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Effective: September 1, 2008 |
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19.55.10ar2 - Applying Home Equity Limit (Archive) |
Archived: January 1, 2011 |
The home equity limit policy is applied only in specific situations and at certain times.
For home equity limit policy processing steps, see LTC Home Equity Limit.
When Not to Apply the Home Equity Limit Policy
Do not request information or review the home equity limit policy:
l when an exception to the home equity policy applies.
l at six-month renewal for a client subject to the home equity limit.
When to Apply the Home Equity Limit Policy
Apply the home equity limit policy at the following times:
l When a request for MA payment of LTC services is made, if the request:
n Was made on or after July 1, 2006.
n Is made after a break in LTC services occurring on or after July 1, 2006, regardless of when the first request for payment was made.
l At annual renewal for enrollees approved for MA payment of LTC services under a request filed on or after July 1, 2006.
l When an exception ends or begins.
Example:
Louis enters a LTC facility on October 18, 2006. He applies for MA, including MA payment of LTC services, on the same day and requests three months of retroactive coverage. He owns his own home and lives alone. The FMV of his home is $300,000. Louis did not receive LTC services prior to entering the LTC facility.
Action:
Apply the home equity limit policy when determining Louis’ eligibility for MA payment of LTC services as of October 1. Louis’ home's FMV is below the home equity limit. If he meets all other eligibility criteria he is eligible for MA payment of LTC services.
Do not apply the home equity limit policy when determining Louis' eligibility for MA payment of non-LTC services. The home equity limit policy also does not apply to Louis’ request for retroactive coverage for MA payment of non-LTC services.
Example:
Katie is applying for MA on November 5, 2006, and is approved for Elderly Waiver (EW) services. She lives in her own home. Katie's home equity interest is $600,000.
Action:
Katie is applying for MA payment of LTC services because she wants MA to pay for her EW services. Although her home is excluded as her homestead for MA eligibility, the home equity limit must still be applied because Katie is requesting MA payment for EW services. Katie’s home equity interest is above the home equity limit. She is ineligible for MA payment of LTC services.
Example:
Paul applied for MA payment of LTC services on June 22, 2006. He did not begin receiving MA payment of LTC services until August 1, 2006, due to a short transfer penalty. He met all other MA and MA payment of LTC services eligibility criteria. His annual renewal is due in June 2007.
Action:
Apply the home equity limit at Paul's first annual renewal and at each annual renewal thereafter.
Example:
Joan was determined to be ineligible for MA payment of LTC services on September 16, 2006, because her home equity interest was above $500,000; however, she continued to be eligible for MA payment of non-LTC MA covered services.
On December 20 Joan submits evidence verifying her home equity interest was reduced to $480,000 on November 22. She requests MA payment of LTC services retroactive to October 1.
Action:
Joan is ineligible for MA payment of LTC services for the month of October because her home equity interest was above the home equity limit. However, she is eligible for MA payment of LTC services beginning November 1 if she meets all other MA and MA payment of LTC services eligibility criteria, because her home equity interest was verified as less than the home equity limit in November.
Example:
Herb is an MA enrollee receiving Elderly Waiver (EW) services since July 2006. He currently lives in his home with his wife. On August 10 Herb’s wife dies.
Action:
Herb met an exception to the home equity limit at the time of his request for MA payment of LTC services Herb because his wife lived in the home.
Apply the home equity limit upon the death of his wife because Herb no longer meets an exception.
Note: The home equity limit must be applied even though Herb lives in the home and the real property (homestead) is excluded as an available asset.