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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 68 Chapter 24 Long Term Care

Penalty Calculation Example: Mr. Cactus makes an uncompensated transfer of $24,534 in the month of application for Medicaid coverage of nursing facility services. Step 1: $24,534 Uncompensated transfer amount ÷ $11,903 State’s average monthly nursing facility private pay rate

2.06 Number of months for penalty period Step 2: $11,903 State’s average monthly nursing facility private pay rate

x 2 Whole months in penalty period

$23,806

Step 3: $24,534 Total uncompensated transfer amount -$23,806 Amount for two whole months in period

$728 Partial month’s penalty amount If Mr. Cactus applies in July and is otherwise eligible, the penalty period runs for two full months from July through August, with a partial month’s penalty calculated for September of $728. The September partial month’s penalty amount of $728 is added to the calculated September contribution for his cost of care. If Mr. Cactus had a $500 monthly contribution, he would be required to pay $1,228 for the cost of care in September. 24.8.2.J.3 Who Is Affected by the Penalty The institutionalized client is affected by any transfer described above when he or his spouse or any entity acting on their behalf or at their direction transfers an asset. When the three following conditions are met, any remaining penalty period is divided equally between the institutionalized person and spouse: • The spouse transferred resources which resulted in ineligibility for the institutionalized client; • The spouse either is eligible for or applies for Medicaid and is, then, an institutionalized individual; and, • Some portion of the penalty against the original institutionalized spouse remains when the above conditions are met. If the penalty period is not equally divisible, the extra month in the penalty period is assigned to the spouse who actually transferred the resource.