Current through 2024-38, September 18, 2024
Once it has been established that a transfer of assets for
less than Fair Market Value occurred within the look back period, the penalty
period must be determined.
Any penalty imposed under this Chapter will apply only to
State-Funded Assistance. No penalty under this Chapter will be applied to other
state services or Medicaid services for which the individual qualifies.
There are three different methods of calculating the penalty
period as follows.
I. If there has
been only one transfer during the look back period:
A. Determine the date that each transfer
occurred.
B. Determine the amount
of the transfer.
C. Divide the
amount of the transfer by the average monthly private rate for a semi-private
room for a nursing facility at the time of application (see Chapter 332,
Charts, Chart 4.3). This determines the number of whole months of ineligibility
based on the transfer.
D. When the
value of the transfer is less than the average monthly private rate for a
semi-private room for a nursing facility in (see Chapter 332, Charts, Chart
4.3), or the penalty calculation includes a partial month, the partial month
shall be counted and implemented as a period of ineligibility using the
following method:
1. After determining the
amount of transfer and dividing that amount by the average monthly private rate
for a semiprivate room for a nursing facility, impose a period of ineligibility
for the whole months.
2. Convert
the remaining partial month into a dollar amount by multiplying the number of
whole months by the monthly private rate used in the calculation above, and
subtracting that figure from the total amount of the transfer.
3. This remainder is added to the cost of
care for the first month of eligibility after imposing the penalty period.
Example:
If the monthly private rate is $6,000 and the transfer amount
is $56,400, this would result in a transfer penalty of 9.4 months. To determine
the remainder amount, you would take $6,000 X 9 months = $54,000. $56,400 -
$54,000 = $2,400. You would add $2,400 to the cost of care for one month. If
the penalty period begins March 1st, it would end November 30th. $2,400 would
be added to the cost of care for December.
In an instance where the penalty period is less than a full
month, the partial month penalty will be added to the cost of care in the first
month a cost of care is due.
Example:
The individual enters a Residential Care Facility on November
27th. There is a partial month transfer penalty of $3000. A cost of care will
be due beginning with the month of December. The $3000 partial month transfer
penalty will be added to the December cost of care.
II. If there has been
more than one transfer in the same month, the penalty period is determined as
follows:
A. Determine the total, cumulative,
value of all transfers in the same month.
B. Divide the amount by the average monthly
private rate for a semiprivate room for a nursing facility at the time of
application (see Chapter 332, Charts, Chart 4.3). This determines the number of
whole months of ineligibility.
C.
When the value of the transfer is less than the average monthly private rate
for a semi-private room for a nursing facility (see Chapter 332, Charts, Chart
4.3), or the penalty calculation includes a partial month, the partial month
shall be counted and implemented as a period of ineligibility using the
following method:
1. After determining the
amount of transfer and dividing that amount by the average monthly private rate
for a semiprivate room for a nursing facility, impose a period of ineligibility
for the whole months.
2. Convert
the remaining partial month into a dollar amount by multiplying the number of
whole months by the monthly private rate used in the calculation above, and
subtracting that figure from the total amount of the transfer.
3. This remainder is added to the cost of
care for the first month of eligibility after imposing the penalty period. In
an instance where the penalty period is less than a full month the partial
month penalty will be added to the cost of care in the first month a cost of
care is due.
III. If there have been multiple transfers in
more than one month during the look-back period, all transfers can be added
together into one penalty period using the following method:
A. Add all transfer amounts
together.
B. Divide the amount by
the average monthly private rate at the time of application for a semiprivate
rate for a nursing facility (see Chapter 332, Charts, Chart 4.3). This
determines the number of whole months of ineligibility.
C. The transfer is treated as one transfer
and is treated as if it occurred on the earliest date of the multiple
transfers.
D. When the value of the
transfer is less than the average monthly private rate for a semi-private room
for a nursing facility (see Chapter 332, Charts, Chart 4.3), or the penalty
calculation includes a partial month, the partial month shall be counted and
implemented as a period of ineligibility using the following method:
1. After determining the amount of transfer
and dividing that amount by the average monthly private rate for a semiprivate
room for a nursing facility, impose a period of ineligibility for the whole
months.
2. Convert the remaining
partial month into a dollar amount by multiplying the number of whole months by
the monthly private rate used in the calculation above, and subtracting that
figure from the total amount of the transfer.
3. This remainder is added to the cost of
care for the first month of eligibility after imposing the penalty period. In
an instance where the penalty period is less than a full month the partial
month penalty will be added to the cost of care in the first month a cost of
care is due.
IV. The penalty period for transfers begins
with the later of:
A. the first day of a
month in which the transfer for less than Fair Market Value occurred;
B. the first day of the month the individual
is eligible for Medicaid and would otherwise be receiving State-Funded
Assistance based on an approved MaineCare application were it not for the
Department imposing an asset transfer penalty period; or
C. the first day which does not occur during
any other period of ineligibility.
V. In the case of a married couple which is
assessed a penalty at the time both spouses reside in a Residential Care
Facility, Cost Reimbursed Boarding Home, or Adult Family Care Home and have
applied for and are otherwise eligible for State-Funded Assistance, and there
is a penalty period in effect for either spouse, the remaining penalty period
can be divided between the spouses into any combination of full months. Whether
there is a division of the penalty and, if so, how it will be divided, is a
decision of the spouses.
When, for some reason, one spouse is no longer subject to a
penalty (for example, no longer lives in a Residential Care Facility or dies),
the remaining period applicable to both spouses must be served by the remaining
spouse.
