Eligibility Online Manual
M801 Counting Resources
Purpose: This section will assist in determining which resources should be counted.
Current Policy Effective Date: April 1, 2021
Date Last Reviewed: March 26, 2021
Previous Policy: February 1, 2019
POL M801: COUNTING RESOURCES
1. Most Aged, Blind, and Disabled Programs and Medicare Savings Programs Count Resources
Resources are exempt from consideration for the EID Program.
2. Resources of Spouse May Be Available to Other Spouse
Resources of a spouse are available to the other spouse.
Resources of a spouse are not available the month after the marriage ends or the month after the married couple are separated and not living in the same household.
3. Resources of Parent(s) May Be Available to a Child
The resources of a natural parent, adoptive parent or stepparent are available to a child except:
A child who is disabled and has received or is receiving SSI while in an institution.
A child who is applying for the Comprehensive, Support or Children’s Mental Health Waiver.
4. Proceeds From Selling an Resource Must Be Considered Resources
Proceeds from the sale of an exempt or nonexempt resource are countable and the client must be within the maximum resource limit to remain eligible. Refer to Table 7 to see resource standards.
5. Equity Value Must Be Calculated
The equity value of a resource is calculated by using the cash, trade-in, or current market value and subtracting the unpaid principal or amount of the lien(s). Equity value is used to determine eligibility.
6. Fair Market Value (FMV) Is Selling Price
Current or FMV is the selling price on the open market as set by current standards. FMV may be determined by a market analysis or appraisal by a realtor, or other knowledgeable sources who are familiar with property values in a given community.
7. Resources May Be Re-Appraised
An applicant or client may obtain a new appraisal for a resource when the value of a resource(s) causes ineligibility and the applicant or client disputes the value.
8. Commingled Resources May Be Exempted
Exempt resources commingled with non-exempt resources when identifiable.
Assistance units should be encouraged to separate exempt and nonexempt resources.
9. Resources Must Be Evaluated from the First of the Month
10. Income Must Not Be Counted as a Resource in First Month
Calculate the available bank account balance, by deducting any income received in the first month, when the individual is over the maximum resource limit.
11. Acquired Resources and Resources Increasing in Value Count in Next Month
Resources acquired within a month and resources increasing in value are counted in the following month.
12. Outstanding Checks Must Be Considered Legal Encumbrances
Outstanding checks must be considered legal encumbrances when evaluating a checking account. Deduct any outstanding checks written and delivered to the payee prior to the first of the month that have not cleared, when the individual is over the resource limit.
13. Qualified Long Term Care Insurance Partnership Policies Must Be Reviewed by WDH
Qualified Long Term Care Insurance Partnership policies must be sent to WDH to determine if the policy meets the criteria of a qualified partnership policy.
14. Resources May Be Disregarded through a Qualified Long Term Care Insurance Partnership
Disregard any resources claimed by the applicant in an amount equal to or less than the benefits paid on behalf of the individual by a Qualified Long Term Care Insurance Partnership policy for the following programs:
Institutional Related
HCBS Waivers
The disregarded resources can include a resource that is exempt for eligibility but not for estate recovery (i.e. home).
Reference:
Defining Requirement: 20 CFR 416, Subpart L
42 CFR 435, Subpart G
Clarifying Information:
Worker Responsibilities:
Determining Countable Resources
1. Refer to Medicaid Table 8 for information on Countable Resources.
Determining Amount of Resources that Can Be Disregarded Through A Qualified Long Term Care Insurance Partnership Policy
1. Disregard the resources claimed on the Qualified Long Term Care Insurance Partnership Asset worksheet in an amount equal to or less than the benefits paid on behalf of the individual by a Qualified Long Term Care Insurance Partnership policy.
2. Applicant must claim these resources at initial application and then additional resources at review.
3. Additional resources can be exempted as the policy continues to pay towards the long term care services.
Example:
Qualified Long Term Care Insurance Partnership Disregard
Example 1
A Qualified Long Term Care Insurance Partnership policy has paid $50,000 on behalf of John Doe. Mr. Doe has a CD worth $50,000 that was claimed on the Qualified Long Term Care Insurance Partnership Asset worksheet, this amount can be disregarded before testing against the resource standard. Mr. Does is eligible for benefits.
Example 2
A Qualified Long Term Care Insurance Partnership policy has paid $75,000 on behalf of Jane Smith. Mrs. Smith has a savings account worth $75,000 that was claimed on the Qualified Long Term Care Insurance Partnership Resource worksheet. In addition she has real property worth $25,000. The $75,000 can be disregarded, the $25,000 is a countable resource and must be tested against the standard. Mrs. Smith is not eligible for benefits.