SSI-Related Medicaid Resource Eligibility Criteria

DEPARTMENT OF CHILDREN AND FAMILY SERVICES
Economic Self-Sufficiency Program

RULE NO.: RULE TITLE:
65A-1.712: SSI-Related Medicaid Resource Eligibility Criteria

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 38 No. 8, February 24, 2012 issue of the Florida Administrative Weekly.

(2) Exclusions. The Department follows SSI policy prescribed in 20 C.F.R. § 416.1210 and 20 C.F.R. § 416.1218 (2011) in determining resource exclusions, with the exceptions in paragraphs (a) through (g)(f) below, in accordance with as adopted by the Department under 42 U.S.C. § 1396a(r)(2) (2010).

(e) One automobile is excluded, regardless of value.

(e) through (f) relettered (f) through (g) No change.

(3)(a) The Department follows the policy for transfer of resources in accordance with mandated by 42 U.S.C. §§ 1396p (2010) and 1396r-5 (2010). Transfer policies apply to the transfer of income and resources.

(b)2.a. Certain Ttransactions, such as additions of principal to an existing annuity or electing to annuitize an existing annuity that occurs on or after November 1, 2007 make an annuity (including an annuity purchased before November 1, 2007) subject to the transfer of resources provisions unless the criteria of 2.(a) through 2.(d) above are met.

(d)4. A life estate interest purchased in another individual’s home on or after November 1, 2007 (and within the look back period) is considered a transfer of resources for less than fair market value. If the individual has not lived in the home for at least one year after the date of the purchase, the full amount of the purchase price paid for the life estate will be considered an uncompensated transfer without considering the value of the life estate. If the individual who purchased the life estate has resided in the home for at least one continuous year after the date of the purchase, the value of the life estate will be considered compensation and will be calculated by multiplying the current market value of the property at the time of the purchase by the life estate factor that corresponds to the individual’s age at the time of the purchase. The life estate tables can be found on from the Social Security Administration’s website at https://secure.ssa.gov/apps10/poms.nsf/lnx/0501140120 online Program Operations Manual System (SI 01140.120) (04/99), can be found in Appendix A-17 of the Department’s online manual located at http://www.dcf.state.fl.us/programs/access/esspolicymanual.shtml. Brief absences from the life estate property such as stays in a rehabilitation facility or vacations may not disrupt the client’s residency in the home. The facts of each absence will be evaluated to determine if the home continued to be the individual’s principal place of residence such as whether the person’s mail was delivered and received there or whether they paid the property taxes.

(g) For transfers prior to November 1, 2007 (and within the look back period), periods of ineligibility are calculated beginning with the month in which the transfer occurred and shall be equal to the actual computed period of ineligibility, rounded down to the nearest whole number. For transfers made on or after November 1, 2007 (and within the look back period), periods of ineligibility begin with the later of the following dates: (1) the day the individual is eligible (pursuant to Rules 65A-1.711 through 65A-1.713, F.A.C.) for Medicaid and would be receiving institutional level care services in a nursing home facility, an institution with a level of care equivalent to that of a nursing facility, or home or community based services furnished under a waiver based on an approved application for such care but for the application of the penalty period; or (2) the first day of the month in which the individual transfers the asset; or (3) the first day following the end of an existing penalty period. The Department shall not round down, or otherwise disregard, any fractional period of ineligibility of the penalty period but will calculate the period down to the day. There is no limit on the period of ineligibility. Once the penalty period is imposed, it will continue although the individual may no longer meet all factors of eligibility and may no longer qualify for Medicaid long-term care benefits, unless all assets or income are returned to the individual or fair market value compensation is paid for the transferred assets or income. If all transferred assets or income are returned to the individual, the penalty period is eliminated. Eligibility must be evaluated with returned assets included as though the individual had never transferred the assets or income. Returned assets or income must be counted as available when determining eligibility for retroactive months. Penalty periods will not be shortened when only a partial return is made.

(4) Spousal Impoverishment. The Department follows policy in accordance with 42 U.S.C. § 1396r-5 (2010) for resource allocation and income attribution and protection when an institutionalized individual, including a hospice recipient residing in a nursing facility, has a community spouse. Spousal impoverishment policies are not applied to individuals applying for, or receiving services under, HCBS Waiver Programs, except for individuals in the Long-Term Care Community Diversion Program, the Assisted Living Facility Waiver or the Cystic Fibrosis Waiver.

(5)(a) The Department follows the policy for home equity interest in accordance with 42 U.S.C. § 1396p.(f). Individuals shall not be eligible for ICP, Institutional Hospice or HCBS Waiver Programs on or after November 1, 2007, if the equity interest in the home exceeds the home equity limit $525,000.

2. Unless evidence to the contrary is on file or is received, accept the individual or designated representative’s statement for the as to equity value of a home that is more than $25,000 below the home equity limit less than $500,000. For equity values within $25,000 of the home equity limit value of $500,000 or more, the individual or designated representative must provide verification of current market value and indebtedness. Verification of the current market value must be obtained from a knowledgeable source commonly involved in the housing industry in the geographic locale, such as a real estate broker, mortgage broker, property appraiser, or builder. The verification must include the current market value, the name of the person providing the estimate, and the contact information of the business or agency for whom the person providing the estimate works.

3. Paragraph (5)(a) above does not apply if the individual’s spouse, individual’s child under age 21 or the individual’s blind or disabled child (in accordance with based on the federal definitions of “blindness” in 20 C.F.R. §§ 416.981-416.986 (2011), and “disability” in 20 C.F.R. §§ 416.905-416.906) (2011), of any age is residing in the institutionalized individual’s home.

5. The Department will mail a Nnotice of Excess Home Equity Interest, CF-ES 2354, 05/2012, incorporated by reference, to individuals whose home equity interest exceeds the home equity limit $525,000 (Form CF-ES 2354, 02/2007, Notice of Excess Home Equity Interest, incorporated herein by reference), advising of the opportunity to have the home equity interest policy waived.

(c) The Department follows SSI policy prescribed in 20 C.F.R. § 416.1208 in determining SSA’s Program Operations Manual System, SI 01120.010 and SI 01140.215 with regard to block accounts as countable resources. SSI policy requires resources in a blocked account to be countable resources. This applies regardless of whether the individual or their representative is required to petition the court to withdraw funds for the individual’s care. A blocked account is one in which state law protects an individual’s funds by specifically requiring that the funds be made available for the care and maintenance of the individual.

IF REQUESTED WITHIN 7 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: June 6, 2012, 1:30 p.m.

PLACE: 1317 Winewood Boulevard, Building 3, Room 455, Tallahassee, Florida 32399-0700

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 3 days before the workshop/meeting by contacting: Cindy Keil. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Cindy Keil, Economic Self-Sufficiency Program, [phone], 1317 Winewood Boulevard, Tallahassee, Florida 32399-0700, [e-mail]