Ohio Administrative Code
Title 5160:1 - Eligibility
Chapter 5160:1-3 - Medicaid for the Aged, Blind, or Disabled (ABD)
Section 5160:1-3-05.1 - Medicaid: resource requirement
Universal Citation: OH Admin Code 5160:1-3-05.1
Current through all regulations passed and filed through September 16, 2024
(A) This rule describes how resources are treated for purposes of determining eligibility for medical assistance.
(B) Definitions.
(1)
"Countable resources" mean those resources remaining
after all exclusions have been applied.
(2)
An "encumbrance"
means a claim, lien, charge, or liability attached to and binding on an
identified piece of real or personal property.
(3)
"Equity value"
means the fair market value of a resource minus any encumbrance on
it.
(4)
"Fair market value" of a resource means the going
price, for which real or personal property can reasonably be expected to sell
on the open market, in the particular geographic area involved.
(5)
"Geographic area"
means the area covered by radio, television, newspaper, and other media serving
the area where the individual lives and where the property is
located.
(6)
"Personal property" means any property that is not real
property. The term includes, but is not limited to, such things as cash,
jewelry, household goods, tools, life insurance policies, automobiles,
promissory notes, etc.
(7)
"Real property" means land, including buildings or
immovable objects, attached permanently to the land.
(8)
"Resources" is
defined in rule
5160:1-1-01
of the Administrative Code.
(9)
"Resource limit"
means the maximum combined value of all resources an individual can have an
ownership interest in and still qualify for medical assistance.
(a)
For an
individual, the resource limit is two thousand dollars.
(b)
For a married
couple, whether both are eligible or one is ineligible, the resource limit is
three thousand dollars.
(c)
A child living with a parent is considered to be an
individual and has a resource limit of two thousand dollars.
(10)
"Trust" is defined in rule 5160:1-3-05.2 of the
Administrative Code.
(C) Treatment of non-excluded resources and determination of resource availability. The administrative agency shall evaluate and calculate the value of all resources held by an individual and the individual's spouse. An individual is ineligible for medical assistance when he or she has an ownership interest in resources with an aggregate or total countable value greater than the resource limit. The following provisions govern that process.
(1)
Receipt and
retention of cash or in-kind items.
(a)
An individual or the individual's spouse may receive
cash or in-kind items during a calendar month (the "month of receipt"). The
administrative agency must treat the cash or in-kind items as a potential
source of countable income for the month of receipt under the rules governing
income.
(b)
When the individual or the individual's spouse retains
the cash or in-kind items beyond the month of receipt, the administrative
agency shall determine the availability of the cash or in-kind items as a
potential countable resource under the rules governing
resources.
(c)
Receipt of cash or in-kind items from the sale or
exchange of timber, minerals, or other like items that are part of the land
must be governed by this provision.
(d)
When the
individual or the individual's spouse receives cash or in-kind items as the
result of an exchange, sale, replacement, or conversion of a resource, the
administrative agency must consider the availability of the cash or in-kind
items effective the month following the month of receipt under the rules
governing the treatment of resources.
(2)
Changes in the
value of resources.
(a)
The administrative agency shall review any change
(increase or decrease) in the total value of an individual's resources when the
change may affect the individual's eligibility for medical
assistance.
(b)
The review shall be initiated by the administrative
agency based upon information derived from any reliable source indicating the
value of an individual's available resources has increased or
decreased.
(c)
The administrative agency shall conduct the review of
any changes in the value of resources upon discovery of the
changes.
(3)
Discovery of previously unknown ownership
interests.
(a)
Any individual alleging lack of knowledge of an ownership
interest in a resource must provide a signed statement attesting to the lack of
knowledge and explaining the circumstances resulting in its
discovery.
(b)
The individual shall obtain supporting documentation,
which may include signed statements from other individuals who are familiar
with the individual's situation, confirming the individual's
claim.
(c)
When the administrative agency obtains both the signed
statement and adequate supporting documentation from the individual, the
administrative agency shall not count an individual's ownership interest as an
available resource during any period in which the individual was unaware of the
ownership interest.
(d)
The administrative agency shall evaluate the value of
previously unknown ownership interests, including any monies (interest,
dividends, or other earnings) that have accumulated on it, under
income-counting rules for that item.
(e)
When the signed
statement or the supporting documentation is not provided, the administrative
agency shall count an individual's ownership interest as an available resource
during any period in which the individual claimed to be unaware of the
ownership interest. When appropriate, the administrative agency shall evaluate
the individual for overpayment or potential fraud in accordance with rule
5160:1-2-04
of the Administrative Code.
(4)
Shared
ownership.
(a)
When the individual shares ownership with another person
(co-owner) and the individual is unable to make the resource available because
one of the owners cannot be located, the cost of a legal action is prohibitive,
or the individual was unsuccessful in a legal action, the resource is not
countable. Availability of the resource shall be reexamined at each eligibility
review.
(b)
When the co-owner is the individual's spouse, parent
(when the individual is under age eighteen), or child under age eighteen, the
ability to use or dispose of the resource exists for the individual unless he
or she provides documentation to the contrary.
(5)
Continuing
verification.
(a)
The administrative agency shall verify the value of
real and personal property with each application or renewal and any time
information is provided indicating a change in the individual's resources may
have occurred.
(b)
The administrative agency shall record the verification
and place all supporting documents in the case record.
(6)
Property that has not been sold.
(a)
This provision
governs real and personal property that has not been sold. When an individual
owns property affecting his or her eligibility for medical assistance and the
property has not been sold, it will not be counted as an available resource as
long as the individual continues to list the property for sale at an amount
equal to the fair market value determined by the county auditor, where
available, or any other knowledgeable source.
(b)
Real property
that was the principal place of residence must first be considered in
accordance with rule 5160:1-3-05.13 of the Administrative Code before the
provisions of this paragraph are applied.
(c)
The inability to
sell property may result from legal technicalities, general economic conditions
in the community, or the inability to find a buyer. In order for property to be
excluded as a countable resource, the individual has the burden of producing
reliable documentation establishing one of the following:
(i)
The individual
may produce documentation from two different types of knowledgeable sources in
the geographic area who agree that although the property is listed for sale,
the property has not been sold due to an attribute of the property or the
market or both.
(a)
In the case of real property, knowledgeable sources are
limited to the following entities who have experience in the sale or valuation
of the type of real property in question: county auditors, real estate brokers,
real estate agents, real estate appraisers, United States department of
agriculture (USDA) rural development service center offices, USDA farm service
agency service center offices, banks, savings and loan associations, mortgage
companies and similar lending institutions, and the county extension service
offices.
(b)
In the case of personal property, knowledgeable sources
are limited to the following: any professional, business owner or operator, or
expert who has experience in the sale, trade, restoration, or valuation of the
type of personal property in question.
(ii)
The individual
may produce documentation showing an actual but unsuccessful sale attempt has
been made.
(a)
In the case of real property, the documentation must show
that the property has been, and is currently, listed for sale in a newspaper or
with a for sale by owner website, real estate agent, real estate broker, or
real estate firm in the geographic area. The documentation may include a
listing agreement with a real estate agent, broker, or firm, or a written
statement signed by a real estate agent, broker, or firm confirming that the
real property has an active status with the multiple listing service (MLS). The
property is a countable resource until it is listed for sale.
(b)
The property must
be listed for sale at an amount equal to the fair market value determined by
the county auditor, where available, or any other knowledgeable
source.
(c)
The real estate agent, broker, or firm must verify that
no reasonable offer to purchase the property has been declined. An offer is
reasonable when it is not less than ninety per cent of the fair market value
established by the county auditor, where available, or any other knowledgeable
source.
(d)
When the individual receives an offer for the property
that is less than ninety per cent of the fair market value established by the
county auditor, where available, or any other knowledgeable source, the low
offer may be an indication that the value is incorrect.
(e)
When it appears
that the stated market value is incorrect, either the individual or the
administrative agency may obtain an appraisal from a second source to set a
more accurate value. A second appraisal is not necessary when the purchase
offer is so low that it is obviously unreasonable.
(f)
The individual
has the right to rebut the value of the property by obtaining an appraisal of
the property.
(iii)
The individual
may produce documentation showing good cause.
(a)
A good cause
exception may be requested by the individual or the individual's authorized
representative.
(b)
Good cause exists when the individual was prevented by
circumstances beyond his or her control from listing the property for
sale.
(D) Resources of family members, households, and non-citizens.
(1)
The resources of
spouses residing together are addressed in accordance with the deeming of
resources in rule 5160:1-3-05.20 of the Administrative Code.
(2)
The
administrative agency shall apply the resource limit for an individual
effective the month following the month a married couple separates or divorces
or one member dies.
(3)
The resources of a child under the age of eighteen are
addressed in accordance with the deeming of resources in rule 5160:1-3-05.20 of
the Administrative Code.
(4)
The resources of a non-citizen and sponsor(s) are
addressed in accordance with the sponsor-to-non-citizen deeming requirements in
accordance with rule 5160:1-3-05.20 of the Administrative Code.
(E) Resources that are determined to be excluded from the applicable resource limit for medical assistance remain excluded at the time of the individual's death. Excluded resources are part of the deceased individual's estate and are subject to the estate recovery provisions in accordance with section 5162.21 of the Revised Code.
(F) The entrance fee for individuals residing in a continuing care retirement community or a life care community must be considered an available resource in accordance with rule 5160:1-6-02.3 of the Administrative Code.
Replaces: 5160:1-3- 05.1
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