December 1973 Eligibility Requirements

1040.010.00 GENERAL PROVISIONS

IM-142, September 15, 2020; IM-22, March 17, 2005;  IM-15, January 27, 2003;  IM-42, June 23, 1994

Beginning August 11, 1993, nursing facility benefits (vendor level of care) and HCB services must be denied to participants who have transferred resources for less than fair market value within 60 months prior to the date the participant is first institutionalized and has applied for or is receiving Medicaid.  Institutionalized individual for transfer-of-property purposes means a participant who has entered a Medicaid certified bed in a nursing facility (NF), ICF-MR, Mental Hospital at least age 65 or under age 21, or entry into the Personal Care Services program.  All further references in the Transfer of Property policy to vendor benefits or institutionalization apply to any type of vendor facility and to HCB services.

NOTE:  Transfers that occur on or after July 1, 1989, for non-institutionalized individuals will NOT render participants ineligible for non-vendor levels of coverage assistance.  Explore these types of transfers at the time they are reported or discovered.   Should the participant later become institutionalized, these provisions apply.

  1. The period of ineligibility for each transfer for institutionalized participants begins with the date the resource was transferred.  The number of months of ineligibility equals the total uncompensated value of the resource divided by the statewide average cost to a private pay patient at the time of application for vendor level services.
  2. Transfers for less than fair market value are NOT penalized in the following circumstances:
    1. the property was the home of this institutionalized individual and it was transferred to:
      • the spouse;
      • a child who is either under age 21 OR who is blind or permanently and totally disabled;
      • a sibling with an equity interest who has resided there for at least one year immediately prior to the participant’s institutionalization;
      • a son or daughter caretaker who has resided there for at least two years immediately prior to the institutionalization.  ‘Caretaker’ means the son or daughter provided care in the home that allowed the participant to remain at home rather than be institutionalized.

      NOTE:  Consider a transfer of the home to persons other than those listed above as a transfer of property.  The home includes all adjoining acreage.  Evaluate these cases to determine if fair and valuable consideration was received.

    2. property other than the home was transferred to the community spouse or to a blind or permanently and totally disabled child.
    3. the property was intended to be disposed of for fair and valuable consideration.
    4. property other than the home was transferred solely for a purpose other than qualifying for assistance.