Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.24 - Medical Assistance Eligibility
Section 10.09.24.08 - Consideration of Resources for MAGI Exempt Coverage Groups
Universal Citation: MD Code Reg 10.09.24.08
Current through Register Vol. 51, No. 19, September 20, 2024
A. This regulation contains the rules for considering resources of members of the MAGI exempt assistance unit and those individuals whose income and resources are considered pursuant to Regulation .06 of this chapter in determining financial eligibility of an assistance unit for retroactive and current eligibility for the period under consideration.
B. Definitions.
(1) "Account" means cash savings or any other
form of liquid resource in a bank, credit union, savings and loan association,
or any other financial institution in which the resource is subject to
withdrawal by the owner or owners of the account.
(2) Automobile.
(a) "Automobile" means a passenger car or any
other vehicle used to provide necessary transportation.
(b) "Automobile" does not mean an airplane,
farm machinery, or a vehicle used solely for recreational purposes.
(3) "Burial funds" means a
revocable burial contract, burial trust, or other burial arrangement or any
other separately identifiable fund which is clearly designated as set aside for
a person's burial expenses.
(4)
"Burial spaces" means conventional gravesites, crypts, mausoleums, urns, and
other repositories which are customarily and traditionally used for the remains
of deceased persons.
(5) "Equity
value" means the fair market value of property less any legal debt on the
property.
(6) "Fair market value"
means the amount for which property can be sold on the open market in a
particular geographical area.
(7)
"Funds in an irrevocable trust or other irrevocable arrangement that are
available to meet burial expenses" means funds which are held in an irrevocable
burial contract, an irrevocable burial trust, or an amount in an irrevocable
trust which is specifically identified as available for burial
expenses.
(8) "Home" means any
shelter in which a member of the assistance unit or any person whose income and
resources are considered in determining the financial eligibility of the
assistance unit, has an ownership interest and uses as his principal place of
residence. The home includes the parcel of land on which the shelter is
situated and any related outbuildings necessary to its operation. Only one
residence may be considered home property.
(9) "Immediate family" means a person's
spouse or a person's minor and adult children, including adopted children and
stepchildren, or a person's brothers, sisters, parents, adoptive parents, and
the spouses of these persons. Neither dependency nor living in the same
household are factors in determining whether a person is an immediate family
member.
(10) "Institutionalized
person" means a person who is:
(a) An
inpatient in a nursing facility;
(b) An inpatient in a medical institution and
with respect to whom payment is made based upon a level of care provided in a
nursing facility; or
(c) Receiving
services under a home and community-based services waiver under COMAR 10.09.27
or 10.09.31.
(11) "Joint
account" means an account in which two or more persons are named as owners of
the account and the funds in the account are subject to withdrawal by any of
the persons named as owners.
(12)
"Medicaid qualifying trust" means a trust or similar legal device established
on or before August 10, 1993, other than by will, by an individual or an
individual's spouse, under which the individual or the individual's spouse may
be the beneficiary of all or part of the payments from the trust, and the
distribution of payment is determined by one or more trustees who are permitted
to exercise any discretion with respect to the distribution to the
individual.
(13) "Nonapplicant"
means a person who is neither an applicant nor the spouse of an
applicant.
(14) Property.
(a) "Property" means any thing or things in
which a person has a legal or equitable interest.
(b) "Personal property" means all property
that is not real property.
(c)
"Real property" means property which is fixed or immovable such as land or a
building.
(15)
"Uncompensated value" means the difference between the fair market value of a
person's interest in a resource at the time it was disposed of and the amount
of compensation received for the resource.
C. The applicant shall report all resources to the Department or its designee with the exception of non-disabled children and their caretaker relatives who are not being considered as medically needy.
D. Countable income that is retained at redetermination or reapplication shall be considered a resource unless specifically excluded by other regulations.
E. The Department or its designee shall require an accounting and reasonable documentation, consisting of convincing testimony or other evidence, of the disposal of previously held resources within 30 months before the month of application to assure that the resources are no longer available and the disposal meets the requirements of this regulation.
F. Excludable Resources for Aged, Blind, or Disabled Noninstitutionalized Individuals and Aged, Blind, or Disabled Institutionalized Individuals Who Intend to Return Home. The following resources are excluded in determining financial eligibility for aged, blind, or disabled noninstitutionalized individuals and for an aged, blind, or disabled institutionalized individual who intends to resume living in the individual's home:
(1) The home, as defined
under §B(7) of this regulation, unless the person is institutionalized and
has a life estate interest with full powers in the home.
(2) Income-Producing Property.
(a) Income-producing property associated with
the home includes farm machinery, business equipment, vehicles, special tools,
farm animals, and livestock related to self-support activities. The property
shall be excluded if the total equity value of these resources does not exceed
the limit set forth in §F(2)(c) of this regulation and the resource
produces a net annual return of at least 6 percent of the equity.
(b) Income-producing property not associated
with the home includes land, buildings, farm machinery, business equipment,
vehicles, special tools, farm animals and livestock related to self-support
activities. This property shall be excluded if the total equity value of these
resources does not exceed the limit set forth in §F(2)(c) of this
regulation and the resource produces a net annual return of at least 6 percent
of the equity.
(c) $6,000 Equity
Value Exclusion. A $6,000 equity value exclusion applies to the combined equity
value of resources in §F(2)(a) and (b) of this regulation. The exclusion
does not apply to each individual property.
(d) Limitations on Equity Value Exclusion.
(i) The full equity value of each property
not producing a net annual return of 6 percent will be a countable
resource.
(ii) The combined equity
value in excess of $6,000 of all properties producing an individual net annual
return of 6 percent will be a countable resource.
(3) Household Goods and Personal
Effects.
(a) Household Goods.
(i) Household goods include those items of
personal property customarily found in the home and used in connection with the
maintenance, use, and occupancy of the premises as a home and in the functions
and activities of home and family life, as well as those items which are for
comfort and accommodation.
(ii)
Household goods necessary for the maintenance, use, and occupancy of the home
shall be excluded regardless of value. The equity value of nonessential items
shall be added to other countable resources and measured against the applicable
resource standard.
(b)
Personal Effects.
(i) Personal effects
include those items of personal property which are worn or carried by a person
or have an intimate relation to him.
(ii) Personal effects shall be excluded
except as specified in §F(3)(b)(iii) of this regulation.
(iii) The equity value of nonessential
personal effects of considerable value such as furs, and jewelry which is not
excluded in §F(3)(c) of this regulation, shall be added to other countable
resources and measured against the applicable resource standard.
(c) A wedding ring and an
engagement ring shall be excluded from consideration as resources.
(d) Prosthetic devices, dialysis machines,
hospital beds, wheelchairs, and similar equipment required because of a
person's physical condition shall be excluded from consideration as
resources.
(e) For an
institutionalized person, household goods and personal effects remaining in the
possession of the person at the long-term care facility shall be excluded from
consideration as resources.
(4) Livestock and farm produce that is used
only for home consumption.
(5)
Automobiles.
Any automobile owned by a member of the assistance unit shall be excluded regardless of its value or purpose.
(6) Life Insurance with a Maximum Face Value
of $1,500 for Each Person.
(a) Life insurance
policies such as term or burial insurance which do not have a cash surrender
value may not be used in determining the total face value of all
policies.
(b) Whenever the total
face value of all policies on any person exceeds the allowable maximum face
value, the entire cash surrender value of these policies shall be counted as a
resource. Cash surrender value includes available accrued dividends and
interest.
(7) Cash and
In-Kind Replacement Received for Casualty Losses of Excluded Resources.
(a) Cash, including interest earned on the
cash, or in-kind replacement received from any source for the purpose of
replacing an excluded resource that is lost, damaged, or stolen, shall be an
excluded resource for a period of 9 months, beginning with the date the cash or
in-kind replacement was received.
(b) The initial 9-month exclusion period
specified in §F(7)(a) of this regulation shall be extended for a
reasonable period up to an additional 9 months if circumstances beyond the
control of the individual prevent him from repairing, replacing, or contracting
for the repair or replacement of the resource.
(c) Any of the cash and interest or in-kind
replacement that is not used to repair or replace the excluded resource shall
be counted as a resource beginning with the period under consideration after
expiration of the initial 9-month period, or the extended period, if
any.
(d) If an extension of the
time period is made pursuant to §F(7)(b) of this regulation and the
individual changes his intent to repair or replace the excluded resource, cash
and interest, or in-kind replacement previously excluded, shall be counted as
resources effective with the month the individual reports his change of
intent.
(8) Assistance
Received Because of a Major Disaster.
(a)
Assistance, including any interest earned on the assistance, received under the
Disaster Relief Act of 1974 (PL 93-288) or other assistance provided under a
federal statute because of a catastrophe which is declared to be a major
disaster by the President of the United States shall be excluded in determining
countable resources for a period of 9 months from the date of
receipt.
(b) The initial 9-month
period for not counting the assistance specified in §G(8)(a) of this
regulation shall be extended for a reasonable period up to an additional 9
months if circumstances beyond the control of the person prevented him from
repairing, replacing, or contracting for repair or replacement of damaged or
destroyed property.
(9)
Burial spaces for a person and the person's immediate family.
(10) Proceeds from Sale of a Home. Proceeds
from the sale of a home shall be excluded from consideration as a resource for
a period not to exceed 3 months from the date the proceeds are received if the:
(a) Person indicates he intends to replace
the home during that period;
(b)
Home is in fact replaced during that period; and
(c) Replaced home itself was an excluded
resource under the provision of §F(1) of this regulation.
(11) Payment received under the
Uniform Relocation Assistance and Real Property Acquisition Policies Act of
1970, 42 U.S.C. § 4601 et seq. Compensation received for the
fair market value of the acquired real property is not subject to this
regulation.
(12) Assistance
provided in cash or in-kind under the Emergency Energy Conservation Services
Program, including plans for crisis intervention to prevent fuel cut-offs and
assistance provided under the Low-Income Home Energy Assistance Act.
(13) Burial Funds.
(a) In determining the resources of a person
and the person's spouse, if any, there shall be excluded an amount up to $1,500
per person of funds specifically set aside for burial arrangements of the
person or the person's spouse.
(b)
Interest earned on excluded burial funds and appreciation on the value of
excluded burial arrangements shall be excluded from resources if left to
accumulate and become a part of the burial fund.
(c) Funds or interest earned on funds and
appreciation in the value of burial arrangements, which have been excluded from
resources because they are burial funds, shall be used solely for that
purpose.
(d) If any excluded funds,
interest, or appreciated value set aside for burial expenses are used for any
purpose other than the burial arrangements of the person or the person's spouse
for whom the funds were set aside, the unit shall be determined ineligible
until the unit spends for medical services an amount which is equal to the
amount of burial funds used for some other purpose.
(e)
§F(13)(d) of this regulation may not
apply if countable resources, when added to the total excluded burial funds,
including the amount misspent, were within the applicable amount in Schedule
MA-2 during the month in which the use of burial funds for some other purpose
occurred.
(f) An individual's
$1,500 exclusion as described under §F(13)(a) of this regulation shall be
reduced by:
(i) The face value of life
insurance policies owned by the individual or the individual's spouse if the
cash surrender value of those policies has been excluded from resources;
and
(ii) Amounts in an irrevocable
burial fund as described under §F(14) of this regulation.
(14) An irrevocable
burial fund of any amount, which has been set aside for the burial of the
individual or the individual's spouse.
G. Excludable Resources for Aged, Blind, or Disabled Institutionalized Individuals Who Do Not Intend to Return Home. The following resources are excluded in determining financial eligibility for an aged, blind, or disabled institutionalized individual who does not intend to resume living in the individual's home:
(1)
The home as defined in §B(4) of this regulation, if it is occupied by the
institutionalized person's spouse or any one of the following relatives who are
medically or financially dependent:
(a)
Son;
(b) Daughter;
(c) Grandson;
(d) Granddaughter;
(e) Stepson;
(f) Stepdaughter;
(g) In-laws;
(h) Mother;
(i) Father;
(j) Stepmother;
(k) Stepfather;
(l) Half sister;
(m) Half brother;
(n) Niece;
(o) Nephew;
(p) Grandmother;
(q) Grandfather;
(r) Aunt;
(s) Uncle;
(t) Sister;
(u) Brother;
(v) Stepbrother;
(w) Stepsister.
(2) Household Goods and Personal Effects
Remaining in the Possession of the Person at the Long-Term Care Facility.
(a) Household goods include those items of
personal property which are customarily found in the home and used in
connection with the maintenance, use, and occupancy of the premises as a home
and in the functions and activities of home and family life, as well as those
items which are for comfort and accommodation.
(b) Personal effects include those items of
personal property which are worn or carried by a person or have an intimate
relation to him.
(c) Household
goods and personal effects include, but are not limited to, items of personal
clothing, toilet articles, prosthetic devices, an engagement ring, and a
wedding ring.
(3) Life
Insurance with a Maximum Face Value of $1,500 for Each Person.
(a) Life insurance policies such as term or
burial insurance which do not have a cash surrender value may not be used in
determining the total face value of all policies.
(b) Whenever the total face value of all
policies exceeds the allowable maximum face value, the entire cash surrender
value of these policies shall be counted as a resource. Cash surrender value
includes all available accrued dividends and interest.
(4) Burial spaces for a person and the
person's immediate family.
(5)
Income-Producing Property.
(a)
Income-producing property associated with the home includes farm machinery,
business equipment, vehicles, special tools, farm animals, and livestock
related to self-support activities. This property shall be excluded if the
total equity value of these resources does not exceed the limit set forth in
§G(5)(c) of this regulation and the resource produces a net annual return
of at least 6 percent of the equity.
(b) Income-producing property not associated
with the home includes land, buildings, farm machinery, business equipment,
vehicles, special tools, farm animals, and livestock related to self-support
activities. This property shall be excluded if the total equity value of these
resources does not exceed the limit set forth in §G(5)(c) of this
regulation and the resource produces a net annual return of at least 6 percent
of the equity.
(c) $6,000 Equity
Value Exclusion. A $6,000 equity value exclusion applies to the combined equity
value of resources in §G(5)(a) and (b) of this regulation. The exclusion
does not apply to each individual property.
(d) Limitations on Equity Value Exclusion.
(i) The full equity value of each property
not producing a net annual return of 6 percent will be a countable
resource.
(ii) The combined equity
value in excess of $6,000 of all properties producing an individual net annual
return of 6 percent will be a countable resource.
(6) Burial Funds.
(a) In determining the resources of a person
and the person's spouse, if any, there shall be excluded an amount up to $1,500
per person of funds specifically set aside for burial arrangements of the
person or the person's spouse.
(b)
Interest earned on excluded burial funds and appreciation on the value of
excluded burial arrangements shall be excluded from resources if left to
accumulate and become a part of the burial fund.
(c) Funds or interest earned on funds and
appreciation in the value of burial arrangements, which have been excluded from
resources because they are burial funds, shall be used solely for that
purpose.
(d) If any excluded funds,
interest, or appreciated value set aside for burial expenses are used for any
purpose other than the burial arrangements of the person or the person's spouse
for whom the funds were set aside, the unit shall be determined ineligible
until the unit spends for medical services an amount which is equal to the
amount of burial funds used for some other purpose.
(e) Section G(6)(d) of this regulation may
not apply if countable resources, when added to the total excluded burial
funds, including the amount misspent, were within the applicable amount in
Schedule MA-2 during the month in which the use of burial funds for some other
purpose occurred.
(f) An
individual's $1,500 exclusion as described under §G(6)(a) of this
regulation shall be reduced by:
(i) The face
value of life insurance policies owned by the individual or the individual's
spouse if the cash surrender value of those policies has been excluded from
resources; and
(ii) Amounts in an
irrevocable burial fund as described under §G(7) of this
regulation.
(7) An irrevocable burial fund of any amount,
which has been set aside for the burial of the individual or the individual's
spouse.
H. Exclusion of the home under §§F(1) and G(1) of this regulation and exclusion of income-producing property under §§F(1) and G(5) of this regulation do not prevent a lien being attached to or executed on the home or property except as provided in Regulation .15A-2(3) of this chapter.
I. Treatment of Joint Accounts.
(1) If a joint account exists between an
applicant and a nonapplicant, all of the funds in the account are considered
available to the applicant.
(2) If
a joint account exists between the spouse of an applicant and a nonapplicant,
all of the funds in the account are considered available to the spouse of the
applicant.
(3) If a joint account
exists between an applicant, the spouse of an applicant, and a nonapplicant,
all of the funds in the account are considered available to the applicant and
the spouse of the applicant.
(4)
Rebuttal of Presumption of Full Ownership Interest.
(a) If the nonapplicant owner can
demonstrate, to the Department's satisfaction, that the nonapplicant made
regular and proportionate contributions of the nonapplicant's own funds to the
account, a pro rata share of the funds is considered available to the
nonapplicant.
(b) If either the
applicant, the spouse of the applicant, or the nonapplicant owner of a joint
account believes that the ownership interest attributed to him or her by the
Department under §I(1)-(3) or (4)(a) of this regulation is incorrect and
can demonstrate, under §I(5)(b) of this regulation, to the satisfaction of
the Department, an ownership interest other than that attributed to him or her
by the Department, the Department shall consider the amount established through
rebuttal as the correct amount for the purpose of determining eligibility for
Medical Assistance.
(5)
Declaration of Ownership Interests.
(a) The
applicant and the nonapplicant of a joint account shall declare their ownership
interests on a form designated by the Department.
(b) The applicant shall provide adequate
documentation to substantiate the declared ownership interests.
(6) If the nonapplicant owner
withdraws funds from the account during or after the 30-month period
immediately before the month of application, the withdrawal is considered a
disposal by the applicant or the spouse of the applicant to the extent that the
remaining funds are less than the amounts considered available to the applicant
under §I(1)-(4) of this regulation.
J. Medicaid Qualifying Trust.
(1) In the case of a Medicaid qualifying
trust as defined under §B(12) of this regulation, the amount from the
trust considered available to the person or the person's spouse establishing
the trust is the maximum amount of payments that may be permitted under the
terms of the trust to the beneficiary, assuming the full exercise of discretion
by the trustee or trustees for the distribution of the maximum amount to the
beneficiary.
(2) Section J of this
regulation shall apply whether or not the:
(a)
Medicaid qualifying trust is irrevocable or has been established for purposes
other than to enable a person to qualify for Medical Assistance; or
(b) Discretion described under §J of
this regulation is actually exercised.
(3) If the beneficiary of a trust is an
intellectually disabled person who resides in an intermediate care facility for
the intellectually disabled, the trust may not be considered a Medicaid
qualifying trust if it was established before April 17, 1986 and is solely for
the benefit of the intellectually disabled person.
(4) The Department may waive the application
of §J of this regulation if the Department determines that to do so would
work an undue hardship.
K. Disposal of Resources for Less than Fair Market Value.
(1) In determining eligibility
for Medical Assistance for any period under consideration beginning before
October 1, 1993, an institutionalized individual shall be determined ineligible
for nursing facility services, for a level of care in a medical institution
equivalent to that of nursing facility services, and for waiver services under
COMAR 10.09.27 and 10.09.31 if the individual or the individual's spouse:
(a) Disposes of a resource for less than fair
market value at any time during or after the 30-month period immediately before
or after the date the person becomes an institutionalized person if the person
is entitled to Medical Assistance on that date; or
(b) If not entitled to Medical Assistance on
that date, then on the date the person applies for Medical Assistance while an
institutionalized person.
(2) If a person disposes of a resource for
less than fair market value while in a period of ineligibility for an earlier
disposal, the later disposal is considered a part of the earlier disposal for
purposes of computing the total period of ineligibility.
(3) The period of ineligibility shall begin
with the month in which the resource was transferred and the number of months
in the period shall be equal to the lesser of:
(a) 30 months; or
(b) The total uncompensated value of the
transferred resource, divided by the average cost, to a private patient at the
time of application, of nursing facility services in the state in which the
person is institutionalized.
(4) An institutionalized person may not be
determined ineligible for Medical Assistance under §K(1) of this
regulation if the resource transferred was a home and title to the home was
transferred to:
(a) The spouse of the
person;
(b) The person's child as
defined under Regulation .02B(12) of this chapter or who is blind or disabled
as determined under Regulation .05D and E of this chapter;
(c) A sibling of the person who has an equity
interest in the home and who was residing in the home for a period of at least
1 year immediately before the date the person became an institutionalized
person; or
(d) A son or daughter of
the person other than the person's child described under §K(4)(b) of this
regulation, who:
(i) Is lawfully residing in
the home,
(ii) Was residing in the
home for a period of at least 2 years immediately before the date the person
became an institutionalized person, and
(iii) Can establish, to the Department's
satisfaction, that the son or daughter provided the care that permitted the
person to reside at home rather than in an institution.
(5) A person may not be determined
ineligible for Medical Assistance by reason of the transfer of any resource,
excluded or nonexcluded, if the resource was transferred under any one of the
conditions below:
(a) The resource was
transferred to the community spouse, or to another for the sole benefit of the
community spouse, as defined under Regulation .10-1B(1) of this
chapter;
(b) The resource was
transferred to the person's son or daughter who is blind or disabled as defined
under Regulation .05D and E of this chapter;
(c) The resource was transferred to the
person's spouse, or to another for the sole benefit of the person's spouse, if
the spouse does not transfer the resource to another person for less than fair
market value;
(d) The person
furnishes convincing evidence, consisting of testimony or other corroborative
evidence, that the person intended to dispose of the resource at fair market
value or for other valuable consideration;
(e) The person furnishes convincing evidence
that the resource was transferred exclusively for a purpose other than to
qualify for Medical Assistance; or
(f) The Department determines that the denial
of eligibility would work an undue hardship.
L. A unit shall be ineligible for any month in which countable resources exceed the applicable standard, but may reapply for any following month in which countable resources are less than or equal to the applicable standard.
M. Schedule MA-2.
| Individuals | Medically Needy ResourceStandard (ABD) |
| 1 | 2,500 |
| 2 | 3,000 |
| 3 | 3,100 |
| 4 | 3,200 |
| 5 | 3,300 |
| 6 | 3,400 |
| 7 | 3,500 |
| 8 | 3,600 |
| 9 | 3,700 |
| 10 | 3,800 |
| Each Additional Individual | 100 |
N. Schedule MA-2A.
| Categorically Needy Resource Standard | ||
| Effective | Individual | Couple |
| January 1, 1987 | $1,800 | $2,700 |
| January 1, 1988 | 1,900 | 2,850 |
| January 1, 1989 | 2,000 | 3,000 |
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