Penalty Periods 510-05-80-15

(Revised 2/04 ML #2900)

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(N.D.A.C. Section 75-02-02.1-33.1)

 

 

  1. The number of months and days of ineligibility for an individual shall be equal to the total uncompensated value of all income and assets transferred by the individual, or individual's spouse, on or after the look-back date, divided by the average monthly cost, or daily cost as appropriate, of nursing facility care in North Dakota at the time of application.

The following example demonstrates how the monthly and daily period of ineligibility is calculated:

 

Example:  On December 10, 2002, Mr. Brown made a disqualifying transfer of $70,000.  He applied for Medicaid on July 18, 2003.  The average cost of nursing facility care at the time of application is $3945 per month and $129.71 per day.  $70,000 divided by $3945 is 17.74 months.  Seventeen months at $3945 per month is $67,065, leaving $2935 to which the daily rate is applied.  $2935 divided by $129.71 is 22.63 days.  Mr. Brown's penalty period is 17 months and 23 days (partial days are rounded up).

  1. The period of ineligibility begins the first day of the month in which the income or assets were transferred for less than fair  market value, or if that day is within any other period of ineligibility under this chapter, the first day thereafter that is not in such a period of ineligibility.

For Example: Mr. Smith made a disqualifying transfer in January of last year that resulted in a ten-month period of ineligibility. The period begins the first day of the month of transfer, January, and goes through October. In July of last year, he made a second disqualifying transfer that resulted in a 12-month period of ineligibility. Because the month of transfer, July, was already within a period of ineligibility, the 12-month period from the second transfer only begins in November, and goes through October of this year.

  1. If a transfer results in a period of ineligibility for an individual receiving nursing care services, and the individual’s spouse begins receiving nursing care services and is otherwise eligible for Medicaid, the period of ineligibility shall be apportioned equally between the spouses. Any months remaining in the period of ineligibility must be assigned or reassigned to the spouse who continues to receive the nursing care services if one spouse dies or stops receiving nursing care services.