5101:1-40-14 Covered families and children (CFC) medicaid: resources: application, definitions, availability, and limitations.

(A) Application of resource policy

The resource policy stated in this chapter do not apply to the following covered families and children (CFC) medicaid covered groups:

(1) Healthy families/low-income families (LIF) assistance groups.

(2) Transitional medicaid assistance groups.

(3) Healthy start assistance groups.

(4) Expedited medicaid assistance groups.

(5) Four-month extended medicaid assistance groups.

(B) Resources: definitions, principles, and availability

(1) Resources are those possessions belonging to members of an assistance group that may be used for their support. Resources include personal property, real property, and liquid assets as well as assets not in a liquid form. All resources belonging to members of an assistance group must be considered in order to determine their value and availability. The resources of certain individuals whose needs are not included in the assistance group are also considered and applied toward the resource limit, as defined in paragraph (C) of this rule. The resources of the following individuals are counted:

(a) Individuals who are ineligible due to the individual’s third failure without good cause to participate in an OWF work activity

(b) Individuals who are non-qualified aliens; and

(2) Ownership of a resource must be clearly established to evaluate availability.

(a) A resource owned solely by a member of the assistance group (or an individual excluded in paragraph (B)(1) of this rule) is considered to be available in its entirety to the assistance group.

(b) A resource owned in common with an individual other than a member of the assistance group (or individual excluded in paragraphs (B)(1)(a) to (B)(1)(c) of this rule) is considered to be available to the assistance group on a prorated basis unless documentation is provided to the contrary. When ownership is shared unequally, the CDJFS must determine the amount of the resource that is available to the assistance group.

(c) Only resources in which the assistance group has a legal interest and the legal ability to use or dispose of are to be counted.

(d) If the ownership of the resource is shared, the assistance group’s ability to use or dispose of the resource must be determined.

(e) When a member of the assistance group shares ownership of a resource with another person who is not a member of the assistance group, it is assumed that the ability to use and dispose of the resource exists unless the assistance group can provide documentation to the contrary. If the owner who is not the assistance group member (or an individual excluded in paragraph (B)(1) of this rule) indicates the intention of blocking the assistance group’s use or disposal of the resource, the assistance group should be referred to available legal services. If legal means of pursuit are available, the assistance group is required to take any and all necessary action to make the resource available. If the assistance group is unwilling to take action to make the resource available, the application must be denied or the assistance terminated. If the assistance group is unable to make the resource available because one of the owners cannot be located, the cost of legal action is prohibitive, etc., the resource is not considered to be available to the assistance group. When there is good cause for being unable to obtain all necessary verification related to availability, an application must be approved pending the receipt of the verification. Availability of the resource must be reviewed at each reapplication.

(3) The CDJFS must consider whether the individual resides with the parent(s) or a spouse. Resources of the parent(s) or a spouse are not considered when determining eligibility if:

(a) A natural or adoptive parent or a spouse is in receipt of SSI; or

(b) An individual does not live in the same household as his parent(s).

(4) For a resource to be considered in determining CFC medicaid eligibility, it must be available to the assistance group. Available is defined as accessible. A resource is considered to be available to the assistance group as long as the owner of the resource (who is a member of the assistance group), or any other member of the assistance group (or any of the specifically excluded individuals identified in paragraph (B)(1) of this rule) is aware, or has reason to be aware of the resource. If the recipient convinces the CDJFS that all members of the assistance group were unaware of the resource and had no reason to be aware of the resource, then the resource shall be considered to have been unavailable. The assistance group has the burden of proving that each member of the assistance group (including the specifically excluded individuals identified in paragraph (B)(1) of this rule) was unaware of and had no reason to be aware of the resource. The resource will be considered to have been unavailable only for the period of time the assistance group can demonstrate that they had no reason to be aware of the resource. Once any member of the assistance group (or any of the individuals identified in paragraph (B) of this rule) becomes, or has reason to become aware of the existence of the resource, the resource will be considered available to the assistance group. The assistance group must have the legal right to control and dispose of the property for it to be counted as a resource.

(5) A resource must be both liquid and available to be considered in determining eligibility for assistance.

(6) The assistance group must have the legal right to dispose of the resource being considered.

(7) The resources of a parent who is living in the home but is not included in the assistance group are counted against the resource limitation on the following basis:

(a) All resources held by the natural parent are available to the child(ren) in their entirety except as specified in paragraph (B)(3) of this rule.

(b) All resources owned solely by the stepparent are not considered available to the natural parent and/or the natural parent’s child(ren).

(c) If a resource is jointly owned and listed with the names connected by “and,” the resource is divided equally between the couple. If a resource is jointly owned but is listed with the names connected by “or,” the resource is considered available in its entirety to the natural parent. All of the resource is then available to the natural parent’s child(ren).

(8) On occasion, an assistance group cannot liquidate nonexempt personal property which causes ineligibility because of legal technicalities, general economic conditions in the community, or the inability to find a buyer. When a bona fide effort as specified in paragraph (B) of rule 5101:1-39-32.1 of the Administrative Code is made to dispose of a resource and evidence shows there is not a current market for the personal property, then the personal property is not counted.

(a) Unavailability of the personal property must be reevaluated at every reapplication.

(b) When personal property has been declared unavailable due to a lack of purchase offers, the assistance group must continue attempts to sell the personal property.

(c) When personal property has been declared unavailable due to a specified condition, the CDJFS must confirm from the assistance group that the specified condition which made the personal property unavailable still exists.

(1) The total equity value of all countable real property, personal property, and liquid assets owned by members of the assistance group cannot exceed one thousand dollars for an assistance group of any size. “Equity value” means fair market value minus liens or encumbrances (legal debts). “Fair market value” means the price an item of a particular make, model, size, material, or condition will sell for on the open market in the geographic area involved.

(2) The one thousand dollar resource limit does not include:

(a) Homestead property which is the usual residence of the assistance group.

(i) Homestead property includes one home and all adjoining land.

(ii) “Adjoining land” means land which is not separated by intervening property owned by someone else. Land which is separated by roads, rivers, streams, etc., is considered to be adjoining.

(b) One motor vehicle, the value of which does not exceed one thousand five hundred dollars with consideration of liens or encumbrances.

(i) If this vehicle has any excess value over the one thousand five hundred dollar limit, the excess is applied to the overall one thousand dollar resource limitation.

(ii) The value of all other motor vehicles, with consideration of liens or encumbrances, is counted toward the one thousand dollar resource limitation.

(c) Items or personal property owned by members of the assistance group that are considered as household goods and personal effects.

(d) The resources of an SSI recipient.

(e) Funeral agreements valued at one thousand five hundred dollars or less for each member of the assistance group. Equity value for funeral agreements that exceed one thousand five hundred dollars per assistance group member shall be counted toward the one thousand dollar resource limitation.

(f) One burial space for each member of the assistance group.

(g) Bona fide loans from any source.

(h) Educational grants and scholarships from any source for undergraduate and graduate college expenses.

(i) Payments received by individuals of Japanese ancestry under section 105 of Public Law 100-383, and payments received by Aleuts under section 206 of Public Law 100-383.

(j) Payments received under the provisions of the Agent Orange Compensation Exclusion Act (Public Law 101-201) received on or after January 1, 1989.

(k) Earned income tax credit (EITC) payments received after December 31, 1990 in the form of a refund of federal income taxes or in the form of an advance payment by an employer must be disregarded in the month of receipt of such payment and in the month following. When an applicant has received the EITC refund in the month prior to application, any remaining portion of the EITC payment will be considered an exempt resource in the month of application.

(l) Effective May 1, 1991, the resources of an individual on whose behalf federal, state or local foster care maintenance payments are made.

(m) Effective May 1, 1991, the resources of an individual who is excluded from the OWF assistance group on whose behalf federal, state or local adoption assistance payments are made.

(n) Payments received under the provisions of the Radiation Exposure compensation Act (Public Law 101-426) received on or after October 15, 1990.

(o) Many federal statutes provide for the exclusion from income and resources of certain payments made to members of Indian tribes and groups. Due to the number of statutes that affect CFC medicaid eligibility, ODJFS will exclude from income and resources for CFC medicaid purposes any payments that are also excluded under the supplemental security income (SSI) program.

(p) Payments received under the provisions of the “Child Care and Development Block Grant” (Section 5082 of Public Law 101-508).

(q) Escrow accounts established and credited as the direct result of the assistance group’s involvement in the “Family Self-Sufficiency Program” on or after May 13, 1992. These escrow accounts are only considered available when the assistance group is no longer receiving any federal, state, or other public assistance for housing.

(r) Effective February 28, 1994 the resources of an individual for whom federal, state or local foster care maintenance or adoption assistance payments are being made.

(s) As a result of the settlement contained in H.B. 2015, none of the payments made from any fund established pursuant to a class settlement in the case of “Susan Walker v. Bayer Corporation,” et al., 96-C-5024 N.D. Ill.) shall be considered income or resources when determining eligibility. Interest received as a result of this settlement is not excluded for resource purposes.

(t) Assistance payments in the month in which they are received.

(u) Child support payment distributions made by ODJFS pursuant to division (C) of Section 1 of Am. S.B. 170 of the 124th General Assembly and rules 5101:1-29-31.1 and 5101:1-29-31.2 of the Administrative Code shall be excluded from consideration as income or resources in the financial eligibility determination for CFC medicaid.

(3) The one thousand dollar resource limit does include:

(a) The equity value of real property not used as the residence of the assistance group, assessed according to its equity value. Any income received from income-producing property is counted as income to the case.

(b) The equity value of any burial spaces in excess of one per person.

(d) Household goods and personal effects not considered as exempt resources.

HISTORY: Eff 6-1-76; 12-31-77; 2-3-80; 5-29-80; 1-1-81; 10-1-81; 5-7-82; 7-15-84; 10-1-84 (Emer.); 12-27-84 (Emer.); 1-1-85 (Emer.); 4-1-85 (Emer.); 4-1-88; 6-30-88; 4-1-89 (Emer.); 5-28-89; 7-1-89 (Emer.); 9-23-89; 12-1-89 (Emer.); 6-1-90; 5-1-91 (Emer.); 7-11-91 (Emer.); 9-22-91; 4-1-92; 9-1-92; 10-1-92 (Emer.); 9-1-94; 8-1-95; 10-31-97 (Emer.); 1-26-98; 1-1-03

Rule promulgated under: RC 111.15

Rule authorized by: RC 5111.01, 5111.011

Rule amplifies: RC 5111.01, 5111.011

R.C. 119.032 review dates: 04/05/2002 and 01/01/2008