|
Effective: October 1, 2007 |
|
|
19.40.20.05ar1 - Transfers Made for Purposes Other Than to Qualify for MA (Archive) |
Archived: August 1, 2008 |
Presume that the transfer was made for the purpose of obtaining or maintaining MA eligibility unless the client provides convincing evidence that it was not. Uncompensated transfers do not result in penalties if the client can show that the transfer was made exclusively for a purpose other than to obtain or maintain eligibility for MA payment of LTC services.
Transfers That Are Not Made for Another Purpose.
Give clients the opportunity to demonstrate that an uncompensated transfer was made exclusively for a purpose other than qualifying for MA payment of LTC services. Verbal assurances and statements signed by the client are not sufficient without further documentation. Evaluate each situation on a case-by-case basis.
Consider the following to be convincing evidence:
l Assets would be below the applicable limit even if the transferred asset had been retained.
n For applicants, total countable assets including the transferred asset must be within the asset limit at all times from the month in which the transfer occurred through the month in which the person requests MA payment for LTC services.
n For enrollees, total countable assets including the transferred asset must be within the asset limit in the month in which the transfer occurred.
Example:
Walter resides in an LTCF and has been receiving MA payment for LTC services since February 2006. In August 2007, Walter has countable assets of $2400. He gives his grandson $25 for a birthday gift.
Action:
Because Walter’s assets of $2400 were below the $3000 limit before he gave $25 to his grandson, consider the transfer to have been made for a purpose other than maintaining MA eligibility for payment of LTC services. The transfer is not subject to a penalty.
Example:
Marjorie resides in a LTCF. At the time of her annual renewal, her assets total $3200 because of her accumulated clothing and personal needs allowance. She gives her daughter $200 to reduce her assets to within the limit.
Action:
Evaluate the $200 for a possible transfer penalty. Giving away assets is not an allowable way to reduce assets.
l The client documents that the transfer was beyond his or her control, such as a court-ordered payment.
l The client demonstrates that the need for long-term care could not have been anticipated at the time of the transfer.
Example:
Ge, age 44, applies for MA payment of LTC services in August, the month he was admitted to the LTCF due to complications from a stroke. At the time of the application, he reports a transfer of $20,000 to his daughter made in May.
Action:
The worker determines a transfer penalty and notifies Ge of that penalty.
Ge’s wife, his authorized representative, contacts his worker immediately upon notification of the denial of LTC services. She states that Ge gave the money to his daughter to pay for her wedding and a down payment on a house.
Action:
The worker requests documentation to show that the transfer was not made to obtain or maintain MA eligibility.
A physician statement indicates Ge was in good health with no reason to anticipate a stroke when he completed a physical in April.
Action:
Based on the evidence, Ge could not anticipate the need for LTC services and the transfer was not made to obtain or maintain assistance. Ge’s eligibility for payment of MA LTC services is approved.
l The client demonstrates an unexpected loss of other assets or income which would have caused ineligibility for MA.
Example:
George enters an LTCF and applies for MA payment of LTC services. He reports giving his daughter $20,000 two years ago. He had expected to be able to pay privately if he needed long-term care in the future. However, six months later, his former employer suffered major financial losses, reducing the value of George’s pension and stock holdings. His assets are now within MA limits and his income is not sufficient to pay all of his long-term care costs.
Action:
The worker reviews the evidence and determines that George’s income and assets would have been sufficient to meet his long-term care costs if his pension and stocks had not lost value unexpectedly. The gift to the daughter was not done to obtain eligibility for MA payment of LTC services and will not result in a transfer penalty.
l The client demonstrates a well-established history of making regular contributions to a religious organization to which he or she belongs.
Example:
Rudy has been a member of St. Angelo’s Church for 45 years. He provides church records showing that he has made annual donations of $500 every year since 1984. He enters a LTCF and applies for MA for payment of LTC services.
Action:
Rudy’s contributions to St. Angelo’s during the lookback period will not be evaluated for a transfer penalty because he has demonstrated that these gifts were not made for the purpose of becoming eligible for MA.
l The client provides proof of intending to receive fair market value.
Transfers That Are Not Made for Another Purpose
Transfers made for the following purposes are always treated as if they were made for the purpose of establishing or maintaining MA eligibility:
l Preserve the estate for the heirs.
l Avoid probate.
l Reduce taxes.