*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: January 1, 2011 |
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19.55.15 - Home Equity Limit Exceptions |
Archived: June 1, 2016 (Previous Versions) |
The home equity limit does not apply in certain circumstances. This section explains the exceptions to applying the home equity limit when determining eligibility for MA payment of LTC services.
No Request for Payment of LTC Services.
Annual Renewal of MA-LTC Eligibility When No Break in LTC Services Occurred.
Does Not Own or Have an Ownership Interest in a Home.
Dependent Relative Lives In Home.
Waiver of Home Equity Limit for Demonstrated Hardship.
No Request for Payment of LTC Services.
Do not apply the home equity limit to MA applicants and enrollees not requesting MA 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.
Annual Renewal of MA-LTC Eligibility When No Break in LTC Services Occurred
The home equity limit does not apply to annual renewals for enrollees who have continuously received MA payment of LTC services under a request for MA-LTC filed before January 1, 2006.
The home equity limit policy does apply if the enrollee experiences a break in LTC services, part or all of which occurs on or after January 1, 2006.
Follow instructions presented in Application Forms, for clients requesting MA payment of LTC services after a break in services. See Applying the Home Equity Limit for instructions on when to apply the home equity limit for these clients.
Example:
Vadim decides he wishes to end the Elderly Waiver services in his home, and requests that MA EW be closed for October 1, 2010. He remains enrolled in MA for payment of non-LTC services. On January 12, 2011, 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 2010, because he experienced a break in LTC services that occurred on or after January 1, 2006.
Does Not Own or Have an Ownership Interest in a Home
Do not apply the home equity limit to people who do not own, or have an ownership interest in the home they currently occupy, or that they occupied as their primary dwelling immediately prior to receiving LTC services.
Note: Please review the glossary definition of home as it applies to the home equity limit.
Example:
Eva applies for MA payment of LTC services in October 2011. She lived with her daughter for two years prior to her admission to an LTC facility in September. Her daughter is the sole owner of the home.
Action:
Eva does not own the home or have an interest in the home she occupied as her primary dwelling prior to her request for MA payment of LTC services. Do not apply the home equity limit.
Dependent Relative Lives In Home
Do not apply the home equity limit if a dependent relative of the client lives in the client’s home.
For purposes of the home equity limit policy, dependent relatives include:
l Spouse.
l Children of the client or the client’s spouse who are either:
n Under 21 years of age.
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, 2010.
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.
Waiver of Home Equity Limit for Demonstrated Hardship
A demonstrated home equity limit hardship is an imminent threat to a person’s health and well-being if MA payment of LTC services is denied. A hardship is demonstrated by supporting documentation provided by either the client or the client’s authorized representative. Documentation of a hardship must be evaluated on a case-by-case basis.
Requests for a waiver of the home equity limit based on hardship must be made in writing by either the client or the client’s authorized representative.
The client must provide documentation showing that there are no other resources available to pay for long-term care and one of the following conditions apply:
l The client’s application for a reverse mortgage or home equity loan has been turned down by at least two financial institutions.
l The client is a joint owner of a home and one or more joint owners refuse to apply for a reverse mortgage or home equity loan in a joint application with the client.
Note: A hardship is not demonstrated if the client’s spouse is the only joint owner refusing to apply for a reverse mortgage or home equity loan.
l There is a legal barrier to the sale of the client’s ownership interest in the home or to the approval of a reverse mortgage or home equity loan.
Review the facts and documentation provided to determine whether a waiver of the home equity limit should be granted.
l Provide a decision within 30 days of the receipt of the written request if all necessary information has been provided.
l Grant an extension if more time is needed to provide the documentation.
l Send the client and, if applicable, the authorized representative, a written notice of decision using the Notice of Action for Payment of LTC Services (DHS-4915).