Asset Considerations 510-05-70-10

(Revised 8/1/13 ML #3373)

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IM 5297

(N.D.A.C. Section 75-02-02.1-25)

 

Assets, not otherwise excluded, that are available to an applicant or recipient and that are in excess of the Medicaid asset limits are considered to be available to meet the medical needs of the applicant or recipient and cause ineligibility for Medicaid. An asset is any kind of property interest, whether real, personal, or liquid.

1. All assets which are actually available must be considered in establishing eligibility for Medicaid. Assets are actually available when at the disposal of an applicant, recipient, or responsible relative; when the applicant, recipient, or responsible relative has a legal interest in a liquidated sum and has the legal ability to make the sum available for support, maintenance, or medical care; or when the applicant, recipient, or responsible relative has the lawful power to make the asset available, or to cause the asset to be made available. Asset availability is also as follows:

1. An individual may have rights, authority, or powers, which he or she does not wish to exercise. Examples include individuals who choose not to collect a secured debt or individuals who believe family disharmony would result from the sale of the individual's interest. It is important to distinguish the individual's desire to avoid a sale from an absence of any right, authority, or power to sell. In such cases, the value of the property will be counted as an available asset whether or not the applicant or recipient pursues selling the asset. Likewise, Medicaid does not require an individual to begin foreclosure against a note in default. However, because the individual has the authority to do so, the current value of the note will be counted as an available asset.
2. When an applicant or recipient files bankruptcy, it is necessary to consider the terms of the bankruptcy and to determine which assets are included in the bankruptcy. Any assets that are exempt from the bankruptcy are considered available assets for Medicaid purposes.
3. When an applicant or recipient is a creditor to someone else who files bankruptcy, determine if the applicant or recipient has any security on the debt. If there is security (e.g. the debt is a contract for deed or promissory note on real property), the asset is considered to be available. If there is no security, the asset is not considered to be available.
4. Occasionally, some children receive money through the Uniform Gift to Minors Act. These funds are considered available to the child for Medicaid purposes. A minor, or if under age 14, someone acting on their behalf, can request that the funds be made available to meet the needs of the child.
5. Funds from a loan that must be repaid, including a reverse mortgage, and that the applicant or recipient demonstrates are for a purpose unrelated to achieving Medicaid eligibility, are not considered to be available assets if identifiable as a loan and if not commingled with other assets.
6. The surrender or equity value of any money, insurance, or other property given to another person or entity to be held for the use of a member of the Medicaid unit is considered to be held in trust and is available to the extent provided in 510-05-70-50 (Trusts).
7. When an applicant or recipient has paid an entrance fee or deposit to a continuous care retirement community or a lifecare community, the entrance fee or deposit is considered  an available asset to the extent that:

1. The individual has the ability to use the funds, or the contract provides that the funds may be used, to pay for care;
2. The individual is eligible for a refund of any remaining funds when the individual dies or leaves the community; or
3. The payment or deposit does not confer an ownership interest in the community.

8. Many benefit programs deposit an individual’s monthly benefit onto a debit card. Any balance remaining on these debit cards are considered a liquid asset beginning the month following the month it was deposited on the card and counted as income. Examples of these benefit programs are TANF benefits, Unemployment Insurance Benefits (UIB), Child Support benefits, Workforce Safety and Insurance (WSI), Social Security Administration Benefits (SSA), etc.
9. Individuals may either purchase for themselves or receive as gifts or bonuses items such as gift cards, debit cards, pre-paid credit cards and in-store credits. Regardless of the source, any of these items that an applicant or recipient has in the month following the month of receipt are considered available assets.
10. Payments made to a provider for an individual’s client share when the client share has not as yet been applied to the individual’s bill are not considered available assets once the individual is eligible and the client share has been determined.

 

Example 1: Ida Maypole applied for Medicaid and was approved with a $500 client share starting in January. She is in a Basic Care facility and knows her monthly bill will exceed her client share. She pays her client share every month on the first. In July, the eligibility worker gets an alert that Ida has not incurred her client share. To date, the facility has not billed Medicaid. Because Ida was informed of her client share, what she paid at this time is not a countable asset for Ida because she was informed of her client share and paid it for services received.

 

NOTE: If it is later determined that Ida did not actually incur her client share due to a 3rd-party payor such as Medicare paying all or part of the bill, at the time this is discovered, the unapplied client share IS counted as an available asset.

 

Example 2: Donald Duck applied for Medicaid and was approved with a client share of $785 per month. Donald is in receipt of HCBS services at home, however, the wrong living arrangement was entered, and his HCBS claims are not being applied to his client share. Donald knows his client share and has been paying it to his HCBS provider monthly. His credit balance with his provider is not an available asset because once the living arrangement is corrected, claims will be adjusted and his client share will be incurred.

 

2. The financial responsibility of any individual for any applicant or recipient of Medicaid is limited to the responsibility of spouse for spouse and parents for a disabled child under age eighteen. Such responsibility is imposed as a condition of eligibility for Medicaid. Except as otherwise provided in this section, the assets of the spouse and parents are considered available even if those assets are not actually contributed. For purposes of this paragraph, biological and adoptive parents, but not stepparents, are treated as parents.

 

3. All spousal assets are considered actually available unless:

1. A court order, entered following a contested case, determines the amounts of support that a spouse must pay to the applicant or recipient;
2. The spouse from whom support could ordinarily be sought, and the property of such spouse, is outside the jurisdiction of the courts of the United States;
3. The applicant or recipient has been subject to marital separation, with or without court order, the parties have not separated for the purpose of securing Medicaid benefits; or
4. In cases where spousal impoverishment applies, the assets are those properly treated as belonging to the community spouse.

Pre-nuptial, or post-nuptial, agreements have no affect and do not allow spousal assets to be considered unavailable.

 

4. All parental assets are considered actually available to a disabled child under age eighteen unless the child is living:

1. Independently; or
2. With a parent who is separated from the child's other parent, with or without court order, if the parents did not separate for the purpose of securing Medicaid benefits. Only the assets of the parent the child is residing with must be considered.

 

5. Assets received from the estate of a spouse, or a parent who was providing support, are available as of the date of the person's death. Assets received from any other estate are available at the earlier of:

1. The day on which the assets are received from the estate; or
2. Six months after the person's death.

 

6. Transfers of an applicant or recipient's property made by someone with a confidential relationship, whether to themselves or to a third party, for which 100% of fair market value was not received, are not considered to be transfers without adequate compensation when an applicant or recipient is not competent, or if competent, does not approve. In these situations, regardless of when the transfer was made, the uncompensated value is considered to be available to the applicant or recipient because the person who made the transfer must account for and replace any amounts lost by the applicant or recipient.

See the definition for "Someone in a Confidential Relationship," 510-05-80-05, for additional information.