29.10 Determination of countable resources

In general. Countable resources are determined by combining the resources of the members of the financial responsibility group, as described in § 29.03, and comparing them to the resource standard of the Medicaid group, as described in § 29.04. Countable resources are determined for different types of Medicaid groups: adults without spouses, adults with spouses, children, and individuals requesting Medicaid coverage of long- term care services and supports. If the resources of the Medicaid group fall below or are equal to the applicable resource standard, the resource test is passed. If an excess resource amount remains after all exclusions have been applied (see § 29.08), the individual has not passed the resource test. An individual may become eligible for MABD by spending down or giving away excess resources as provided in § 30.00 subject to transfer of resource rules (see § 25.00) for those seeking Medicaid coverage of long-term care services and supports. Determining countable resources for individuals other than children. The general rule in paragraph (a) above is followed to determine whether total resources, after exclusions, of an individual other than a child falls below the resource maximum for one. Determining countable resources for individuals with spouses and not in long-term care. The general rule in paragraph (a) above is followed to determine whether the total resources, after exclusions, of an individual living with their spouse and requesting MABD, other than Medicaid coverage of long-term care services and supports under MABD, falls below the resource maximum for two. Financial Methodologies Part 5 – Page 41 (Sec.29.00, Sub.29.10) Determining countable resources for children Unless otherwise specified in the coverage group rules at §§ 8.05 and 8.06, the countable resources of an eligible child are determined by: (i) Combining the resources of the parents living with the child with the child’s resources, until the child reaches the age of 18; (ii) Subtracting the resource maximum for one, if one parent, or two, if two parents, from the parent’s countable resources; and (iii) Deeming and adding the remainder to the child’s own countable resources. If the child’s total countable resources fall below the resource maximum for one, the resource test is passed. Determining countable resources for individuals requesting Medicaid coverage of long term care services and supports under MABD who have spouses. For an individual requesting Medicaid coverage of long-term care services and supports under MABD who has a spouse, the resource evaluation process of assessment and allocation is performed as set forth in this paragraph at the beginning of the first continuous period of long-term care. An individual discharged from long-term care and readmitted later does not undergo these steps again; only the resources of, and any new transfers by, the readmitted individual are counted. An institutionalized spouse (sometimes referred to in this rule as the “IS”) who receives additional resources after allocating less than the community spouse resource allocation (CSRA) maximum27 to their community spouse (sometimes referred to in this rule as the “CS”) and being found eligible for Medicaid coverage of long-term care services and supports under MABD, may, until the first annual review of their eligibility, continue to transfer resources to the CS up to a combined total transfer of no more than the CSRA maximum. After the IS’s first regularly- scheduled annual redetermination of eligibility, no further transfers are allowed even if the CSRA maximum has not been allocated to the CS; the rules regarding transfers apply after the IS’s first regularly-scheduled annual redetermination (see § 25.00). Assessment of resources for individuals with community spouses. At the time of admission to long-term care and application for Medicaid coverage of long-term care services and supports under MABD, including long-term care services and supports in a home and community-based setting, AHS completes an assessment of resources. An individual or their spouse may also request a resource assessment prior to admission to long-term care. AHS provides a copy of the assessment to each spouse and retains a copy. The assessment must include at least: (i) The total value of countable resources in which either spouse has an ownership interest; (ii) The basis for determining total value; (iii) The spousal share or one-half the total; 27 For the current CSRA maximum, see Vermont’s Eligibility Standards for Healthcare Programs on the Department of Vermont Health Access website. Financial Methodologies Part 5 – Page 42 (Sec.29.00, Sub.29.11) (iv) Conclusion as to whether the IS would be eligible for MABD based on resources; (v) The highest amount of resources the IS and CS may retain and still permit the IS to be eligible; (vi) Information regarding the transfer of assets policy; and (vii) The right of the IS or the CS to a fair hearing at the time of application for MABD. Allocation of resources for individuals with community spouses (i) An allocation of resources is completed at the time of the IS’s application for Medicaid coverage of long-term care services and supports under MABD, as follows: The total countable resources of the couple are determined at the time of the application for Medicaid coverage of long-term care services and supports under MABD, regardless of which spouse has an ownership interest in the resource; The greatest of the following is deducted: (I) CSRA maximum; (II) Amount set by a fair hearing, or (III) Amount transferred from the IS to the CS under a court order. (ii) The remaining resources allocated to the IS are compared to the resource maximum for one to determine whether or not the IS passes the MABD resource test. If the IS does not pass the resource test, see the spenddown provisions at § 30.00. (iii) The resources of the CS are considered available to the IS until the month after the month in which the IS becomes eligible for Medicaid coverage of long-term care services and supports under MABD. If the CS fails to make the resources accessible to the IS, after AHS has determined that they are available, AHS may still grant the IS Medicaid coverage of long-term care services and supports under MABD if: The IS assigns any rights to support from the CS to AHS; or Denial of Medicaid coverage of long-term care services and supports would work an undue hardship, as specified in § 25.05. (iv) The CS is provided with the amount determined to be the share of the CS (or to someone else for the sole benefit of the CS). Any transfer of resources from the IS to the CS must be completed by the next review of eligibility of the IS. The transfer will be verified at the next regularly scheduled redetermination of the IS’s eligibility. (v) For purposes of allocation, an “assisted living” facility is considered a community setting and not an institution for long term care provided that the assisted living facility does not include 24-hour care, has privacy, a lockable door, and is a homelike setting. An IS is permitted to allocate income and resources to a CS when the CS resides in an assisted living facility.