5101:1-39-36.2 Medicaid: transfer of resources for institutionalized spouses with a spouse in the community.

(A) Once eligibility has been established, resources not used to determine eligibility for an institutionalized spouse (pursuant to rule 5101:1-39-36.1 of the Administrative Code) must be legally transferred to the community spouse when not already in the name of such person. The institutionalized spouse (IS) is entitled to a period of protected eligibility while the resources are being transferred legally to the community spouse. The period of protected eligibility is twelve months or one year from the month in which the eligibility determination is completed. The resource transfer must take place no later than the twelfth month after the month of the eligibility determination and authorization. For example, if the eligibility determination is completed in the month of June, the transfer of the resources must be completed by the end of June of the next year. Resources being transferred do not count for the purpose of determining continuing eligibility for the institutionalized spouse.

(B) The CDJFS shall discuss the intent to transfer with the IS and encourage the IS to transfer the resources as soon as possible; however, no later than the twelfth month after the month of the initial eligibility determination. The institutionalized spouse must indicate to the case worker intent to legally transfer the resources to the community spouse. The CDJFS shall verify the institutionalized spouse's intent to transfer the resources to the community spouse by completing the JFS 07213 "Resources Transfer Statement". The protected period is available immediately following the month in which the initial eligibility determination is completed.

(C) If the institutionalized spouse comes into additional resources, during a period of protected eligibility, these resources will be exempt when at least one of the following conditions exist:

(1) The new resources combined with other resources the institutionalized spouse intends to retain, do not exceed the resource limit for one person; and/or

(2) The institutionalized spouse intends to transfer the new resources to the community spouse whose resources are below what have been protected through the resource assessment.

If the institutionalized spouse receives additional resources during the protected period of eligibility, the CDJFS shall determine whether or not these resources can be transferred to the community spouse. If the original amount of protected resources for the community spouse was less than the spousal resource allowance, the institutionalized spouse may transfer to the community spouse the amount which will bring the community spouse's resources up to the determined spousal resource allowance.

(D) If the institutionalized spouse fails to transfer resources to the community spouse within the protected period of eligibility (from approval for medicaid until the first regularly scheduled redetermination), eligibility for the institutionalized spouse must be determined counting all of the resources in the institutionalized spouse's name. The CDJFS shall take the appropriate actions necessary if the institutionalized spouse has resources which exceed the individual resource standard.

(E) The CDJFS shall determine resource eligibility for each month of the retroactive period in accordance with rule 5101:1-38-01.3 of the Administrative Code. Deduct from the current countable resources the community spouse resource allowance for each month of the retroactive period. This method of determining resource eligibility is used since there is no protected period of medicaid eligibility to transfer resources to a community spouse because the couple was unaware that such transfers may be allowed to ensure eligibility for the institutionalized spouse. This does not apply for retroactive periods associated with subsequent applications for the same period of institutionalization.

(F) Medicaid eligibility requirements for community spouses and other family members does not change when it is determined that a transfer of resources from the institutionalized spouse to the community spouse has occurred. Resources are considered in accordance with the rules in Chapters 5101:1-39 and/or 5101:1-40 of the Administrative Code that would apply to each individual. Those resources that the institutionalized spouse intends to transfer to the community spouse are considered to be available to the community spouse during the institutionalized spouse's protected eligibility period.

Eff 1-1-90 (Emer.); 4-1-90; 6-1-90 (Emer.); 8-1-90; 1-1-92; 7-1-95; 10-1-02
Rule promulgated under: RC 111.15
Rule authorized by: RC 5111.01 , 5111.011
Rule amplifies: RC 5111.01 , 5111.011
Replaces: 5101:1-39- 36.3, 5101:1-39- 36.4, 5101:1-39- 36.5
R.C. 119.032 review dates: 5/6/2002 and 10/01/2007