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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 66 Chapter 24 Long Term Care

▪ Penalty for Transfers during the Look-Back Period Examples Example 1: Mr. Ivy enters the nursing facility and applies for Medicaid in October 2024. The individual transferred $50,000 in April 2024. Based on the average private pay nursing facility rate of $11,903 a month, the penalty is four whole months, beginning October 2024 when Mr. Ivy was otherwise eligible for and receiving an institutional level of care that would have been covered by Medicaid, if not for the imposed penalty. A partial month’s penalty of $2,388 is imposed for February 2025. Mr. Ivy is required to pay this amount to the nursing facility, in addition to the calculated monthly contribution. See Length of Penalty below. Example 1.1: Same situation as above, but during the penalty period the Worker discovers an additional, undisclosed transfer that occurred during the look-back period. The penalty period is recalculated to include the undisclosed transfer of resources. Example 2: Ms. Fern enters a nursing facility in January 2024 and applies for Medicaid in October 2024 with a request for backdated coverage to August 2024. Ms. Fern transferred $19,000 in January 2024, $19,000 in February 2024 and $19,000 in March 2024. The Worker must calculate the penalty period by adding the transfers together. The total of $57,000 is divided by the nursing facility cost of $11,903. The penalty period is four whole months, beginning in August 2024, because the individual requested backdated coverage to August 2024, and was otherwise eligible for and receiving institutional level of care that would have been covered by Medicaid, if not for the imposed penalty. A partial month’s penalty for December 2024 of $9,388 is also imposed. Ms. Fern is required to pay this to the nursing facility, in addition to his calculated monthly contribution. See Length of Penalty below for partial month penalties. Example 2.1: Same situation as above, but after the penalty period ends and Ms. Fern is receiving Medicaid, the Worker discovers an undisclosed transfer occurred during the look-back period. A penalty is assessed, and advance notice of an additional transfer penalty is sent to Ms. Fern. ➢ Transfers During a Penalty Period When an individual is in a penalty period and transfers additional resources during the penalty, a new penalty period begins as soon as the previous penalty ends. All penalties for resources transferred on or after March 1, 2009 run consecutively.