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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 42 Chapter 24 Long Term Care

24.8.2.A.3 Institutionalized Individual An institutionalized individual is: • An individual who is an inpatient in a nursing facility, or who is an inpatient in a medical institution, and for whom payment is made for a level of care provided in a nursing facility; or, • An individual who is a HCBS waiver participant. For purposes of this section, a medical institution includes intermediate care facilities for individuals with intellectual disabilities (ICF/IID). 24.8.2.A.4 Resources Resources include all income and assets of the individual and of his spouse that are counted for SSI-Related Medicaid purposes. This includes some income or assets which the individual or the spouse is entitled to, but does not receive, because of any action or inaction by: • The individual or his spouse; • A person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or the individual's spouse; or • Any person, including a court or administrative body, acting at the direction or upon the request of the individual or the individual's spouse. Resources to which an individual or spouse is entitled include resources to which the individual is actually entitled, or would be entitled if action had not been taken to avoid receiving the resources. Examples of actions which cause income or assets not to be received are: • Irrevocably waiving pension income; • Waiving an inheritance; • Not accepting or accessing injury settlements; • Settlements which are diverted by the defendant into a trust or similar device to be held for the benefit of the plaintiff; or