NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
Family Services, Department for Medicaid Services has responsibility to
administer the Medicaid Program.
KRS
205.520(3) authorizes the
cabinet, by administrative regulation, to comply with any requirement that may
be imposed, or opportunity presented, by federal law to qualify for federal
Medicaid funds. This administrative regulation establishes the resource
standards for determining eligibility for Medicaid benefits.
Section 1. Resource Limitations.
(1) For an individual whose Medicaid
eligibility is determined using a resource standard, the upper limit for
resources for a family size of:
(a) One (1)
shall be $2,000;
(b) Two (2) shall
be $4,000; or
(c) Three (3) or more
shall be $4,000 plus fifty (50) dollars added for each additional member over
the initial two (2) members.
(2)
(a) For
a qualified disabled and working individual, resources shall be limited to the
low income subsidy limits established by the Centers for Medicare and Medicaid
Services pursuant to
42
U.S.C.
1395w-
114(a)(3)(D).
(b) For a qualified Medicare beneficiary, a
specified low-income Medicare beneficiary, or a Medicare qualified individual
group 1(QI-1), resources shall be limited to three (3) times the allowable
amount for the SSI program.
(3) Resources shall be limited to the amounts
allowed in the SSI program for:
(b) A person with hemophilia who received a
settlement in a class action lawsuit as described in
907
KAR 20:005; or
(c) A child who lost supplemental security
income eligibility due to the change in definition of childhood disability as
established in
907
KAR 20:005.
(4) In accordance with
42
U.S.C.
1396p, an individual shall not be
eligible for Medicaid nursing facility services or other Medicaid long-term
care services if the individual's equity interest in his or her home exceeds
the amount established in
42
U.S.C.
1396p(f) unless:
(a) The individual has a spouse who is
lawfully residing in the individual's home;
(b) The individual has a child under the age
of twenty-one (21) who is lawfully residing in the individual's home;
or
(c) The individual has a child
of any age who is blind or permanently and totally disabled who is lawfully
residing in the individual's home.
(5) There shall be no resource test or
standard for:
(a) An individual for whom a
modified adjusted gross income is the Medicaid eligibility standard;
or
(b) An individual between the
age of nineteen (19) and twenty-six (26) years who:
1. Formerly was in foster care; and
2. Aged out of foster care while receiving
Medicaid coverage.
Section 2. Resource Exclusions.
(1)
(a) A
homestead, household or personal effects, or farm equipment shall be excluded
from consideration without limitation on value.
(b) After permanent institutionalization,
property shall cease to be a homestead unless:
1. A spouse or other dependent family member
continues to reside there; or
2. A
signed statement verifies that the permanently-institutionalized individual
intends to return to the homestead.
(c) The signed statement shall:
1. Be signed by:
a. The permanently-institutionalized
individual;
b. A representative
payee;
c. A person who has power of
attorney for the individual;
d. The
individual's guardian; or
e.
Another legal representative; and
2. Be renewed annually.
(2) For an adult Medicaid case,
the requirements established in this subsection shall apply.
(a)
1.
Equity of $6,000 in income-producing, nonhomestead real property, business or
nonbusi-ness, essential for self-support, shall be excluded from consideration.
2. The value of property, including
the tools of a tradesperson or the machinery or livestock of a farmer, shall be
excluded from consideration as a resource if the property:
a. Is essential for self-support for the
individual or spouse, or family group in the instance of a family with a child;
and
b. Is used in a trade or
business or by the individual or member of the family group as an
employee.
(b)
Except as provided in paragraph (c) of this subsection, equity of $4,500 in
automobiles shall be excluded from consideration.
(c) If an automobile is used as a home, for
employment, to obtain medical treatment of a specific or regular medical
problem, or is specially equipped for use by an individual with a disability,
the total value of the automobile shall be excluded.
(d) A payment or benefit from a federal
statutory program, other than an SSI benefit, shall be excluded from
consideration as a resource if precluded from consideration in an SSI
determination of eligibility by the specific terms of the statute.
(3) For an ABD Medicaid case:
(a) Real property or nonreal property shall
be excluded from consideration if it can be demonstrated the individual is
making a reasonable effort to sell the property at fair market value or for
other valuable consideration.
(b)
1. Property which previously was a homestead
shall no longer be considered a homestead at the point an individual becomes
permanently institutionalized.
2.
a. Non-homestead property which was
previously the homestead property of a permanently-institutionalized individual
shall be excluded for six (6) months if there is a verified effort to sell the
property at fair market value.
b.
If a party on behalf of the permanently institutionalized individual
demonstrates to the department, every six (6) months subsequent to the initial
six (6)-month period, a continuing effort to sell the property referenced in
clause a. of this subparagraph at fair market value, the department shall
continue to exclude the property from resource consideration.
3. Reasonable effort to sell the
property shall consist of:
a. Listing the
property with a real estate agent if the agent:
(i) Places a "For Sale" sign on the property
which is clearly visible from the nearest public road; and
(ii) Advertises the property in the local
newspaper, a local television or radio station, or the internet; or
b. A combination of at least two
(2) of the following actions:
(i) Advertising
the property in the local newspaper or on local television or radio
stations;
(ii) Placing a "For Sale"
sign on the property which is clearly visible from the nearest public
road;
(iii) Distributing fliers
advertising the property for sale;
(iv) Posting notices regarding availability
of the property on community bulletin boards; or
(v) Showing the property to interested
parties on a continuing basis.
(c) Proceeds from the sale of a home shall be
excluded from consideration for three (3) months from the date of receipt if
used to purchase another home.
(4) A burial reserve of up to $1,500 per
individual, which may be in the form of a burial agreement, prepaid burial or
similar arrangement, trust fund, life insurance policy, savings account,
checking account, or other identifiable fund, shall be excluded from
consideration.
(a) For an adult Medicaid case,
the cash surrender value of life insurance shall be considered if determining
the total value of burial reserves.
(b) If a burial fund is commingled with
another fund, the applicant shall have thirty (30) days to separately identify
the burial reserve amount.
(c)
Interest or other appreciation of value of an excluded burial reserve or space
shall be excluded as a resource if the amount is left to accumulate as a part
of the burial reserve or space.
(5) A burial trust, burial space, plot,
vault, crypt, mausoleum, urn, casket, or other repository which is customarily
and traditionally used for the remains of a deceased person shall be excluded
from consideration as a countable resource without regard to value.
(6) An individual development account up to a
total of $5,000, excluding interest accruing, shall be excluded from
consideration as a resource.
(7)
Disaster relief assistance shall be excluded from consideration.
(8) Cash or in-kind replacement for repair or
replacement of an excluded resource shall be excluded from consideration if
used to repair or replace the excluded resource within nine (9) months of the
date of receipt.
(9) A life
interest that a Medicaid applicant or recipient has in real estate or other
property shall be excluded from consideration as an available
resource.
(10) Real property other
than the homestead shall be excluded from consideration if:
(a) The property is jointly owned and its
sale would cause loss of housing for the other owner or owners;
(b) Its sale is barred by a legal impediment;
or
(c) The owner's reasonable
efforts to sell by informing the public of his or her intention to sell the
property at fair market value have been unsuccessful.
(11) A cash payment intended specifically to
enable an applicant or recipient to pay for a medical or social service shall
not be considered as a resource in the month of receipt or for one (1) calendar
month following the month of receipt. If the cash is still being held at the
beginning of the second month following its receipt, it shall be considered a
resource.
(12) An amount received
which is a result of an underpayment or a retroactive payment of benefits from
Retirement, Survivors, and Disability Insurance or SSI shall be excluded as a
resource for the first six (6) months following the month in which the amount
is received.
(13) A federal
Republic of Germany reparation payment shall not be considered as an available
resource.
(14) An amount received
from a victim's compensation fund established by a state to aid victims of
crime shall be:
(a) Completely excluded as a
resource if the individual can show that the amount was paid as compensation
for expenses incurred or losses suffered as a result of a crime; or
(b) Excluded as a resource for nine (9)
months if the individual can show that the amount was paid for pain and
suffering.
(15) An
Austrian social insurance payment based on a wage credit granted under Sections
500-506 of the Austrian General Social Insurance Act shall be excluded from
resource consideration.
(16) An
individual retirement account, Keogh plan, or other tax deferred asset shall be
excluded as a resource until withdrawn.
(17) A payment made from a fund established
by a settlement in the case of Susan Walker v. Bayer Corporation or payment
made for release of claims in this action shall be excluded from consideration
as an available resource.
(18) A
payment received from a class action lawsuit entitled "Factor VIII or IX
Concentrate Blood Products Litigation" shall be excluded from consideration as
an available resource.
(19) An
annuity that is irrevocable and cannot be sold or transferred shall be excluded
from consideration as a resource.
(20) Except for real property pursuant to
subsection (10) of this section, a jointly held resource shall be considered as
a countable resource for an applicant.