Ohio Administrative Code
Title 5160:1 - Eligibility
Chapter 5160:1-3 - Medicaid for the Aged, Blind, or Disabled (ABD)
Section 5160:1-3-05.14 - Medicaid: resource exclusions
Universal Citation: OH Admin Code 5160:1-3-05.14
Current through all regulations passed and filed through December 16, 2024
(A) This rule describes excluded resources for the purpose of determining medical assistance eligibility for the aged, blind, or disabled.
(B) Resource exclusions.
(1)
Resources excluded by federal laws other than the Social
Security Act, in accordance with
20 C.F.R.
416.1236 (as in effect October 1, 2020),
unless otherwise noted. This list contains unspent income from exempt
sources:
(a)
Agent orange settlement payments received on or after
January 1, 1989, under the Agent Orange Compensation Exclusion Act
(Pub.
L. No. 101-201).
(b)
Restitution
payments under the Civil Liberties Act of 1988, to U.S. citizens of Japanese
ancestry and permanent resident Japanese non-citizens who were interned during
World War II, or their survivors, in accordance with
50
U.S.C. 4215 (as in effect October 1,
2020).
(c)
Restitution payments under the Aleutian and Pribilof
Island Restitution Act in accordance with
50 U.S.C.
4236 (as in effect October 1,
2020).
(d)
Payments to victims of Nazi
persecution.
(e)
Payments received under the Radiation Exposure
Compensation Act of 1990 (Pub.
L. No. 101-426).
(f)
Austrian social
insurance payments, based in whole or in part, on wage credits paid under
paragraphs 500 to 506 of the Austrian General Social Insurance Act (as in
effect October 1, 2020).
(g)
Payments received from the Dutch government as a result
of the Netherlands' Benefit Act for victims of persecution from 1940-1945
(Dutch acronym, WUV) (Pub.
L. No. 103-286).
(h)
Payments made to
Native Americans as listed in section IV of 20 C.F.R 416 subpart K appendix (as
in effect October 1, 2020).
(i)
Payments from the
Ricky Ray Hemophilia Relief Fund Act of 1998 (Pub.
L. No. 105-369) or payments made from any fund
established pursuant to a class settlement in the case of Susan Walker v. Bayer
corporation, 96-C-5024 (N.D. Ill).
(j)
The first two
thousand dollars per calendar year received as compensation for participation
in clinical trials that meet the criteria detailed in section 1612(b)(26) of
the Social Security Act (as in effect October 1, 2020).
(k)
Payments made for
supporting services or reimbursement of out-of-pocket expenses to volunteers
participating in corporation for national and community service (CNCS, formerly
ACTION) programs in accordance with
42
U.S.C. 1382a (as in effect October 1,
2020):
(i)
AmeriCorps VISTA program; and
(ii)
Special and
demonstration volunteer program; and
(iii)
Retired senior
volunteer program (RSVP); and
(iv)
Foster
grandparents program; and
(v)
Senior companion program.
(l)
Payments received
under the Energy Employees Occupational Illness Compensation Program Act of
2000 (Pub.
L. No. 106-398). Interest received on any unspent
payment is a countable resource.
(m)
Student financial
assistance received under the Higher Education Act of 1965 (as in effect
October 1, 2020) or bureau of Indian affairs is excluded from income and
resources, regardless of use:
(i)
Pell grants; and
(ii)
Student services
incentives; and
(iii)
Academic achievement incentive scholarships;
and
(iv)
Federal supplemental education opportunity grants;
and
(v)
Federal educational loans (Stafford loans, William D.
Ford federal direct and direct PLUS loans, etc.); and
(vi)
Upward bound;
and
(vii)
Gear up (gaining early awareness and readiness for
undergraduate programs); and
(viii)
State
educational assistance programs funded by the leveraging educational assistance
program; and
(ix)
Work-study programs.
(n)
Home energy
assistance payments or allowances in accordance with
20 C.F.R.
416.1157 (as in effect October 1,
2020).
(o)
Contributions, matching funds, or interest in
individual development accounts (IDAs), either demonstration project or
TANF-funded, in accordance with
42
U.S.C. 604 (as in effect October 1,
2020).
(p)
Veterans affairs payments made to or on behalf
of:
(i)
Certain
Vietnam veterans' natural children, regardless of age or marital status, for
any disability resulting from spina bifida suffered by such children;
and
(ii)
Certain Korea service veterans' natural children,
regardless of age or marital status, for any disability resulting from spina
bifida suffered by such children; and
(iii)
The natural
children, regardless of age or marital status, with certain birth defects born
to a woman who served in Vietnam.
(q)
Funds and
interest held in an account under the Stephen Beck, Jr., Achieving a Better
Life Experience (ABLE) Act of 2014 (Pub. L.
No. 113-295):
(i)
A contribution to
an ABLE account by another individual or by a third party is neither income nor
a resource to the ABLE account holder. If the individual who made the
contribution later requests medical assistance for long-term care services, the
contribution will be evaluated in accordance with rule
5160:1-6-06 of the
Administrative Code.
(ii)
A distribution from an ABLE account may be used to pay
for a qualified disability expense (QDE). A QDE is any expense related to the
blindness or disability of the individual and made for the benefit of the
individual. QDEs include but are not limited to:
(a)
Education;
and
(b)
Housing; and
(c)
Transportation;
and
(d)
Employment training and support; and
(e)
Assistive
technology; and
(f)
Health; and
(g)
Prevention and
wellness; and
(h)
Financial management and administrative services;
and
(i)
Legal fees; and
(j)
Expenses for ABLE
account oversight and monitoring; and
(k)
Funeral and
burial; and
(l)
Basic living expenses.
(iii)
A distribution
from an ABLE account with the intent of paying for a QDE, except for housing,
is excluded as income and will be excluded as a resource while:
(a)
The individual
continues to maintain the ABLE account; and
(b)
The distribution
is unspent; and
(c)
The distribution is identifiable even if commingled
with nonexcluded funds; and
(d)
The individual's
intent to use the distribution for a QDE, other than housing, has not
changed.
(i)
If
the intent has changed and the individual spent the distribution for a non-QDE
or for housing, the distribution is counted as a resource for the month in
which the distribution was spent.
(ii)
If the intent
has changed and the individual has decided to use the distribution for a
non-QDE or for housing, but has not yet spent the distribution, the retained
portion of the distribution is a countable resource the first day of the month
following the month in which the intent changed.
(iv)
A
distribution from an ABLE account with the intent of paying for a non-QDE or
for a housing expense is:
(a)
Not countable income.
(b)
A countable
resource if retained into the following month.
(2)
Resources excluded by the Social Security Act, in
accordance with
20 C.F.R.
416.1210 (as in effect October 1, 2020),
unless otherwise noted:
(a)
Household goods and personal effects of a reasonable
value as described in rule
5160:1-3-05.10 of the
Administrative Code.
(b)
One automobile or other mode of transportation as
described in rule
5160:1-3-05.11 of the
Administrative Code.
(c)
Life insurance policies as described in rule
5160:1-3-05.12 of the
Administrative Code.
(d)
The home considered the principal place of residence as
described in rule
5160:1-3-05.13 of the
Administrative Code.
(e)
Real or personal property considered essential to the
means of self-support as described in rule
5160:1-3-05.19 of the
Administrative Code.
(f)
Certain burial funds and contracts as described in rule
5160:1-3-05.6 of the
Administrative Code.
(g)
Value of a burial space as described in rule
5160:1-3-05.7 of the
Administrative Code.
(h)
Cash or in-kind replacement received from any source
for purposes of replacing or repairing an excluded resource which is lost,
damaged, or stolen. Any interest earned on such cash payments is not income.
The total amount of cash (including interest earned) or the value of the inkind
replacement is excluded as a resource for a period of nine months from the date
of receipt.
(i)
If the exclusion time expires and the individual has not
used all of the cash, any remaining cash (as well as interest earned on such
cash) is a countable resource effective the first day of the month following
the month in which the time period expires.
(ii)
The exclusion
time may be extended for good cause for a reasonable period not to exceed an
additional nine months (a total of eighteen months from the date the cash is
received).
(iii)
Good cause may be found if circumstances beyond the
individual's control:
(a)
Prevent repair or replacement of the lost, damaged, or
stolen property; or
(b)
Keep the individual from contracting for such repair or
replacement.
(iv)
Any cash and interest retained become a resource the
first day of the month following the month in which the eighteen-month period
ends.
(v)
Temporary housing received by an individual whose home
was destroyed or damaged is also excluded for a period of nine months beginning
with the month the temporary housing is first provided. For purposes of this
rule, temporary housing includes the value of support and maintenance. When a
home is damaged or destroyed and temporary housing is furnished to an
individual who owned the home, any form of in-kind support and maintenance is
not counted as income.
(i)
Funds held in a
plan to achieve self-support (PASS) account in accordance with section
1613(a)(4) of the Social Security Act (as in effect October 1,
2020).
(j)
Federal tax refunds and advance tax payments with
respect to refundable credits received on or after January 1, 2010, are
excluded for twelve months beginning the month following the month of receipt
under the American Taxpayer Relief Act of 2012 (Pub. L. No.
112-240).
(k)
Funds or interest
held in a dedicated account in a financial institution for an individual under
the age of eighteen, that is maintained by a representative payee, from
past-due supplemental security income (SSI) benefits that exceed six times the
monthly SSI payment which are allowed to be deposited into such an account, and
the use of which is restricted by section 1631(a)(2)(F) of the Social Security
Act (as in effect October 1, 2020), are excluded as income and resources as
defined in rule
5160:1-3-05.4 of the
Administrative Code.
(l)
Payments received from a fund established by a state to
aid victims of crime are excluded for nine months beginning the month following
the month of receipt in accordance with section 1613(a)(9) of the Social
Security Act (as in effect October 1, 2020). Interest earned on any unspent
payment is a countable resource.
(m)
Relocation
assistance in accordance with section 1613(a)(10) of the Social Security Act
(as in effect October 1, 2020).
(i)
Payments under Title II of the Uniform Relocation
Assistance and Real Property Acquisitions Policies Act of 1970 ( Pub. L. No.
91-646) provided to individuals displaced by projects in the acquisition of
real property are excluded with no time limits.
(ii)
Relocation
assistance payments from a state or local government are excluded for nine
months.
(iii)
Interest earned on unspent relocation assistance is a
countable resource.
(n)
Grants,
scholarships, fellowships, and gifts used or intended to be used to pay the
cost of tuition, fees, or other necessary educational expenses, in accordance
with section 1613(A)(15) of the Social Security Act (as in effect October 1,
2020) are excluded for nine months.
(o)
Filipino veteran
equity compensation fund payments in accordance with section 1002 of the
American Recovery and Reinvestment Act of 2009 (Pub.
L. No. 111-5). Interest earned on the payment is a
countable resource.
(p)
Value of food or assistance provided under federal food
and nutrition programs.
(q)
Unspent portion of retroactive SSI and retirement,
survivors, and disability insurance (RSDI) payments are excluded for nine
months following the month of receipt in accordance with section 1613(a)(7) of
the Social Security Act (as in effect October 1, 2020).
(r)
Payments provided
for flood mitigation activities under section 1324 of the National Flood
Insurance Act of 1968 (Pub.
L. No. 109-64).
(s)
Payments received
under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (
Pub. L. No. 100-707) and assistance provided under any federal statute because
of a presidentially-declared disaster in accordance with section 1613(a)(6) of
the Social Security Act (as in effect October 1, 2020).
(t)
The value of
federal housing assistance in accordance with section 1613(a) (8) of the Social
Security Act (as in effect October 1, 2020) provided by:
(i)
The office of
housing and urban development (HUD); or
(ii)
The U.S.
department of agriculture's rural housing service (RHS), formally known as the
farmers home administration (FHA).
(u)
Gifts to children
with life-threatening conditions in accordance with section 1613(a)(13) of the
Social Security Act (as in effect October 1, 2020) from an organization
described in section 501(c)(3) of the Internal
Revenue Code of 1986, within the following limitations:
(i)
In-kind gifts not
converted to cash.
(ii)
The first two thousand dollars of any cash gifts within
a calendar year.
(iii)
Interest or dividends earned on any gift is a countable
resource.
(v)
Restitution payments for misused benefits for
beneficiaries of RSDI, special benefits for certain world war II veterans, and
SSI are excluded for nine months following the month of receipt in accordance
with section 1613(a) (14) of the Social Security Act (as in effect October 1,
2020). Payments are made to the beneficiary or the beneficiary's representative
payee in the amount equal to the benefits misused in the following
situations:
(i)
The misuse resulted from the negligent failure of the social
security administration (SSA) to investigate or monitor a representative payee;
or
(ii)
An organization or individual payee misused the
benefits, without regard to whether SSA was negligent.
(w)
A
state annuity paid by a state, to an individual and/or the individual's spouse,
on the basis of the state's determination that the individual is a veteran and
is blind, disabled, or aged in accordance with section 1613(a) (16) of the
Social Security Act (as in effect October 1, 2020).
(C) Payments or benefits listed in this rule that have been commingled with countable resources need to be identifiable in order to be excluded as a resource.
(D) Administrative agency responsibilities.
(1)
Evaluate interest
received on excluded resources in accordance with rule
5160:1-3-05.9 of the
Administrative Code.
(2)
Consider any resource purchased with funds listed in
this rule as not automatically excluded and subject to medicaid resource
requirements.
Replaces: 5160:1-3- 05.14
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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