for engaging in this activity How the license, permit or property is being used If not being used, why not Copy of the license, permit and/or other documents
Table of Contents
Personal property used by an employee for work
Examples of Personal Property Used at Work: Tools Uniforms Safety Equipment
302.21.02 Essential Property Excluded – Up to $6,000 Equity – Regardless of Rate of Return
(Eff. 10/01/05)
POM SI 01130.502
Applies to non-business property – may be real or personal property.
No specified rate of return is required.
Property must be in use or, if not in use for reason beyond the individual’s control, there must be a reasonable expectation that the required use will resume.
If the equity value exceeds $6,000, the excess is not excluded; it is countable toward the resource limit. (Example: If the resource is valued at $7,000, then $6,000 is excluded and $1,000 is counted.)
Procedure Example of Non-Business Property – Real or Personal: Property used to grow produce or livestock raised solely for the individual’s household, like land Property used in activities essential to the above – such as tractor used for plowing, boat for fishing. ( Note: This does not include any vehicle that qualifies as an automobile.) Verification Needed: Individual’s statement giving: Description of property Description of how it is used Estimate of the Current Market Value (CMV) and any legal encumbrances Verification of the CMV
Table of Contents
302.21.03 Essential Property Excluded – Up to $6,000 Equity – If It Produces a 6% Rate of Return
(Eff. 10/01/05)
POMS SI 01130.503
Applies to non-home income producing property
Equity value = current market value – legal debts
Up to $6,000 can be excluded if the net annual return is equal to or greater than 6% of the equity value.
Procedure Example of Non-Home Income Producing Property: Property rented to someone for use in farming Verification Needed: Individual’s statement giving: Description of property Description of how it is used Estimate of the Current Market Value (CMV) and any legal encumbrances Verification of the CMV Treatment: Any equity value exceeding $6,000 counts toward the resource limit. ( Example: Property meets the 6% rule but has an equity value of $7,500. The amount of $6,000 is excluded under this provision and the remaining $1,500 is countable.) If the net annual return is less than 6%, the entire equity value is counted. Exceptions: Lower return that is beyond the individual’s control Crop failure Fire Illness There is a reasonable expectation that the property will again produce a 6% return. Up to 24 months is allowed for the resumption of a 6% return. This begins with the first day of the tax year following the one in which the rate dropped below 6% Note: If the individual owns more than one piece of non-home property: The 6% return rule applies individually to each piece. The $6000 equity value limit applies to the combined equity values of properties meeting the 6% return rule. Example: Mr. Green has a piece of land on which he grows corn for sale at the market. The equity value of the land is $7,000. He nets a minimum of $500 per year in sales. $500 ¸ $7,000 = 7.14%. Therefore, $6,000 of the equity value is excluded, and $1,000 is counted. Last year, his crop caught fire and he made no money. He expects to plant/sell again next year at the regular rate. The $6,000 may still be excluded because the he had no control over the fire. His 24-month period began Jan 1. 3. Mr. Green owns three non-connected acres of pastureland. He rents them to different horse and cattle owners for $500 per year each. They have equity values of $2,000; $3,500 and $1,200 for a total of $6,700. · 6% rule: $500 ¸ $2,000 = 25% · $500 ¸ $3,500 = 14% and $500 ¸ $1,200 = 42% · Since the 6% rule is met, $6,000 is excluded, and $700 is countable.
Table of Contents
302.22 Resources Set Aside as Part of Plan for Achieving Self-Support
(Eff. 10/01/05)
POMS SI 01130.510
A Plan for Achieving Self-Support (PASS) allows blind and disabled (but not aged) individuals to set aside income and/or resources necessary for the achievement of its goals. Resources set aside as part of an approved PASS are excluded.
302.23 Retained Cash Payments
(Eff. 10/01/05)
The treatments of retained cash payments are discussed in the following sections.
302.23.01 Retroactive Supplemental Security Income (SSI) and Retirement, Survivors, and Disability Insurance (RSDI)
(Eff. 10/01/05)
POMS SI 01130.600
The unspent portion of retroactive SSI and RSDI benefits is excluded from resources for nine calendar months following the month in which the individual receives the benefits.
Retroactive SSI
Retroactive SSI benefits are SSI benefits issued in any month after the calendar month for which they are paid. Thus, benefits for January that are issued in February are retroactive.
Retroactive Social Security Benefits (RSDI) Retroactive RSDI benefits are those issued in any month that is at least two calendar months after the calendar month for which they are paid. Thus, RSDI benefits for January that are issued in February are not retroactive, but RSDI benefits for January that are issued in March are retroactive.
Procedure for Verification: Obtain verification of the amount of the retroactive payment and the month of receipt. The best source is a copy of the Award Letter from Social Security.
Table of Contents
302.23.02 Dedicated Accounts for Past-Due Benefits Due to Individuals Under Age 18 Who Have a Representative Payee
(Eff. 10/01/05)
POMS SI 01130.601
Past-due benefits and other underpayments deposited into a dedicated financial institution account and any accrued interest or other earnings on such an account are excluded from resources. This exclusion does not apply if funds are co-mingled.
Exception If the financial institution requires other funds be used to open the dedicated account, these funds may be co-mingled in the account until the end of the month following the month that the past-due benefits are paid. Note If the benefits are not deposited into a dedicated account, there is a time limitation on the exclusion.
Procedure Verification: The eligibility worker must obtain verification of: The amount of past due benefits, such as a copy of the award letter. The dedicated bank account. If the bank requires other funds be used to open the account, then verify: The fact that the bank requires other funds to be used to open the account. The amount used to open the account. The date the other funds were withdrawn. Treatment: Exclusion applies to: The past due benefit Any interest or earnings, such as dividends, earned on and left to accrue in the excluded account. The exclusion does not apply to: Any funds, other than the past-due benefits the bank requires be used to open the account. If these funds are not withdrawn by the end of the month following the month the past-due benefits are paid, the exclusion will not apply at all. The entire account for any month in which the past-due benefits is co-mingled with other funds. The exclusion is time limited if: The past-due benefits are not deposited into a dedicated account. Limited to the lesser of: 6 months Until the funds are deposited into the dedicated account – obtain verification.
Table of Contents
302.23.03 Cash Received for the Repair or Replacement of Lost, Damaged, or Stolen Excluded Resources
(Eff. 10/01/05)
POMS SI 01130.630
Cash receipts for the replacement or repair of lost, damaged, or stolen excluded resources are not treated as resources for a certain amount of time.
Procedure Such receipts are not considered resources for 9 months from the date of receipt. This may be extended up to 9 more months if the individual verifies good cause for the repair or replacement not being done. Good cause exists if circumstances beyond the individual’s control: Prevent the repair or replacement of the property Keep the individual from contracting for such repair or replacement If good cause is alleged, obtain a statement from the individual describing the circumstances and any corroborating evidence that may be available.
302.23.04 Disaster Assistance
(Eff. 05/01/26)
POMS SI 01130.620
Disaster Assistance includes assistance received from the following sources:
The Disaster Relief and Emergency Assistance Act (P.L. 100707)
Another Federal statute because of a presidentially declared major disaster
A State or local government’s comparable assistance associated with the presidentially declared major disaster
A disaster assistance organization in response to the presidentially declared major disaster.
Example: Red Cross, Samaritan’s Purse
Note: If the funds are excluded from income, the unspent amount is excluded from resources.
302.23.04A COVID-19 Economic Impact Payments (EIPs)
POMS SI 00830.620
POMS SI 01130.620
(Rev. 05/01/26)
The Internal Revenue Service issued first, second and third rounds of Economic Impact Payments (EIPs), also known as Recovery Rebates, authorized by Congress in the CARES Act beginning in March 2020, CAA beginning in December 2020 and ARPA beginning in March 2021.
First Round: Payment levels were up to:
$1,200 for individuals,
$2,400 for couples filing jointly, and an additional $500 per qualifying child.
Second Round: Payment levels were up to:
$600 for individuals,
$1,200 for couples filing jointly, and an additional $600 per qualifying child.
Third Round: Payment levels were up to:
$1,400 for individuals,
$2,800 for couples filing jointly, and an additional $1,400 per qualifying child.
Non-MAGI Determinations
EIPs are considered disaster assistance. Therefore, they are excluded as income in the month received and any retained funds are excluded as a resource. If the applicant or their spouse has passed away and the surviving spouse retained their EIP funds, those funds should also be excluded. If excluded amounts are commingled with countable funds in an account, assume countable funds are spent first. MPPM 302.23.04A. For instructions on Long-Term Care EIP Determinations, refer to MPPM 304.09.02C.
Note:
To determine the retained EIP amount for individuals that exceed the resource limit, the Eligibility Specialist should complete the DHHS Form 1766-EIP, Disaster Assistance Declaration Form, with the applicant via collateral call. If unable to complete with applicant/AR by phone, the form should be sent via DHHS Form 1233. If the form is not returned, assume the applicant/spouse did not retain any of the EIP funds.
Example 1 Allison Anderson is applying for ABD coverage. She receives $1,000 monthly in Social Security Benefits and her current bank balance is $12,000. $12,000 (current bank balance) - $1,000 (monthly income) = $11,000 (current countable resource) Since Allison’s resources exceed the limit, the Eligibility Specialist contacted Allison to complete the DHHS Form 1766-EIP Disaster Assistance Declaration Form. Allison confirmed that she has retained all EIP funds. After subtracting her monthly income, the applicant still exceeds the resource limit. Since Allison has retained her $3,200 EIPs, we would exclude the $3,200 from her bank account balance. $11,000 (current countable bank balance) - $3,200 (total EIP) = $7,800 The countable value of her account is $7,800 after subtracting the EIP stimulus. Example 2 Bailey Bryant is married and is applying for ABD coverage. She receives $1,200 monthly in Social Security Benefits and her spouse Robert receives a monthly pension of $250. The couple has one joint bank account with a current bank balance of $20,000. $20,000 (current bank balance) - $1,450 (monthly household income) = $18,550 (current countable resource) Since the couple’s resources exceed the limit, the Eligibility Specialist contacted them to complete the DHHS Form 1766-EIP Disaster Assistance Declaration Form. Though the collateral call was unsuccessful, the couple returned the form confirming they retained $2,500 EIP funds. After subtracting their monthly income, the applicant still exceeds the resource limit for a couple. Since they have retained $2,500 EIPs, we would exclude the $2,500 from their bank balance. $18,550 (current countable bank balance) - $2,500 (reported retained EIP) = $16,050 The countable value of the account is $16,050 after subtracting the EIP stimulus. Example 3 Wendy Pan is applying for ABD coverage. Wendy receives $900 monthly in Social Security Benefits and her husband, Peter, receives a monthly income of $1,100. They share one bank account. The account balance is $20,000. $20,000 (current bank balance) - $2,000 (monthly household income) = $18,000 (current countable resource) Since the couple’s resources exceed the limit, the Eligibility Specialist contacted them to complete the DHHS Form 1766-EIP Disaster Assistance Declaration Form. The collateral call was unsuccessful, and the couple failed to return the form verifying retained EIP amounts. We assume no EIP funds were retained.
302.23.05 Presidentially Declared Major Disasters
(Eff. 10/01/05)
POMS SI 01130.620
Some catastrophes (such as hurricane damage) cause such wide spread destruction that the President of the United States declares them Major Disasters. Any unspent funds are excluded from resources.
Table of Contents
302.23.06 Netherlands WUV Payments to Victims of Persecution
(Eff. 10/01/05)
POMS SI 01130.605
The Netherlands' Act on Benefits for Victims of Persecution 1940-1945, WUV (Wet Uitkering Vervlgingsslachtoffers) provides payments to individuals who were victims of persecution during World War II during the German and Japanese occupation of the Netherlands and the Netherlands East Indies (now the Republic of Indonesia).
Note: Excluded: Unspent WUV payments made by the Dutch Government. Counted: Interest earned on unspent WUV payments.
302.23.07 German Reparations Payments
(Eff. 10/01/05)
POMS SI 01130.610
German reparations payments are made to:
Certain survivors of the Holocaust under the Federal Republic of Germany's Law for Compensation of National Socialist Persecution, or German Restitution Act.
These payments may be made periodically or in a lump sum.
Note: Unspent German reparations payments are excluded from resources.
302.23.08 Austrian Social Insurance Payments
(Eff. 10/01/05)
POMS SI 01130.615
The nationwide class action lawsuit, Bondy v. Sullivan, involved Austrian social insurance payments that were based on wage credits granted under Paragraphs 500506 of the Austrian General Social Insurance Act. These paragraphs grant credits to individuals who suffered a loss (that is, were imprisoned, unemployed, or forced to flee Austria) during the period of March 1933 to May 1945 for political, religious, or ethnic reasons.
Procedure – Austrian Social Insurance Payments Excluded: Austrian social insurance payments not based on wage credits are excluded. Not Excluded: Unspent Austrian social insurance payments based on wage credits granted under Paragraphs 500 506 of the Austrian General Social Insurance Act granted under Paragraphs 500 506 are not excluded from resources under this provision. Note: Interest earned on unspent Austrian social insurance payments is counted as income unless it can be excluded under another provision, such as infrequent or irregular income.
302.23.09 Benefits Excluded from Both Income and Resources by a Federal Statute Other Than Title XVI
(Eff. 10/01/05)
Federal statutes other than Title XVI specify many SSI income and resources exclusions. Examples of these are listed below.
302.23.09A Agent Orange Settlement Payments
(Eff. 10/01/05)
POMS SI 01130.660
No limit on the length of time unspent funds are excluded.
Interest earned on conserved payments is counted as income.
302.23.09B Victims Compensation
(Eff. 10/01/05)
POMS SI 01130.665
Some states establish funds to assist victims of crimes. Unspent payments received from such a fund are excluded for 9 months IF received for expenses incurred or losses suffered because of the crime.
Interest earned on unspent victims' compensation payments is not excluded from income or resources.
Examples of Victims’ Compensation Payments: Medical expenses resulting from injuries Lost wages
Table of Contents
302.23.09C Relocation Assistance Payments
(Eff. 10/01/05)
POMS SI 01130.670
Sometimes projects acquire real property and individuals are displaced from their home or business. Relocation assistance may be provided to them under local, State, or Federal programs. Such payments may be excluded for certain lengths of time. The length of the exclusion depends on the source.
Procedure – Relocation Assistance Payments State and Local Program Assistance Unspent payments are excluded from resources for 9 months. Federal Assistance There is no time limit on the exclusion for assistance provided under the Uniform Relocation Assistance and Real Property Acquisitions Policies Act of 1970. Note: Interest earned on unspent payments IS NOT excluded from income or resources.
302.23.09D Tax Advances and Refunds Related to Earned Income Tax Credits
(Rev. 04/01/11)
POMS SI 01130.676
An unspent Federal tax refund or payment made by an employer related to Earned Income Tax Credits (EITC) is excluded from resources for 12 months following the month the refund or payment is received.
Interest earned on unspent tax refunds related to EITC's is not excluded from income or resources.
302.23.09E Radiation Exposure Compensation Trust Fund Payments
(Eff. 10/01/05)
POMS SI 01130.680
The Radiation Exposure Compensation Trust Fund (RECTF) authorizes the Department of Justice (DOJ) to make compensation payments to individuals (or their survivors) that were found to have contracted certain diseases after exposure. The payments will be made as a one-time lump sum.
Procedure – Radiation Exposure Compensation Trust Fund Payments Unspent payments are excluded from resources. Interest earned on unspent payments is counted as income unless it is excludable under another provision.
302.24 Gifts of Domestic Travel Tickets
(Eff. 10/01/05)
POMS SI 01120.150
The value of a ticket for domestic travel received by an individual (or spouse) is not a resource if the ticket is:
Received as a gift;
Not converted to cash; and
Excluded from income.
302.25 Identifying Excluded Funds That Have Been Co-mingled with Non-Excluded Funds
(Eff. 10/01/05)
POMS SI 01130.700
To qualify for exclusion, excludable funds must be identifiable. This does not require them to be separate from other funds (such as in a separate bank account.)
Procedure: When withdrawals are made from co-mingled funds, assume non-excluded funds are withdrawn first. If excluded funds are withdrawn, the excluded funds left in the account can only be added to by: Deposits of subsequent funds excluded under the same provision Excluded interest
302.26 Countable Resources
(Eff. 10/01/05)
The value of countable resources is considered in determining eligibility. The following are considered countable resources.
302.26.01 Cash
(Eff. 10/01/05)
POMS SI 01140.010
Money on hand that is in the form of coin or currency.
Treatment | Verification Countable | Accept allegation of cash on hand. If rare coin collection, obtain knowledgeable source statement. (Refer to Appendix C for definition of knowledgeable sources.)
Table of Contents
302.26.02 Checking/Savings Accounts
(Rev. 11/01/23)
POMS SI 01140.200
Treatment | Verification Unrestricted access: all funds are considered a resource. Restricted access: only the portion the individual can withdraw is considered a resource. | Bank statements Bank book Written Statement from bank Collateral Call with bank Asset Verification System (AVS) DHHS Form 1253 ME, Request for Financial Investigation (Only if unable to verify with AVS) Policy A resource shall not be considered as an asset and as income in the same month. When income received in a month is deposited into a checking or savings account, the value of such account for that month will be determined by subtracting the total amount of income deposited from the lowest balance of the account. We will assume that all income received by an applicant, beneficiary, or their family is deposited into an account. An exception will be if: It has been reported by the individual that there is income not deposited into an account; or We know for sure that there is income not deposited into an account. If the applicant or beneficiary is eligible without subtracting the income, it is not necessary to make the adjustment to the balance. Example A beneficiary in a nursing home has an Income Trust. The Schedule A lists specific income that is deposited into the trust. The identified income would not be subtracted from other bank accounts owned by the beneficiary. Example An applicant reports that he receives Social Security Retirement that is deposited into his checking account. He also receives a private pension check in the mail. He tells the case worker that he normally takes the check to the bank to cash it and keeps the cash on hand. The amount of the private pension will not be subtracted from the total. Do not count the cash he keeps as resource in that month. Procedure If more than one bank account is listed on the application or if more than one bank account is found when AVS returns, the Eligibility Specialist must verify the applicant’s/beneficiary’s ownership interest in each account. Bank Statements may be scanned into OnBase in no specific order. If bank statements are provided, Eligibility Specialists must review the name of the institution and account numbers to ensure that each account is verified individually. Verification must be documented in the case record and on the Documentation Template for each account. AVS reports the balance for all accounts as of the first day of the month. To determine the countable balance, the Eligibility Specialist should total the balances of all accounts and then subtract the income received by the household from the lowest total balance of all the verified checking or savings accounts as one balance. You do not have to identify the specific account used by the applicant or beneficiary, but you do have to record on the documentation template how you determined the countable amount. If an applicant or beneficiary has earned income, subtract the net income to reflect what the individual received. Additional information may need to be obtained from the applicant or beneficiary. When reviewing the AVS results, balances from the 1 st day of the following month can be used as verification of the lowest monthly balance of a previous month due to “neighboring” balances. “Neighboring” refers to the AVS or bank statement balance for the subsequent month being the same as the last day of the application month or retroactive request month. Eligibility Specialists must document the use of neighboring balances on the Documentation Template. Neighboring Balances Example (AVS) An ABD applicant applied for coverage on 7/23/2023 requesting retroactive coverage. The AVS results have returned with a value of $10,000.00 for 6/1/2023 after income is deducted. However, the 7/1/2023 AVS balance is $7000.00. The applicant meets resource eligibility for ABD in the retroactive month and in the application month because the beginning balance of July can also be used as the ending balance for June. Neighboring Balances Example (Bank Statement) An ABD applicant applied for coverage on 7/23/2023. The AVS results have returned with a value of $10,000.00 for 7/1/2023 after income is deducted. However, there is a bank statement on file for 8/1/2023 indicating that balance on 8/1/2023 was $7000.00. The applicant meets resource eligibility for ABD in the application month because the beginning balance of August can also be used as the ending balance for July. Note The concept of “neighboring” balances applies to all programs using liberalized resources. Note If there is a bank statement on file showing the lowest balance for the month, use the bank statement. If there is no bank statement on file and the “neighboring” balance on the AVS shows a lower balance’ use the AVS results without requesting additional information. If the AVS “neighboring” balance, does not help the individual become eligible, request a bank statement for the month(s) being assessed to determine the lowest monthly balance. If the countable resources of the individual or family are over the appropriate resource limit, obtain the lowest balance for each account if this may make a difference in the eligibility determination. Total the lowest balances and then subtract the total income received, following the same procedure shown above. Example An applicant has non-homestead property valued at $100,000 that does not meet any exclusions and makes her ineligible for Medicaid. It is not necessary to obtain bank balances before denying the application.
302.26.03 Joint Checking/Savings Accounts
(Rev. 10/01/23)
POMS SI 01140.205
Treatment | Verification If one owner is an applicant/beneficiary and has unrestricted use, all funds are counted. If more than one owner is an applicant/ beneficiary, divide the balance evenly between the owners, and count the individual’s share toward his countable resources. | Bank statements Bank book Written Statement from bank Collateral Call with bank Asset Verification System (AVS) DHHS Form 1253 ME, Request for Financial Investigation. (Only if unable to verify with AVS) Procedure Refer to MPPM 302.26.02
302.26.03A Rebuttal of Joint Checking/Savings Accounts
(Eff. 10/01/05)
An applicant/beneficiary may rebut ownership of part or all of the funds in a jointly held account. He is responsible for providing verification to support this claim. If the rebuttal is successful, the applicant/beneficiary must be advised of responsibilities for record keeping and future treatment of the account.
Procedure for Rebuttal If an applicant/beneficiary rebuts applicable ownership assumption, each of the joint account holders must complete and sign the DHHS Form 904 ME , attaching necessary verifications, to document the following: Bank Name, account number, and the names of the account holders Ownership of the funds, including amounts if partial ownership is claimed Reasons for establishing a joint account; Who has made deposits to and withdrawals from the account. Verification of the deposits and withdrawals must be attached (for example; pay stub; award letter; cancelled checks. How withdrawals have been spent. If a rebuttal is successful, the applicant/beneficiary must be advised of the following: If partial ownership is established, the applicant/beneficiary must keep records of all future deposits and withdrawals to provide at review to allow for proper determination of countable resources. If the applicant/beneficiary owns none of the funds (that is, the individual’s name is on another person’s account for emergency purposes only), they must not add any of their own funds to the account in the future. If full ownership is attributed to the applicant/beneficiary, any future deposits by the other account holder(s) will be considered income and/or a resource to the applicant/ beneficiary.
302.26.04 Time Deposits
(Eff. 09/01/16)
POMS SI 01140.210
Examples: Certificates of Deposit (CD), savings certificates
Treatment | Verification The resource value is the amount the owner would receive upon withdrawing it at that time, excluding interest paid that month. Generally, that is: Amount originally deposited; Plus accrued interest for all but the current month; and Minus any penalty for early withdrawal. | Asset Verification System (AVS) response Bank statements Redemption receipts
Table of Contents
302.26.05 Conservator Account
(Eff. 10/01/05)
POMS SI 01140.215
A person or institution has been court appointed to manage and preserve an individual’s assets.
Treatment | Verification Absent evidence to the contrary, the funds are available for the individual's support and maintenance and are countable as that individual's resource. | See court order establishing account.
302.26.06 Stocks
(Eff. 10/01/05)
POMS SI 01140.220
Types of stocks: common; over the counter (penny stock), preferred (refer to MPPM Chapter 104 – Appendix I for definitions of various kinds of stocks.)
Treatment | Verification Shares of stock represent ownership in a business corporation. Their value shifts with demand and may fluctuate widely. Absent evidence to the contrary, assume each owner owns an equal share of the stock and can sell the stock at will, at current value. Broker fees do not reduce the value that stocks have as a resource. | Stock Certificate Brokerage Account statement (Refer to Appendix E on how to read stock tables.)
302.26.07 Mutual Fund Shares
(Eff. 10/01/05)
POMS SI 01140.230
Types of mutual funds: growth funds, income funds, balanced funds, municipal bonds, money market funds, load funds, no load funds (refer to MPPM Chapter 104 – Appendix I for definitions of various types of mutual funds.)
Treatment | Verification Shares in a mutual fund represent ownership in the investments held by the fund. The investments may be pooled assets (such as stocks or bonds, managed by an investment company. A mutual fund share represents ownership interest in this pool as opposed to a particular stock or bond. | (Refer to Appendix E for table on Mutual Funds and Stocks.)
Table of Contents
302.26.08 US Savings Bonds
(Rev. 11/01/07)
POMS SI 01140.240
Treatment | Verification US Savings Bonds issued on or after 02/01/03 cannot be redeemed for twelve months after the issue date on the face of the bond. The individual in whose name a US Savings Bond is registered owns it. The Social Security Number shown on a bond is not proof of ownership. The co-owners of a US Savings Bond own equal shares of the redemption value of the bond. If one of the co-owners refuses to relinquish possession of the bond, it is not a resource for the other owner. | Table of redemption value for US Savings Bonds Statement from a bank On-line at: www.TreasuryDirect.gov
302.26.09 Municipal, Government, or Corporate Bonds
(Eff. 10/01/05)
POMS SI 01140.250
Treatment | Verification These are negotiable and transferable. Value as a resource is their CMV. Their redemption value, available only at maturity, is immaterial. | Copy of the bond and contact the bond’s issuer to verify the value.
302.26.10 Other US Government Securities
(Eff. 10/01/05)
POMS SI 01140.990
Examples of other US Government Securities: Treasury Bills, Treasury Notes and Bonds, Tiger and Cats, Federal Agency Securities
Treatment | Verification Countable | Receipt of purchase and contact with the issuer to verify the value.
Table of Contents
302.26.11 Contents of a Safety Deposit Box
(Eff. 10/01/05)
An applicant/beneficiary or his spouse may have a safe deposit box. Some of the contents may be countable as resources.
Treatment | Verification Treatment is dependent upon the type of resources, if any, that are contained in the safety deposit box (that is, stock certificate; coins; jewelry; life insurance policies). (Refer to appropriate MPPM sections for specific resources.) | Obtain a signed, written statement from the applicant/beneficiary, the spouse, or the authorized representative listing the contents of the safety deposit box. For any resource contained in the box, obtain appropriate verification of the value (such as, financial statements, knowledgeable source statements.)
302.26.12 Non-Home Real Property
(Eff. 10/01/05)
This is land and any permanent buildings/immovable objects attached to it that are not considered a principal place of residence.
Treatment | Verification Generally, a countable resource if it can be sold at its CMV. Resource value is the CMV minus any legal debt. If jointly owned, count the individual’s share. Exclusion can be developed if there is a bona fide effort to sell. (Refer to MPPM 302.14.05 .) | Ownership and/or value may be verified by: Tax assessment notice or bill Current mortgage statement Deed Report of title search Wills, court records, or other documentation of inheritance Appraisal Bona-Fide effort to sell can be verified by: Copy of realtor listing (must set up a tickler file to update when listing expires) Copy of newspaper advertisement Rebuttal of Fair Market Value Knowledgeable source statements Example of when a rebuttal may be done: Condemned property
Table of Contents
302.26.13 529 Plan
(Eff. 10/01/05)
This is a State-sponsored investment program. Parents may fund these to pay for their child’s college education.
Treatment | Verification Parents are the owners and the account is considered a resource. Withdrawal for reason other than to pay for qualified college education is taxed at their rate plus a 10% penalty. | Account Statements
302.26.14 Direct Express Account
(Eff. 08/01/23)
Federal benefits can be obtained through Direct Express debit cards. As of January 2020, Comerica Bank serves as the fiscal agent for the Direct Express prepaid debit card program, which is run by the U.S. Department of the Treasury's Bureau of the Fiscal Service.
Treatment | Verification The Direct Express attested balance is considered a resource. If the applicant or beneficiary is eligible without subtracting the income, it is not necessary to make an adjustment to the balance. SSI, SSA, and other government benefits are examples of unearned income that is deposited into a Direct Express account. | Accept client’s statement of account balance. Accept client’s attestation on any current Medicaid application or review. Accept client’s verbal statement. Accept self-attestation for any persons who have Social Security checks directly deposited onto Direct Express cards. This refers to Direct Express cards only. All other pre-paid cards such as Blue Bird, Green Do t, Netspend etc., are to be handled like regular bank accounts (refer to 302.26.02 Checking/Savings Accounts).
302.27 Cash to Purchase Medical or Social Services
(Eff. 10/01/05)
POMS SI 01120.110
A cash payment for medical or social services that is not income also is not a resource for the month following the month of receipt.
Exception
Cash received as a repayment for bills already paid is a resource and is counted the month after receipt.
Note: If the cash was neither income nor repayment, it is not a resource for the month following the month of receipt.
302.28 Retroactive In-Home Supportive Services
(Eff. 10/01/05)
POMS SI 01120.112
In-Home Supportive Services (IHSS) are payments from governmental programs to a spouse or parent of a disabled individual who provide certain IHSS such as:
Attendant
Homemaker
Chores
This type of payment is made under limited circumstances.
Procedure – In-Home Supportive Services Treatment: Ineligible Spouse or Parent Income when received Not included as income for deeming purposes Retroactive Payments A payment is considered retroactive if the payment is made after the month it was due. Excluded the month of receipt and the calendar month after receipt. Beginning the second calendar month after receipt, it is a resource and is subject to deeming. Any interest included is also counted. A payment is NOT considered retroactive if it is made in the month due, but after the month the service(s) was provided.
Table of Contents
302.29 Encumbrance
(Rev. 12/01/23)
An encumbrance is defined as a legal obligation to pay a debt. If an applicant/ beneficiary’s combined resources exceed the resource limit, the eligibility worker must deduct the amount of any encumbrances from the Current Market Value (CMV) to determine the equity value of a resource. The equity value is countable toward the resource limit. Encumbrances must be explored for all liberalized Non-MAGI and Long-Term Care categories as an option in reducing resources.
An encumbrance may occur when:
The applicant has funds in a bank account or the cash value of a life insurance policy, and has a legal obligation to pay medical expenses that were incurred prior to the month of requested eligibility;
The applicant/beneficiary has signed an irrevocable preneed burial contract with a funeral home and assigned an existing life insurance policy(ies) to the funeral home, but the insurance company records do not indicate an irrevocable assignment or change in ownership (reference MPPM 302.20.02); or
The applicant/beneficiary has alleged a check has been written from a bank account, and it has not cleared the bank.
Encumbrance Procedure When a Legal Obligation Exists to Pay Medical Expenses If the applicant incurred medical expenses before the month of requested eligibility, and he has a legal obligation to pay his medical expenses, give a deduction for the actual amount paid for the cost of medical care. Allowable costs include: Nursing home bills, Doctor bills, Hospital charges, Durable medical equipment costs, and Prescription drug expenses. Verifications Needed: Copy of the medical expense, Paid receipt or cancelled check, and Updated bank statement or verification the life insurance policy(ies) was cashed in and used to pay for the expenses Once the verifications have been obtained, the countable resources can be established as of the requested month. Eligibility cannot be established in the month the debt was incurred.
Encumbrance Procedure When a Check Has Not Cleared the Bank If the beneficiary has alleged a check has been written from a bank account, and the check has not cleared the bank, the eligibility worker must examine evidence indicating that the check was written, therefore legally obligating the funds from the bank account. Verifications Needed: Paid receipt, or Copy of Cancelled check. This verification must be obtained before allowing a reduced equity value of the bank account. Once the verification is received, the equity value of the bank account can be established by deducting the amount of the written check.
Encumbrance Procedure for a Life Insurance Funded Pre-need Burial Contract The cash value of life insurance used to fund a pre-need burial contract can be considered for an exclusion back to the date the contract was signed once verification of the change in ownership of the life insurance policy to the funeral home is provided. Refer to MPPM 302.20 for detailed information on pre-need burial contracts. Verifications Needed Copy of pre-need burial contract, and Documentation from the insurance company showing the change in ownership to the funeral home
Encumbrance Examples Example 1 Medical Expenses: Ms. Jane Doe was in the nursing home as private pay and applied for MAO-Nursing Home Assistance on January 4, 2023 . She incurred a nursing home bill for December 2022 for $2,800 and has $3,000 in her bank account. She has a legal obligation to pay the bill. On February 4, 2023 she paid the nursing home $2,800 for the December 2022 bill. The equity value of the bank account can be established as of the application month when the applicant presents the bill and paid receipts, which verifies that the resource was used toward the payment of the incurred nursing home bill. The incurred nursing home bill of $2,800 is an encumbrance. In determining the equity value of the bank account, the encumbrance of $2,800 is deducted from the $3,000 bank account. Eligibility can be established for January 2023 , if the applicant is otherwise eligible. Example 2 Medical Expenses: Ms. Jess Brown entered the nursing home on June 1, 2022 , and applied for MAO-Nursing Home assistance the same day. She has an outstanding hospital bill for May 2022 in the amount of $3,000. For June, she had $400 in the bank and life insurance with a cash value of $4,000. In July, she cashed in the life insurance, deposited the $4,000 into her bank account, and paid the hospital bill. She provides verification of all the transactions. The $3,000 payment can be deducted from Ms. Brown’s June resources; therefore, the worker should deduct the hospital bill amount from the total amount of Ms. Brown’s bank account. ($4,400 - $3,000 = $1,400) Because $1,400 is below the allowable $2000 limit, eligibility can be established for June 2022 . Example 3 Preneed Burial Contract: Mr. James Fletcher applied for MAO Nursing Home Assistance on May 5, 2023 . He has a bank account with a balance of $825. He also has a Carolina Life insurance policy with a face value of $12,000 and cash value of $5,000. His preneed burial contract dated April 4, 2023 , with Jones Funeral Home is marked as irrevocable, and indicates the Carolina Life insurance policy is assigned to Jones Funeral Home. The life insurance company verifies that their records show Mr. Fletcher as owner. Mr. Fletcher initiates the paperwork with the insurance company to assign the policy. Once it is verified that the ownership of the policy has changed to the funeral home , the insurance cash value can be deducted from the countable assets, effective with the date of the preneed contract, April 2023 . Initial Calculations Final Calculations Bank Balance 825.00 Life Insurance CV 5000.00 Countable Resources 5825.00 Bank Balance 825.00 Life Insurance CV – excluded 0.00 Countable Resources 825.00 Example 4 Check: Mr. John Doe applied for ABD on January 4, 2023. As of January 31, 2023, Mr. Doe’s bank statement shows a checking account balance of $1,350 that, combined with his other alleged countable resource, is over the resource limit. Mr. Doe alleges that the statement balance includes his rent check of $500 that he wrote and gave to his landlord on January 2, 2023, but that his landlord has not cashed the check. The Eligibility Specialist examines Mr. Doe’s check register and finds an annotation for a check in the amount of $500 written on January 2, 2023. Since there is evidence that Mr. Doe has written the check from his account, the Eligibility Specialist can deduct the amount of the un-cashed check. The un-cashed check of $500 is an encumbrance. In determining equity value of the bank account, the encumbrance of $500 is deducted from the $1,350 in the bank account. Eligibility can be established for January 2023, if otherwise eligible.
302.30 Trust Property
(Eff. 10/01/05)
POMS SI 01120.200
The policy in this section applies to the treatment of trusts as related to SSI determinations. For information on the treatment of trusts for Medicaid purposes, refer to Chapter 304, Nursing Home, Waivered Services, and General Hospital.
A trust is a legal arrangement involving property and ownership interests. Property held in a trust may or may not be considered a resource for SSI purposes. The general rules concerning resources apply to evaluating the resource status of property held in a trust.
Trusts are often complex legal arrangements involving State law and legal principles. All trusts must be sent to the Division of Medicaid Policy and Planning at the State Department of Health and Human Services for review and a determination of the appropriate treatment of the trust.
Procedure – Trust Property For ALL Trusts, the eligibility worker must: Obtain a copy of the trust document Forward a copy of the trust document to the DHHS Division of Medicaid Policy and Planning. The Division will: Review the document and may have agency attorneys review the document and determine the appropriate treatment. Forward the determination to the county eligibility worker for the instructions to be carried out.
302.30.01 Trust Terms and Definitions
(Eff. 10/01/05)
The following are common terms associated with Trusts. (Refer to MPPM Chapter 104 – Appendix I for definitions of these and other terms.)
Term | Definition Discretionary Trust | Trustee has full discretion of the trust. He decides under what circumstances a distribution is appropriate, and the amount of any distributions. The beneficiary has NO CONTROL over the trust. Grantor | The creator of a trust. (Also known as the settlor or trustor.) Grantor Trust | The grantor is also the sole beneficiary. Mandatory Trust | Trustee is required to pay trust earnings from the principal to the beneficiary or for his use. Trustee has no discretion. Example: Specific dollar amounts are to be paid out at the beneficiary’s 25 th , 30 th , and 35 th birthdays. Residual Beneficiary | Not a current beneficiary but will receive benefits under specific circumstances. Example: Children of the grantor receive the residual benefits of the trust at his spouse’s death or remarriage. Trust | Property interest where property is held by a trustee with the duty to use the property for another’s benefit Trust Beneficiary | Person for whose benefit the trust exists. Does not hold legal title but has equitable ownership. Trust Earnings (Income) | Examples: interest, dividends, royalties, rents. Unearned income if able to use these trust earnings for support Trustee | Holds legal title to property for another person’s use or benefit. Generally, may not revoke the trust or use it for personal gaint. Trust Principal | Property placed in the trust plus any earnings paid in and left to accumulate Totten Trust | This is a tentative trust. The grantor makes himself/herself the trustee of his own funds for the benefit of someone else. If he dies, ownership passes to the beneficiary.
Table of Contents
302.30.02 Instruments Similar to Trusts
(Eff. 09/01/16)
The following accounts and instruments are similar to trusts and may be titled as trusts but may or may not be considered a resource.
Instrument | Definition | Difference from a Trust Conservator Account | Established by a court Court appointed conservator uses the account for the individual. | Beneficiary is the owner even when the assets are not available. Procedure Verification: Copy of court order appointing conservator Copy of bank statements for the conservator account Treatment: Generally, counted as a resource. (Refer to MPPM 302.10.01 .)
Instrument | Definition | Difference from a Trust Patient Trust Account | Held and maintained by institution Used for things such as toiletries, cigarettes, candy. | Patient is the owner. Procedure Obtain verification from the nursing home or institution verifying the amount in the fund and any interest from the past 3 months. Acceptable verification includes: DHHS Form 1272 ME , Request for Financial Verification from Medical Facility Written statement from the facility Eligibility worker’s documentation of a telephone statement by a member of the nursing facility’s staff Treatment: Count as resource.
Instrument | Definition | Difference from a Trust Representative Payee Account | “In trust for” account Improperly titled Best titled in both the individual and the payee’s names. | Beneficiary is the owner. Procedure Verification: Bank statements Asset Verification System (AVS) Other verification from the bank DHHS Form 1253 ME , Request for Financial Investigation (Only if unable to verify with AVS) Treatment: Count as resource.
Instrument | Definition | Difference from a Trust Totten Trust | Individual deposits his own funds into an account and holds the account as owner for the benefit of another individual. Procedure Verification: Bank statements Asset Verification System (AVS) Written statement from bank DHHS Form 1253 ME , Request for Financial Investigation (Only if unable to verify with AVS) Treatment: Any funds “held for” an individual are considered that individual’s resource.
Table of Contents
302.30.03 Use of Trust Funds
(Eff. 10/01/05)
If an individual (claimant, recipient or deemor) has legal authority to revoke the trust and then use the funds to meet his food, clothing or shelter needs, or if the individual can direct the use of the trust principal for his support and maintenance under the terms of the trust, the trust principal is a resource for SSI purposes.
The following individuals usually have the authority to revoke a trust and its assets.
Grantor
Sometimes, the grantor has the authority to revoke a trust.
Even if the power to revoke is not specifically retained, the trust may be revocable in certain situations.
State law may contain presumptions as to revocability of trusts.
If the principal reverts to the grantor at revocation and can be used for support and maintenance, the principal is a resource.
Beneficiary
Generally, does not have the power to revoke a trust.
Trust may be a resource if he has the authority to direct the use of the principal:
Under specific trust provisions
By order of the trustee
The trustee should not be considered an agent of the beneficiary unless the trust specifically states this. The opposite is true in the case of a Power of Attorney who acts as an agent.
Trustee
Trustees occasionally have the right to revoke a trust.
Trust is not a resource to the trustee on these occasions unless the trustee:
Becomes the owner at revocation.
Can withdraw and use the principal for his own support.
The trustee is considered a third party.
Totten Trust
The creator of a Totten trust has the authority to revoke the financial account trust at any time. Therefore, the funds in the account are his resource.
302.30.04 Trust Revocability and Its Effect on the Status as a Resource
(Eff. 10/01/05)
The following is used to determine when a trust is not a resource.
Individual does not have:
Legal authority to revoke the trust
Legal authority to use the assets for his own support and maintenance
The Trust is IRREVOCABLE:
By its terms and
Under State law
Grantor Trust
If Grantor is sole beneficiary, it is generally considered revocable regardless of the Trust’s language.
If there is a residual beneficiary, it is generally considered irrevocable.
Table of Contents
302.30.05 Disbursements from Trusts
(Rev.04/01/07)
Trust Principal is NOT a Resource
If the trust principal is not a resource, disbursements from the trust may be income depending on the nature of the disbursements. Regular rules to determine when income is available apply. (Refer to MPPM Chapter 301 on Income.)
Trust Principal IS a Resource
If the trust principal is a resource to the individual, disbursements from the trust principal received by the individual are not income, but conversion of a resource. (However, trust earnings, such as interest, are income.)
Trust Earnings
Trust earnings are NOT income to:
The trustee unless designated under the terms of the trust (for example, fees)
The beneficiary unless payment is made to the beneficiary
Under the terms of the trust or
By the trustee
Trust earnings are income to the individual for whom trust principal is a resource, unless the terms of the trust make the earnings the property of another.
Additions to Principal
Additions to trust principal made directly to the trust are not income to the grantor, trustee or beneficiary.
Additions to principal may be income or conversion of a resource, depending on the source of the funds. If funds from a third party are deposited into the trust, the funds are income to the beneficiary. If funds are transferred from an account owned by the individual to the trust, the funds are not income, but conversion of a resource from one account to another.
Assignment of Income
A legally assignable payment that is assigned to a trust is income for SSI purposes unless the assignment is irrevocable. If the assignment is revocable, the payment is income to the individual legally entitled to receive it.
Note: Certain payments are non-assignable by law and, therefore, are income to the individual entitled to receive the payment under regular income rules. They may not be paid directly into a trust, but individuals may attempt to structure trusts so that it appears that they are so paid. Exception: Institutional Income Trusts and Special Needs Trusts allow for placing income in a trust after receipt without the right to the payment being irrevocably assigned. Refer to MPPM 304.19 for Income Trusts and MPPM 302.30.06 for Special Needs Trusts.
Non-assignable payments include:
Family Independence (FI or TANF) payment (formerly known as Aid to Families with Dependent Children-AFDC)
Railroad Retirement Board-administered pensions
Veterans Administration pensions and assistance
Federal employee retirement payments (CSRS, FERS) administered by the Office of Personnel Management
Social Security Title II and SSI payments
Private pensions under the Employee Retirement Income Security Act (ERISA) [29 U.S.C.A. section 1056(d)]
Table of Contents
302.30.06 Special Needs Trusts
(Rev. 02/01/17)
This type of trust is designed especially for individuals under the age of 65 who meet the SSI definition of disability. Special Needs Trusts established for a disabled individual age 64 or younger are exempt from the application of the transfer of assets penalty provision. Therefore, funds placed in a Special Needs Trust established for an individual age 65 or older will be subject to a penalty for a transfer of assets for less than fair market value. Further, once an individual reaches age 65, any funds or assets placed into the trust will be considered a transfer, even if the trust was properly established by a disabled individual age 64 or younger.
Criteria
Established for the sole benefit of the disabled individual by:
Disabled Individual (Only for trusts established on or after December 13, 2016)
Individual’s spouse
A person with legal authority to act in place of or on behalf of the individual or the individual’s spouse,
A person acting at the direction or upon the request of the individual or the individual’s spouse.
Parent
Grandparent
Legal Guardian
Court
Must be funded initially with the income and/or resources of the disabled individual
Note: Assets from any individual may be placed in the trust after the initial funding.
Must contain a provision stating that at the individual’s death, the state will receive all amounts remaining in the trust up to the amount expended by Medicaid on the individual’s behalf.
Some Special Needs Trusts have a provision allowing the trustee to make loans from the trust. On or after September 1, 2003, any loan provision must be accompanied by a requirement that the trustee furnish SCDHHS with documentation of the following:
Source of the payback funds
An amortization schedule (schedule of the monthly payments of principal and interest)
Must have a reasonable rate of interest
Must be actuarially sound (that is, expected to be paid back during the person’s life expectancy).
Documentation must be provided prior to funds being disbursed for the loan.
Loans made that do not meet the above requirements are counted as income in the month received.
May be established with the individual’s income.
The income must belong to the individual and be placed in the trust after he or she has received it.
Income that is placed in the trust is not counted when determining the individual’s Medicaid eligibility. Any income, including Social Security Benefits, VA pensions, private pensions, can be placed directly in the trust by the applicant/beneficiary without it affecting the individual’s Medicaid eligibility. Also any income generated by the trust, which remains in the trust, is not counted as income.
Any payments paid by the trust directly to the individual are counted as income for eligibility purposes.
Any payments made by the trust to purchase food or shelter for the individual is considered as in-kind income for eligibility purposes.
Procedure When Trust is Established: The eligibility worker must forward copies of the trust to the Division of Policy and Planning for review and approval using Service Manager. The relationship of the individual establishing the trust to the disabled individual must be documented. At Annual Review: The eligibility worker must verify whether any money has been paid to the beneficiary to determine countable income. Request copies of bank statements or an accounting of any disbursements for the beneficiary. At the time of case closure, including death of a beneficiary : The eligibility worker must forward a copy of the trust with identifying information to: Department of Health and Human Services Division of Third Party Liability 1801 Main Street Columbia, SC 29202
Table of Contents
302.30.07 Pooled Trusts
(Rev. 08/01/08)
Pooled trusts contain the assets of individuals who meet the SSI definition of disability. Although a pooled trust may be established for beneficiaries of any age, only trusts established for a disabled individual age 64 or younger are exempt from the application of the transfer of assets penalty provision. Therefore, funds placed in a pooled trust established for an individual age 65 or older will be subject to a penalty for a transfer of assets for less than fair market value. Further, once an individual reaches age 65, any funds or assets placed into the trust will be considered a transfer, even if the trust was properly established by a disabled individual age 64 or younger.
Criteria
In order for such a trust to be exempt from the transfer of assets penalty, the trust must:
Be established and managed by a non-profit association
Example: Babcock Center
Have a separate account maintained for each beneficiary
Contain an account in the trust solely for the benefit of the disabled individual which is funded by the disabled individual, parent, grandparent, legal guardian or court; and
Contain a provision stating that at the individual’s death, the state will receive all amounts remaining in the individual’s account up to the amount expended by Medicaid on the individual’s behalf.
Although an account is established for each member of the pooled trust, funds in the trust are pooled for investment and management purposes.
302.30.08 Achieving a Better Life Experience (ABLE) Accounts
(Eff. 09/01/16)
POMS SI 01130.740;
26 U.S.C. 529A;
S.C. Code Ann. § 11-5-400-§ 11-5-460
An Achieving a Better Life Experience (ABLE) account is a type of tax-advantaged account that an eligible individual can use to save funds for the disability-related expenses of the account’s designated beneficiary, who must be blind or disabled by a condition that began before the individual’s 26th birthday.
An ABLE program can be established and maintained by a State or a State agency directly or by contracting with a private company (an instrumentality of the State). An eligible individual can open an ABLE account through the ABLE program in any State. State legislation established the South Carolina ABLE Savings Program effective April 29, 2016.
Upon the death of the designated beneficiary, funds remaining in the ABLE account, after payment of any outstanding, qualified disability expenses, reimburse the State(s) for Medicaid benefits that the designated beneficiary received.
302.30.08A Designated Beneficiary of ABLE Account
(Eff. 09/01/16)
An eligible individual can be the designated beneficiary of only one ABLE account, which must be administered by a qualified ABLE program.
The designated beneficiary is the eligible individual who established and owns the ABLE account. To be an eligible individual, he or she must be:
eligible for Supplemental Security Income (SSI) based on disability or blindness that began before age 26;
entitled to disability insurance benefits (DIB), childhood disability benefits (CDB), or disabled widow’s or widower’s benefits (DWB) based on disability or blindness that began before age 26; or
someone who has certified, or whose parent or guardian has certified, that he or she:
has a medically determinable impairment meeting certain statutorily specified criteria; or,
is blind; and,
the disability or blindness occurred before age 26.
A person with signature authority can establish and control an ABLE account for a designated beneficiary who is a minor child or is otherwise incapable of managing the account. The person with signature authority must be the designated beneficiary's parent, legal guardian, or agent acting under power of attorney. The designated beneficiary is considered to be the owner of an ABLE account, regardless of whether someone else has signature authority over it.
302.30.08B Excluded ABLE account contributions, balances, earnings, and distributions
(Rev. 09/01/21)
Exclude contributions to an ABLE account as income to the applicant or beneficiary. A contribution is the deposit of funds into an ABLE account. Any person can contribute to an ABLE account. However, the Internal Revenue Service (IRS) limits the total annual contributions that any ABLE account can receive from all sources to the amount of the per-donee gift-tax exclusion in effect for a given calendar year. For 2021, that limit is $15,000.
A contribution made by an individual into his or her ABLE account is not income to the individual. However, income received by the individual and deposited into his or her ABLE account is income to the individual.
The fact that a person uses his or her income to contribute to an ABLE account does not mean that his or her income is not countable for Medicaid as it normally would be. Income received by an applicant or beneficiary and deposited into his or her ABLE account is income to the individual. For example, an individual can have contributions automatically deducted from his or her paycheck and deposited into an ABLE account. In this case, include the income used to make the ABLE account contribution in the individual’s gross wages.
An individual cannot use direct deposit to avoid income counting.
Examples of payments that might be deposited into an ABLE account, but still are counted as income as they otherwise would be, include:
Wages;
Benefit payments (Title II, Veterans Administration, pensions, etc.); and
Mandatory Support payments (child support or alimony).
Excluded contributions include rollovers from a family member's (siblings, stepsiblings and half-siblings, by blood or by adoption) ABLE account to an individual’s ABLE account.
The funds in an ABLE account can accrue interest, earn dividends, and otherwise appreciate in value. Earnings increase the account's balance. Exclude any earnings an ABLE account receives from the income of the designated beneficiary.
Exclude the entire balance of funds in an ABLE account from resources for Medicaid determinations. SSI determinations completed by the Social Security Administration exclude up to and including $100,000 of the balance of funds in an ABLE account from the beneficiary’s resources.
Qualified disability expenses (QDE) are expenses related to the blindness or disability of the designated beneficiary and for the benefit of the designated beneficiary. In general, a QDE includes, but is not limited to, the following types of expenses:
Education;
Housing;
Housing expenses for purposes of an ABLE account are the same as they are for in-kind support and maintenance purposes, except for food. QDEs for housing are payments for:
Mortgage (including property insurance required by the mortgage holder);
Real property taxes;
Rent;
Heating fuel;
Gas;
Electricity;
Water;
Sewer; or
Garbage removal.
Transportation;
Employment training and support;
Assistive technology and related services;
Health;
Prevention and wellness;
Financial management and administrative services;
Legal fees;
Expenses for ABLE account oversight and monitoring;
Funeral and burial; and,
Basic living expenses.
A distribution is the withdrawal or issuance of funds from an ABLE account. The designated beneficiary or the person with signature authority determines when he or she makes distributions. Distributions are only to or for the benefit of the designated beneficiary. A distribution from an ABLE account is not income but is a conversion of a resource from one form to another. Do not count distributions from an ABLE account as income of the designated beneficiary, regardless of whether the distributions are for non-housing QDEs, housing QDEs, or non-qualified expenses.
Exclude from the designated beneficiary’s countable resources a distribution for a QDE other than housing if he or she retains it beyond the month received. This exclusion applies while the:
Designated beneficiary maintains, makes contributions to, or receives distributions from the ABLE account;
Distribution is unspent;
Distribution is identifiable. (NOTE: Excludable funds commingled with non-excludable funds must be identifiable.); and
Individual still intends to use the distribution for a non-housing related QDE.
302.30.08C Countable ABLE account balances and distributions
(Rev. 11/01/17)
The funds in an ABLE account are always excluded for Medicaid eligibility decisions.
A special rule applies when the balance of an SSI recipient's ABLE account exceeds $100,000 by an amount that causes the recipient to exceed the SSI resource limit--whether alone or with other resources. When this situation happens, the Social Security Administration (SSA) places the recipient into a special SSI suspension period where:
SSA suspends the recipient's SSI benefits without time limit (as long as he or she remains otherwise eligible);
The recipient retains continued eligibility for Medicaid; and
The individual’s eligibility does not terminate after 12 continuous months of suspension.
The special suspension rule does not apply when:
The balance of an individual’s ABLE account exceeds $100,000 by an amount that causes the recipient to exceed the SSI resource limit;
But the resources other than the ABLE account alone would make the individual ineligible for SSI, due to excess resources
If an individual is ineligible for any reason other than excess resources in an ABLE account, the special suspension status does not apply.
If a designated beneficiary uses a distribution previously excluded, for a non-qualified purpose or a housing-related QDE, or the individual’s intent to use it for a qualified disability expense changes, count the amount of funds used for a non-qualified expense or housing-related QDE as a resource as of the first moment of the month in which the funds were spent. Presume that the individual’s intent to use the funds for a QDE changed as of the first of the month he or she spent the funds. If an individual’s intent to use the funds for a QDE changes at any other time, but he or she has not spent the funds, count the retained funds as a resource as of the first of the following month.
302.31 Uniform Gifts to Minors Act
(Eff. 10/01/05)
POMS SI 01120.205
Most States have adopted the Uniform Gifts to Minors Act (UGMA) that permits making gifts that are tax free to minors. The UGMA is sometimes called the Uniform Transfers to Minors Act.
Under UGMA legislation:
An individual (donor) makes an irrevocable gift of money or other property to a minor (the donee);
The gift, plus any earnings it generates, is under the control of a custodian until the donee reaches the age of majority established by State law;
The custodian has discretion to provide to the minor or spend for the minor’s support, maintenance, benefit, or education as much of the assets as he deems equitable; and
The donee automatically receives control of the assets when he reaches the age of majority.
302.31.01 UGMA and Sources
(Eff. 10/01/05)
A custodian of UGMA assets cannot legally use any of the funds for his own personal benefit. Therefore,
The assets are not his resources.
Additions to or earnings on the principal are not income to the custodian who has no right to use them for his own support and maintenance.
Additions to the principal may be income to the donor before becoming part of the UGMA principal.
Example If the donor is a deemor who receives rental income and adds it to a child's UGMA funds, consider the rental income as income for deeming purposes.
302.31.02 While Donee Remains a Minor
(Eff. 10/01/05)
What IS Income to the Minor?
Custodian’s disbursements to the minor
Disbursements on behalf of the minor used to make certain third-party vendor payments
What is NOT Income?
The UGMA property
Any additions or earnings
When the Donee Reaches Age 18
(Eff. 10/01/05)
All UGMA property will become available to him.
All funds in the UGMA will count as income the month the minor reaches age 18.
Procedure – When the Donee Reaches Age 18 Verification Needed: A copy of the document of ownership such as: Certificate of Deposit Written documentation from the donor Treatment: Accept any document as valid unless there is evidence otherwise. If there is no documentation, treat as though there is no UMG A.
Table of Contents
302 Appendix A Excluded Resources
(Eff. 10/01/06)
Commonly Excluded Resources
The following chart identifies the most commonly excluded resources. It also identifies if there are limits on the value or length of time the resource may be excluded.
Resource | Limit on Value of Exclusion | Limit on Length of Time of Exclusion | Further Reference MPPM & POMS Home property Principal place of residence, including the land it sits on and other buildings on it. Vacant land if person intends to live on it and has no other residence to exclude. Funds from the sale of a home if invested timely in a replacement home | No No No | No No Yes | SI 01130.100 Automobile One vehicle regardless of value. Second vehicle if used for transportation | No | No | SI 01130.200 Life Insurance with face values totaling $10,000 or less | Yes | No | SI 01130.300 Burial funds for applicant/beneficiary and their spouse | Yes | No | SI 01130.4 10 – SI 01130.412 Burial space items owned or held by applicant /beneficiary and/or their spouse or immediate family member | No | No | SI 01130.400 – SI 01130.412 Certain pre-need burial contracts | Yes | No | SI 01130.400 – SI 01130.412 Retained SSI and Social Security Lump Sum benefits | No | Yes | SI 01130.600 Real property other than homestead Property that owner is making a bona fide effort to sell Jointly owned that can not be sold without an undue hardship (loss of housing) to the other owner | No No | No No | SI 01130.140 SI 01130.130 Household goods and personal effects | No | No | SI 01130.430 Property essential to self-support | Yes | No | SI 01130.500 – SI 01130.504 Cash (including accrued interest) received from any source at any time to replace or repair lost, damaged or stolen excluded resources | No | No | SI 01130.630 Resources of a blind or disabled person which are necessary to fulfill a Plan for Achieving Self-Support (PASS) | No | No | SI 01130.510 Federal disaster assistance received due to a Presidentially declared major disaster, including interest accumulated thereon | No | No | SI 01130.620 Tax refunds related to Earned Income Tax Credit (EITC) | No | Yes | SI 01130.67 6
Table of Contents
Less Commonly Excluded Resources
The following chart identifies the most commonly excluded resources. It also identifies if there are limits on the value or length of time the resource may be excluded.
Resource | Limit on Value of Exclusion | Limit on Length of Time of Exclusion | Further Reference MPPM & POMS Restricted, allotted Indian land if the Indian/owner cannot dispose of the land without permission of other individuals, his tribe or an agency of the Federal Government | No | No | SI 01130.150 Stock held by native Alaskans in Alaska regional or village 01/01/92 when the stock becomes a resource | No | No Radiation exposure compensation trust fund payments | No | No | SI 01130.680 German Reparation payments made to World War II Holocaust survivors | No | No | SI 01130.610 Austrian social insurance payments | No | No | SI 01130.615 Japanese-American and Aleutian restitution payments | No | No | SI 01130.683 Certain items excluded from both income and resources by other Federal statutes | Varies | No Agent Orange settlement payments to qualifying veterans and survivors | No | No | SI 01130.660 Victims compensation payments | No | Yes | SI 01130.665 State or local relocation assistance payments | No | Yes | SI 01130.670
Table of Contents
302 Appendix B Verification Procedures
(Rev. 09/01/25)
The value of resources does not have to be verified if:
The resource is totally excluded – regardless of its value, such as home property and two vehicles.
The individual alleges the total Face Value life insurance is below the excludable limit. (MPPM 302.17)
The alleged value of total countable resources exceeds the applicable limit.
The individual is ineligible for a reason other than excess resources
Reminders
The Face Value and Cash Value of all policies must be verified if the attested Face Value of life insurance is above the excludable limit.
Ownership must be verified for excluded Homestead property for all non-MAGI categories
The value and ownership of Homestead property must be verified for individuals applying for Nursing Home or HCBS.)
The equity value of a resource should be developed whenever:
The current market value of all countable resources exceeds the applicable limit,
The individual alleges a debt against the resource, and
The alleged equity value could permit eligibility.
The individual's allegation of the property's value should be accepted if:
Countable resources, including the real property, exceed the limit; and
The individual does not allege any debts against the property that would reduce countable resources to within the limit.
Table of Contents
302 Appendix C Knowledgeable Source Statements
(Eff. 10/01/05)
VERIFICATION OF FAIR AND CURRENT MARKET VALUE
OF REAL PROPERTY
Appraisal - When an appraisal is readily available, use it to establish the value of real property.
Tax Assessed Value – If an appraisal or other method of valuation is not readily available, the County Tax Assessors Office assessed value may be used, for Medicaid purposes, to establish the value of real property for eligibility. If the property was sold, use the higher of the sale price or the tax assessed value as the fair market value.
Knowledgeable Source Statement - When an appraisal is not readily available, or if the applicant/beneficiary disagrees with the tax assessed value, use the statement of a knowledgeable source that is familiar with property values in the area to verify the value of real property. The knowledgeable source must not be related to the applicant/ beneficiary or to a member of his or her immediate family.
Examples of knowledgeable sources are:
Real estate brokers
Local office of the Farmer's Home Administration or Agricultural Stabilization and Conservation Service for rural land
Banks, savings and loan associations, mortgage companies, and similar lending institutions
Official of the local property tax jurisdiction (the individual's estimate, not the office's assessment)
County Agricultural Extension Service
Knowledgeable source statements must contain the following information:
A description of the property and its condition;
The estimated value of the property;
The period of time to which the estimate applies; and
The name and business address of the person providing the estimate.
If the validity of the estimate is doubtful, obtain a second knowledgeable source statement. Always obtain a second estimate if the first estimate is less than the tax assessed value and the knowledgeable source cannot provide a reasonable explanation for the discrepancy.
Table of Contents
302 Appendix D Rebuttal of Ownership of Assets Other Than Joint Bank Accounts
(Eff. 10/01/05)
If the applicant indicates that an asset does not belong to him or did not belong to him at the time of transfer, he is required to provide documentary evidence of his claim. When the asset is not a checking or savings account, the individual must initially furnish a statement that includes:
A description of the asset in question;
The name, address, and telephone number of the alleged owner of the asset;
A written explanation from the client, or the authorized representative, justifying and explaining the inconsistent record of ownership; and
Statements and corroborative evidence from the alleged owner to include:
Supporting equity ownership; or
Indication that payments were made for the property, or indication of sustained payment of taxes and/or expenses; or
Indications that improvements were made (and paid for) to the property beyond those that would normally be expected of a non-owner.
It is the applicant’s responsibility to provide adequate supporting evidence. The eligibility worker should forward all the evidence to the Bureau of Eligibility Administration at the State Department of Health and Human Services. State office concurrence is required before approval of such a rebuttal petition.
Table of Contents
302 Appendix E Stocks, Bonds, Mutual Funds
(Eff. 10/01/05)
DESCRIPTION OF STOCKS
1. Common Stock
Common stock usually is held in the form of a certificate registered in the owner's name. Dividends usually are paid quarterly and may vary with company earnings.
“Listed” stocks are those listed on the NYSE, AMEX, or on one of the regional exchanges such as Boston, Philadelphia, or Chicago.
Over-the-Counter (OTC) stocks, which include “penny” stocks, are not listed on the major exchanges. They usually are reported in the National Association of Security Dealers Automated Quotations (NASDAQ) system.
2. Preferred Stock
Preferred stock receives preference with respect to dividends and, in case of bankruptcy, the distribution of assets. Preferred stock dividends:
Are paid at a fixed rate;
Must be paid before common stock dividends can be paid; and
Must be made up later, when not paid timely, whereas common stock dividends may be skipped.
Reading Stock Quotations
Stock tables vary little from publication to publication. The following quote is typical, showing from left to right:
The standard abbreviation of the name of the company (Philadelphia Electric in this case), followed by “pf” for preferred stock on the second line;
The dividend amount;
The price-to-earnings ratio;
Sales volume, in thousands;
The day's high, low, and closing prices (22 3/4 = $22.75); and
The change in price from the previous day.
NAME | DIV | PE | SALES | HIGH | LOW | LAST | CHG Phil El | 2.20 | 9 | 4323 | 22 7/8 | 22 5/8 | 22 3/4 | - 1/8 Phil E pf | 4.30 | - | 50 | 42 3/4 | 42 3/4 | 42 3/4 | -
Table of Contents
DESCRIPTION OF BONDS
Bonds usually are bought and sold through brokers, securities dealers, or other investors. They may sell for more or less than their face value or purchase price, depending on a variety of factors.
Reading Bond Quotations
The following is a typical bond quotation, showing from left to right:
The name of the issuer (AT&T);
The bond's nominal or coupon rate (3 7/8 percent);
The last two digits of the year in which the bond matures (1990);
The current yield (5.6 percent);
The number of bonds traded during the year (54,000);
The highest, lowest, and last price of the bond for the period covered by the quotation (bond prices are quoted on a par of 100, so the last price of 69 1/4 equals $692.50); and
The net change in the bond price.
ISSUE | CURRENT YIELD | SALES 1000's | HIGH | LOW | CLOSE | CHANGE AT&T 3 7/8, 90 | 5.6 | 54 | 69 3/4 | 69 1/4 | 69 1/4 | -3/8
Table of Contents
DESCRIPTION OF MUTUAL FUNDS
“Mutual fund” is a term that encompasses a wide range of investments. Basically, it is a pool of assets (such as stocks or bonds) managed by an investment company. A mutual fund share represents ownership interest in this pool as opposed to a particular stock or bond.
Reading Mutual Fund Quotations
The format of the following table is typical of those shown in newspapers and financial publications, showing from left to right:
The names of the funds available for each management group (in this case, four funds managed by the Fund Founders Group);
The high and low values for the preceding 52-week period;
The most recent closing price;
The change over the previous week; and
The fund's income and capital gains totals for the previous 12 months.
Fund Founders | 52 Weeks | Week's | Capital Group | H | L | Close | Change | Income* | Gains Growth n. | 8.77 | 6.28 | 6.37 | -0.08 | 0.157 | 2.505 Income n. | 15.18 | 13.72 | 13.87 | +0.01 | 1.273 | 0.232 Mutual | 11.56 | 9.74 | 9.98 | -0.07 | 0.426 | 0.706 Special n. | 37.11 | 22.88 | 23.54 | -0.13 | 1.900 | 1.395 n = no-load *= Last 12 months
Table of Contents
302 Appendix F Life Estate and Remainder Interest Tables
(Eff. 10/01/05)
(UNISEX LIFE ESTATE OR REMAINDER TABLE)
To calculate the value of a Life Estate or Remainder Interest, find the person’s age, and multiply the Current Market Value by the decimal in the appropriate column.
AGE | LIFE ESTATE | REMAINDER 0 1 2 3 4 | .97188 .98988 .99017 .99008 .98981 | .02812 .01012 .00983 .00992 .01019 5 6 7 8 9 | .98938 .98884 .98822 .98748 .98663 | .01062 .01116 .01178 .01252 .01337 10 11 12 13 14 | .98565 .98453 .98329 .98198 .98066 | .01435 .01547 .01671 .01802 .01934 15 16 17 18 19 | .97937 .97815 .97700 .97590 .97480 | .02063 .02185 .02300 .02410 .02520 20 21 22 23 24 | .97365 .97245 .97120 .96986 .96841 | .02635 .02755 .02880 .03014 .03159 25 26 27 28 29 | .96678 .96495 .96290 .96062 .95813 | .03322 .03505 .03710 .03938 .04187 30 33 32 33 34 | .95543 .95254 .94942 .94608 .94250 | .04457 .04746 .05058 .05392 .05750 35 36 37 38 39 | .93868 .93460 .93026 .92567 .92083 | .06132 .06540 .06974 .07433 .07917 40 41 42 43 44 | .91571 .91030 .90457 .89855 .89221 | .08429 .08970 .09543 .10145 .10779 45 46 47 48 49 | .88558 .87863 .87137 .86374 .85578 | .11442 .12137 .12863 .13626 .14422 50 51 52 53 54 | .84743 .83674 .82969 .82028 .81054 | .15257 .16126 .17031 .17972 .18946 55 56 57 58 59 | .80046 .79006 .77931 .76822 .75675 | .19954 .20994 .22069 .23178 .24325 60 61 62 63 64 | .74491 .73267 .72002 .70696 .69352 | .25509 .26733 .27998 .29304 .30648 65 66 67 68 69 | .67970 .66551 .65098 .63610 .62086 | .32030 .33449 .34902 .36390 .37914 70 71 72 73 74 | .60522 .58914 .57261 .55571 .53862 | .39478 .41086 .42739 .44429 .46138 75 76 77 78 79 | .52149 .50441 .48742 .47049 .45357 | .47851 .49559 .51258 .52951 .54643 80 81 82 83 84 | .43659 .41967 .40295 .38642 .36998 | .56341 .58033 .59705 .61358 .63002 85 86 87 88 89 | .35359 .33764 .32262 .30859 .29526 | .64641 .66236 .67738 .69141 .70474 90 91 92 93 94 | .28221 .26955 .25771 .24692 .23728 | .71779 .73045 .74229 .75308 .76272 95 96 97 98 99 | .22887 .22181 .21550 .21000 .20486 | .77113 .77819 .78450 .79000 .79514 100 101 102 103 104 | .19975 .19532 .19054 .18437 .17856 | .80025 .80468 .80946 .81563 .82144 105 106 107 108 109 | .16962 .15488 .13409 .10068 .04545 | .83038 .84512 .86591 .89932 .95455
Table of Contents
302 Appendix G Asset Verification System (AVS)
(Rev. 05/01/26)
Verification of Financial Accounts
Refer to MPPM 302.26.02 for policy and procedures related to determining the countable amount for bank accounts verified through AVS.
SCDHHS has implemented an Asset Verification System (AVS) to directly verify accounts located at banks and credit unions. The AVS search consists of a Financial Institution search, which is for accounts attested to by an applicant/beneficiary, and a Geographical Search (GEO Search), which identifies any additional accounts not attested to by the applicant/ beneficiary. This system will reduce or eliminate the need to request account statements from an applicant or beneficiary to either verify a current balance or to complete a look-back for a Long-Term Care application.
AVS replaces the use of DHHS Form 1233 or DHHS Form 1253 to request bank account information.
If account information is returned through AVS that results in a negative action, always contact the applicant/beneficiary to explore any possible exclusions, deductions or exemptions
Balances from the 1st day of the following month can be used as verification of the lowest monthly balance of the previous month due to “neighboring” balances. “Neighboring” refers to the AVS or bank statement balance for the subsequent month being the same as the last day of the application month or retroactive request month. Eligibility Specialists must document the use of neighboring balances on the Documentation Template.
Any responses that return account information must be uploaded into OnBase
The Action section of the Documentation Template must include a note indicating when an AVS request is created
Any accounts verified through AVS must be documented in the Resource section of the Documentation Template and in the System of Record based on the account number and type.
Note If there is a bank statement on file showing the lowest balance for the month, use the bank statement. If there is no bank statement on file, but the “neighboring” balance on the AVS result shows a lower balance, use the AVS response without requesting additional information. If the AVS “neighboring” balance does not help the individual become eligible, request a bank statement for the month(s) being assessed to determine the lowest monthly balance. Note If current bank account information necessary to complete a decision is already in the record, a new AVS request is not required to process the application or review. This includes a DHHS Form 1253 that has already been completed by a Financial Institution or statements that have been provided by an applicant or beneficiary in response to a DHHS Form 1233. An AVS request is created and then checked at the time of next review.
Applications and Reviews
When processing an application or review, check the application/review for indication of an account or accounts
Applications
If a bank account is listed on the application, create both an AVS request for the specific Financial Institution (FI) and a Geosearch
If a Financial Institution is not participating with AVS, and the Eligibility Specialist is unable to verify an account with a collateral call, use DHHS Form 1253 to request the information
Reminder: Bank statements should only be requested from the applicant after all other options to verify the reported bank account(s) have been exhausted, including 3-way collateral calls.
If no bank account is listed on the application, create a Geosearch only
For Non-MAGI, use the default date range (this range should include the application month and three months prior).
Reviews (Failed AVS Mitigation/Review Form Sent by the System)
If a bank account is listed on the review or if there is a bank account in the record, create an AVS request for the specific Financial Institution (FI)
Edit the date range so that it includes the current month only
Create a Geosearch if one has never been completed either at application or a previous review. This means that a Geosearch is requested only once for an applicant or beneficiary during a period of eligibility
If a Geosearch was created at the previous application or review, check for any responses that may have been returned since the case was processed
If a response is discovered with an unreported account, verify the account before completing a decision
Analyze the application/review to prepare for collateral calls and for any other information that may be required to complete processing
Check AVS for any responses that may have been returned prior to beginning collateral calls, so that if necessary, the information can be discussed with the applicant/ beneficiary
When collateral calls have been completed, put the case into 17-day follow-up (15 days + 2 for scanning) if:
A DHHS Form 1233 needs to be sent to the applicant/beneficiary to ask for any other information,
An AVS request was created for reported accounts at specific FI and it has not been returned when checking AVS and the account cannot be verified by a collateral call, or
Verification is required from a third party
When the case comes back into workflow, check AVS for any new responses and finish processing the case. It is not necessary to wait the full 17 (15 days + 2 for scanning) days for the AVS responses if all other information has been returned.
EXCEPTION If a request was created for accounts at a specific FI and it has not been returned when checking AVS, place the case in 17-day follow-up if the account cannot be verified by a collateral call and send a DHHS Form 1253 to the bank requesting the account information
If no information is required, check AVS for any additional responses that may have been returned while completing the collateral calls and finish making a decision on the case
Long Term Care Application for Nursing Home or In-Home Care (Waiver)
Do not ask for any bank statements from the applicant
If an account is listed on the application or DHHS Form 3400-B, create an FI and Geosearch and modify the date range to include the application month and prior 7 months for the look-back for transfers
If the application includes copies of bank statements for the current months and the seven previous months, create an FI and Geosearch
If no transfers are indicated on the bank statements, the application can be processed as soon as all other information is returned without waiting the 15 days using the provided bank statements. At the next review, check for any responses that may have been returned
If a possible transfer is indicated on the bank statements, wait at least 17 (15 days + 2 for scanning) days for the AVS responses to be returned
If the applicant is currently receiving ABD or SLMB, use the information in the case record to complete a modified look-back and create a request adjusting the date range as appropriate
Analyze application to prepare for collateral calls and for any other information that may be required to complete processing
Prior to beginning collateral calls, check AVS for any responses that may have been returned
If a DHHS Form 1233 is required or if a request for information is sent to a third party, put the case in 17 (15 days + 2 for scanning) day follow-up
When the case comes back into workflow, check AVS for any additional responses
If no additional information is required once collateral calls have been completed, check AVS for any new responses and process the case as appropriate
If a request was created for a specific FI and has not been returned by the end of the 17 (15 days + 2 for scanning) day follow-up period and you are unable to obtain the information from the applicant/beneficiary or by a collateral call, send a DHHS Form 1253 to the bank requesting the account information.
Reminder
Bank statements should only be requested from the applicant after all other options to verify the reported bank account(s) have been exhausted.
Non-MAGI Exparte and Long Term-Care Passive Renewal Cases
Non-MAGI beneficiaries will either be renewed for current Non-MAGI coverage, ex parte to another category, or receive an Annual Review Form. Non-Magi beneficiaries who are auto-renewed will not receive an Annual Case Review Form.
Long Term Care beneficiaries will be passively renewed for the current coverage category. Some Long-Term Care beneficiaries will receive an Annual Review Form if the case fails any part of the test.
All beneficiaries who receive an Annual Case Review Form from Cúram, including Long-Term Care beneficiaries, must be processed for a full case review.
NOTE: During the Non-MAGI ex parte process, one spouse may pass all system tests and renew without any additional information. The other spouse may fail system tests and not auto-renew. The one spouse that does not renew will be sent an Annual Review Form by Cúram. When the Review Form is returned, both spouses must be reassessed. If the Annual Review is not returned, coverage will be end-dated for both spouses according to adverse action rules.
CGIS Manual Chapter 7 for additional information.
Asset Verification System Workflow Non-MAGI Application Use the default date range Review Edit date range to current month Long Term Care New Application: Edit the date range to complete the required look-back for transfers Current ABD Eligible: Edit Date Range to current month and any period when a transfer may have occurred Current SSI Eligible Do not complete a look-back No longer SSI Eligible Edit beginning Date Range to end of SSI coverage