(A) This rule defines how retirement and income supplementing accounts (RISAs) are treated for purposes of determining medicaid medical assistance eligibility.
(1) "Administrative agency" is means the county department of job and family services, the Ohio department of job and family services, or other entity that determines eligibility for a medical assistance program.
(2) A "Community community spouse" is means an individual who an individual who is not in a medical institution or nursing facility and has an institutionalized spouse, except that neither of two spouses, married to each other, who both request or receive services under a home and community-based services (HCBS) waiver program or program of all inclusive care for the elderly (PACE) is considered to meet this definition.:
(a) Is not in a medical institution or nursing facility; and,
(b) Has an institutionalized spouse.
(3) An "Individual individual" is means:
(a) An applicant for or recipient of medicaid medical assistance; and,
(b) Includes, for the purposes of this rule, the community spouse of either an institutionalized individual or an individual who requests or receives long term care services under home and community-based services (HCBS) under the special home and community-based services waiver covered group or PACE.
(4) "Institutionalized" describes means an individual who is likely to be in a medical institution or nursing facility for at least thirty consecutive days or who is eligible for and receives HCBS under the special home and community-based services waiver covered group. receives long term care services in a medical institution, a long term care facility, under an HCBS waiver program, or under PACE.
(5) "Retirement and income supplementing accounts (RISAs)" are plans designed to provide unearned income to supplant or supplement earned income. RISAs may include, but are not limited to such plans as: public and private pension, disability, or retirement plans; defined benefit employer pension planplans, profit sharing pension planplans, 403 (b) pension planplans, money purchase pension planplans, employee stock ownership plan, individual retirement account accounts (IRA); KEOGH pension planplans, Roth IRAIRAs, simplified employee pension plan plans (SEP-IRA), and 401k pension planplans; or any other pension or retirement plan plans authorized under 401, 403, 408 of the Internal Revenue Code (IRC) as outlined in 26 U.S.C, as in effect on March 9, 2002, or any subsequently enacted IRC provisions providing for a pension or retirement plan. or any other similar financial vehicles administered by an individual, employer, or union. A RISA converted into an annuity shall be considered in accordance with rule 5101:1-39-22.8 of the Administrative Code.
(C) RISAs treated as a resource.
(1) A RISA is a countable resource if the individual or the community spouse has an ownership interest in the RISA and the legal ability to convert it to cash. This determination shall be made by reference to documentation describing the RISA and/or a letter from the plan administrator. Self defined retirement plans such as an IRA or KEOUGH KEOGHplan are examples of this type of RISA.
(2) If there is a financial penalty imposed by the plan administrator in order to convert the account to cash, the amount of the countable resource is the net amount payable to the individual after deducting the penalty. The amount payable may not be further reduced by the amount of any tax incurred by the individual as a result of the conversion of the account to cash.
(3) A RISA is not a resource if an individual must terminate employment in order to obtain any lump sum or payment.
(4) If the RISA is determined to be a non-countable resource, then the RISA shall be evaluated as a potential source of unearned income.
(5) A RISA determined to be a resource in accordance with paragraph (C) of this rule, which is owned by an ineligible spouse or parent of a non-institutionalized individual who is otherwise eligible for medicaid, shall not be considered available to the non-institutionalized individual.
(D) RISAs treated as income.
(1) The RISA shall be evaluated as a potential source of unearned income only after it is determined to be a non-countable resource.
(2) A RISA in which an individual has the legal ability to receive regular guaranteed lifetime payments will be treated as a source of unearned income rather than as a resource. A defined benefit employer pension plan is an example of this type of RISA.
(3) The individual is required to obtain the maximum available amount of payment from the plan. If the maximum available amount of payment requires the individual's spouse to consent to a waiver of the spouse's survivor benefits, the individual must document a good faith attempt to obtain that consent, and whether consent was obtained or refused. If consent is not obtained, the individual must elect the minimum spousal survivor benefit required by the plan.
(4) If allowed in the plan, the individual may elect a lesser payment in favor of retaining a minimum survivor benefit for a child who can be documented to be blind or disabled, as defined in rule 5101:1-39-03 of the Administrative Code.
(E) Administrative agency responsibilities.
(1) The administrative agency shall must evaluate any RISA of which the individual is a beneficiary.
(2) The administrative agency shall obtain the summary plan description or other document describing the rights and benefits under the RISA. A letter from the plan administrator may also be obtained to make the determinations required under this rule.
(3) The administrative agency must assist with obtaining verification in accordance with rule 5101:1-38-02 of the Administrative Code.
(F) Individual responsibilities.
(1) An individual is required to provide all available documentation to aid the administrative agency in evaluating any RISA of which the individual is a beneficiary.
(2) As a condition of medicaid medical assistance eligibility, the administrative agency shall require applicants and recipients to take all necessary steps to obtain any pensions, retirement, and disability benefits to which they are entitled, unless they can show good cause for not doing so. Pensions, retirement and disability benefits include, but are not limited to, veterans' compensation and pensions, old age, survivors, and disability insurance (OASDI) benefits, railroad retirement benefits, and unemployment compensation. An individual must access is required to avail him/herself of potential income prior to approval of medicaid medical assistance, in accordance with rule 5101:1-39-08 of the Administrative Code.
(G) Hearing rights.
(1) The administrative agency must issue proper notice and hearing rights as outlined in division 5101:6 of the Administrative Code.
R.C. 119.032 review dates: 07/14/2006 and 10/01/2011
Promulgated Under: 111.15
Statutory Authority: 5111.01 , 5111.11
Rule Amplifies: 5111.01 , 5111.11
Prior Effective Dates: 1/1/93, 7/1/94, 12/1/2004