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Effective: January 1, 2007 |
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19.55.15ar1 - Home Equity Limit Exceptions (Archive) |
Archived: September 1, 2008 |
Certain people are excluded from application of the home equity limit when determining eligibility for MA payment of LTC services.
No Request for Payment of LTC Services.
Request Prior to January 1, 2006.
Request for January 1, 2006 – June 30, 2006.
Dependent Relative Lives In Home.
No Request for Payment of LTC Services.
Do not apply the home equity limit to MA applicants and enrollees not requesting payment of LTC services.
Example:
Jonah applies for MA for himself and his son on July 1 because he has several large doctor bills. He owns the home in which they are living, and it has an equity value of $700,000.
Action:
Jonah is not applying for MA payment of LTC services. Do not apply the home equity limit.
Request Prior to January 1, 2006
Do not apply the home equity limit to people requesting MA payment of LTC services prior to January 1, 2006 and who have not had a break in LTC services.
Follow instructions presented in Application Forms, for clients requesting MA payment of LTC services, after a break in LTC services. See Applying the Home Equity Limit for instructions on when to apply the limit for these clients.
Example:
Vadim is currently enrolled in MA Elderly Waiver and has been since December 2004. He lives alone in his home, which he owns. The home has an equity value of $500,500.
Action:
Check Vadim’s eligibility records to determine if he has received MA Elderly Waiver without a break in LTC payment coverage since applying prior to January 1, 2006.
Vadim has not had a break in eligibility payment of LTC services since his application.
Action:
Do not apply the home equity limit at annual or six-month renewals because Vadim has been continuously enrolled for MA payment of LTC services since prior to January 1, 2006.
Vadim decides he wishes to end the Elderly Waiver services in his home, and request MA Elderly Waiver closed for November 1, 2006. He remains enrolled in regular MA. On January 12, 2007 Vadim requests payment of LTC services to cover the costs of a facility placement. He was admitted to the LTC facility on January 10.
Action:
Apply the home equity limit when determining Vadim’s eligibility for MA payment of LTC services for January 2007 because there was a break in coverage of over one calendar month.
Request for January 1, 2006 – June 30, 2006
For clients requesting MA payment of LTC services on or after January 1, 2006 and prior to July 1, 2006:
l Do not apply the home equity limit at the time of request, at the time of processing the request or at the six-month renewal if there has not been a break in LTC services.
l Do apply the limit at the following times:
n The first annual renewal and all annual renewals thereafter. See LTC/EW Home Equity Limit for more information.
n A request for payment of LTC services after a break in LTC services.
Do not apply the home equity limit to people who do not own the home occupied as the primary dwelling prior to the request for payment of LTC services.
Example:
Eva is applying for MA payment of LTC services in October 2006. She lived with her daughter for two years prior to her admission to an LTC facility in September. Her daughter owns the home.
Action:
Eva does not own the home in which she lived. Do not apply the home equity limit.
Dependent Relative Lives In Home
Do not apply the home equity limit to people whose dependent relative lives in the home owned by the applicant or enrollee.
Dependent relatives include:
l Spouse.
l Children of the client or the client’s spouse who are either:
n Under 21 years of age. The client or the client's spouse must be the child's legal guardian or legal custodian.
n Of any age and who are blind or permanently and totally disabled.
Example:
Ivana and Donald are married and live in the home they have owned for 25 years. The equity value of the home is $800,000. Due to failing health, Donald applies for MA payment of LTC services on July 10, 2006.
Action:
Do not apply the home equity limit when determining Donald’s MA payment of LTC services because his wife, Ivana, a dependent relative, lives in the home.