524 MEDICAID EXCEPTIONS TO APA RESOURCE POLICY
The value and count-ability of resources is determined according to the criteria of the APA program, except as provided below.
524 A. REASONABLE COMPATIBILITY
Reasonable compatibility refers to the standard used to address discrepancy between the client stated resources and information from an electronic data source.
Information from an electronic data source (in this case, AVS in IEVS ) is reasonably compatible if is results in the same eligibility outcome as the client stated information.
This policy change does not alter other program requirements for which resources must be verified or how resources are counted for program eligibility.
Note:
Actual resource information must be used for Long Term Care cases and Medicaid cases that use a Medicaid qualifying trust.
Actions:
The reasonable compatibility test will only be applied to resources that have not otherwise been verified (for example, if a recipient submits bank statements as part of their renewal or if the resource has been verified by another program). It can only be applied when resource information is available through AVS .
Example 1:
Shania is due for her Medicaid renewal and previously reported the following countable resources:
Savings account: $5 (A)
AVS returns the following information:
Savings account: $200 (match with A)
Undisclosed checking account: $800 (new)
Reasonable Compatibility Determination:
Medicaid Resource Limit: $2,000
Result: reasonably compatible because the sum of both calculations is less than the resource limit. No further verification is requested from Shania. Client statement is used to determine resource eligibility.
Example 2:
Johnny is due for his Medicaid renewal and previously reported the following countable resources:
Checking account: $500 (A)
Savings account: $700 (B)
Savings bond: $300 (B)
AVS returns the following information:
Checking account: $800 (matched with A)
Savings account: $400 (matched with B)
Undisclosed checking account: $900 (new)
Reasonable compatibility determination:
Medicaid Resource Limit: $2,000
Result: not reasonably compatible because the sum of countable resources from AVS is above the Medicaid resource limit. In this case, the $700 savings account amount is used when calculating the total countable resources as it is the higher amount when comparing the client stated and AVS information. Verification of countable resources is required.
Example 3:
Dolly is due for Medicaid renewal and previously reported the following countable resources:
Checking account: $1000 (A)
Savings account: $500 (B)
AVS Returns the following information:
Checking account: $2000 (match with A)
savings account: $2500 (match with B)
Reasonable compatibility determination:
Medicaid Resource Limit: $2,000
Result: not reasonably compatible because the sum of countable resources from AVS is above the Medicaid resource limit. Verification of countable resources is required.
524 B. COMMUNITY SPOUSE RESOURCE ALLOWANCE
Resources may be transferred from the Long Term Care spouse to his or her community spouse to meet the eligibility resource limit (see Addendum 1 for current year allowance amount) to qualify for Medicaid under the Special Long Term Care eligibility category. See Section 553.
The APA policy regarding conditional benefits at APA Manual Section 433-2 does not apply. Medicaid does not provide conditional benefits.
The APA policy regarding property up for sale at APA Manual Sections 432-1D and 433-2 does not apply in Medicaid-only determinations. Medicaid has no exemption for property up for sale.
The APA policy regarding transfer of resources at APA Manual Section 433-1 does not apply to Medicaid-only determinations. See Section 554 for Medicaid transfer of asset policy for institutional or waiver applicants and recipients. Federal income tax returns are not subject to Medicaid transfer of asset penalty provisions for 12 months from the date the payments are received. However, payments given away after the exempt period are subject to Medicaid transfer of asset penalty provisions.
524 F. INSTITUTIONAL ALLOTMENT OF RESOURCES
The APA policy regarding financial responsibility of spouses who no longer live together at APA Manual Section 460-2(A) does not apply to institutional or waiver applicants. See Section 553-D for resource eligibility determination and allotment of resources policy.
524 g. INSTITUTIONALIZED INDIVIDUALS WITH SUBSTANTIAL HOME EQUITY
The APA policy regarding exemption of an individual’s home, regardless of its value, APA Manual Section 432-1, does not apply to institutional or waiver applicants for payment of long-term care services. See Section 553-C for resource eligibility determination and allotment of resources policy.
524 H. PROMISSORY NOTES, LOANS, AND PROPERTY AGREEMENTS
For transfer of asset purposes only, the APA policy regarding promissory notes, loans, and property agreements. APA Manual Section 431-2(I) does not apply to institutional or waiver applicants. See Section 554-H for purchase of promissory notes, land, or mortgages policy.
For transfer of asset purposes only, the APA policy regarding life estates. APA Manual Section 431-1(B)(6) does not apply to institutional or waiver applicants. See Section 554-J for purchase of life estates policy.
524 J. RESOURCE LIMIT FOR THE WORKING DISABLED BUY-IN CATEGORY
The APA policy regarding the resource limit at APA Manual Section 430-2 does not apply to the Working Disabled Buy-In category. See Section 534-B for the resource limit.
524 K. INDIVIDUAL INDIAN MONEY ACCOUNTS
Funds deposited or held in an Individual Indian Money (IIM ) account are excluded. However, once funds are removed from an IIM account, they become a countable resource.
IIM accounts primarily contain money collected by the federal government from farming and grazing leases, timber sales, mining, oil and gas production, and other activities on trust land, as well as certain per capita distributions. The funds in IIM accounts are held in trust by the federal government for the benefit of individual Indians.
524 L. ALASKA NATIVE AND AMERICAN INDIAN REAL PROPERTY RESOURCE EXCLUDED
All real property in Alaska owned by an Alaska Native or American Indian is excluded from being a countable resource or as a potential transfer of asset penalty. This includes land and any structures built on the land. The real property does not need to be Native restricted land for this exclusion to apply.
If real property has been determined to be excluded as a resource using the policy described above, it should not be counted as a resource for any other household members' Medicaid eligibility.
Note:
Alaska Native property shall remain exempt if it passes from AN/AI to one or more relatives, such as a spouse or a child. even if the relatives are not AN/AI.
Certain Alaska Native Americans who served in the Armed Forces during the period between August 5, 1964, and December 31, 1971 and haven't received a Native Allotment may receive up to 160 acres in Alaska from the Dingell Act. This land is an exempt resource.
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