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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 69 Chapter 24 Long Term Care

When the penalty period is divided between spouses, the total penalty period applied to both spouses must not exceed the total penalty which remained at the time the penalty was divided. When, for any reason, one spouse is no longer subject to a penalty, such as, when the spouse no longer receives nursing facility services, or dies, the penalty period which was remaining for both spouses must be served by the remaining spouse. A recording in each affected case must specifically explain the division of the penalty period. Division of the Penalty Period Example 1: Mr. Aster enters a nursing care facility and applies for Medicaid. Mrs. Aster transfers a resource that results in a 36-month penalty against Mr. Aster. After 12 months into the penalty period, Mrs. Aster enters a nursing care facility and becomes eligible for Medicaid. The penalty period against Mr. Aster still has 24 months to run. Because Mrs. Aster is now in a nursing care facility, and a portion of the original penalty period remains, the remaining 24 months of the penalty must be divided equally between Mr. and Mrs. Aster. Division of the Penalty Period Example 2: Mr. Juniper is in a nursing facility and applies for Medicaid. Two months before his application he transferred resources to become eligible for Medicaid and a 10-month penalty begins. Two months into the penalty, Mrs. Juniper refuses an inheritance left to both of them because she is afraid it will adversely affect his future eligibility for nursing care coverage. The next month, Mrs. Juniper becomes eligible for HCBS. The Worker inquires about resource transfers and is told about the refusal of the inheritance. This is a transfer of resources. A penalty period is determined to be 12 months. Mr. Juniper continues to serve his 10-month penalty. The other penalty period begins the month after the 10-month period ends. His second penalty lasts six months (half of the 12-month period for his wife's transfer of their resource). Mrs. Juniper receives a six-month penalty period which begins the month she is otherwise eligible to receive an institutional level of care. ➢ Application of the Penalty The only penalty for transferring resources is delayed or lost eligibility for nursing facility, ICF/IID, or HCBS care. The client is approved, if otherwise eligible, for any other applicable Medicaid coverage group.