Section 29-9802. RESOURCE TEST

 

9802.1In order to be eligible for LTCSS, an applicant or beneficiary shall not have gross countable resources that exceed four thousand dollars ($4,000).

 

9802.2Individuals identified at Subsection 9800.2(a) shall be exempt from the resource test in Subsection 9802.1.

 

9802.3If an applicant or beneficiary has a community spouse, gross countable resources shall be determined after spousal impoverishment protections for resources have been applied.

 

9802.4If an applicant or beneficiary’s gross countable resources exceed four thousand dollars ($4,000), the applicant or beneficiary may reallocate excess resources to excludable resource types without affecting eligibility for LTCSS.

 

9802.5Gross countable resources shall exclude the following resource types:

 

(a)The personal home of the applicant or beneficiary, if one (1) of the following conditions is met:

 

(1)The home equity interest does not exceed the maximum home equity limit set annually by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) and available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Spousal-Impoverishment-Page.html (last visited October 14, 2015);

 

(2)The community spouse of the applicant or beneficiary resides in the home; or

 

(3)A child of the applicant or beneficiary who is under age twenty-one (21) or has a disability resides in the home;

 

(b)Accounts receivable;

 

(c)Burial funds that are in a separate, designated account;

 

(d)Promissory notes, if the notes are not related to transfers of resources within the past sixty (60) months;

 

(e)Earned income tax credits;

 

(f)Energy assistance payments;

 

(g)Proceeds from a home sale, if the applicant or beneficiary purchases or intends to purchase a new home within the next twelve (12) months;

 

(h)Household and personal goods;

 

(i)Inaccessible resources, which the applicant or beneficiary can neither use for ongoing support nor sell;

 

(j)Indian lands;

 

(k)Jointly owned resources, if the owner is legally unable to liquidate the resources;

 

(l)Land contracts;

 

(m)Life insurance funded funerals;

 

(n)Resources used to secure a loan for business purposes;

 

(o)Resources not fit to sell or not capable of being sold;

 

(p)Property pending sale;

 

(q)U.S. Department of Housing and Urban Development (HUD) reimbursements;

 

(r)One (1) vehicle per household (if there are multiple vehicles in the household, the vehicle with the highest value shall be excluded);

 

(s)Higher education savings plans;

 

(t)U.S. savings bonds, if penalties apply to early withdrawals or liquidations and they have not been renewed or reinvested during any immediately preceding period of Medicaid eligibility;

 

(u)Individual Retirement Accounts;

 

(v)Keogh accounts;

 

(w)Other retirement accounts including, but not limited to, 401(k), 403(b), and 457 accounts; and

 

(x)Funds or deposits with a Continuing Care Retirement Community (CCRC), unless all of the following conditions are met:

 

(1) The funds can be used to pay for care under the terms of the contract should other resources of the individual be insufficient;

 

(2)The entrance fee, or remaining portion, is refundable when the individual dies or leaves the community; and

 

(3)The fee confers no ownership interest in the community.

 

9802.6The Department shall apply methods used by the Social Security Administration (SSA), detailed at: https://secure.ssa.gov/apps10/poms.nsf/lnx/0501130700 (last visited October 14, 2015), for counting resources in which countable and excluded resource types are comingled.

 

9802.7The Department shall determine the total gross countable resources available to an institutionalized spouse and community spouse at the:

 

(a)Time of the initial eligibility determination; or

 

(b)Request of either spouse during the institutionalized spouse’s first period of institutionalization lasting thirty (30) or more consecutive days.

 

9802.8Any countable resources held by the institutionalized spouse, the community spouse, or both spouses shall be considered available to the institutionalized spouse at the time of the initial eligibility determination, unless:

 

(a)The institutionalized spouse has assigned to the District any rights to support from the community spouse;

 

(b)The institutionalized spouse lacks the ability to execute an assignment due to physical or mental impairment, but the District has the right to bring a support proceeding against the community spouse without such assignment; or

 

(c)The District determines that the denial of eligibility would work an undue hardship.

 

9802.9The Department shall determine the spousal share of resources allocated to each spouse either:

 

(a)At the time of the initial eligibility determination; or

 

(b)At the request of either spouse during the institutionalized spouse’s first period of institutionalization lasting thirty (30) or more consecutive days.

 

9802.10 A community spouse shall be entitled to retain a Community Spouse Resource Allowance equal to the spousal share, unless the spousal share is less than the minimum amount or greater than the maximum amount established annually by CMS and available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Spousal-Impoverishment-Page.html 

 (last visited October 14, 2015).

 

9802.11If the spousal share is less than the minimum amount, the institutionalized spouse may transfer excess countable resources to the community spouse to raise the Community Spouse Resource Allowance to the minimum amount.

 

9802.12If the spousal share is greater than the maximum amount, the community spouse may only retain the maximum amount.

 

9802.13Where an institutionalized spouse is allowed to transfer excess countable resources following the initial eligibility determination to a community spouse, the institutionalized spouse shall reallocate excess countable resources before the first annual renewal.

 

9802.14In accordance with Section 2970 of Title 1 DCMR and 42 C.F.R. § 431.200, an applicant, beneficiary, or community spouse may request a fair hearing to address the following matters:

 

(a)The spousal share of resources;

 

(b)The amount of the Community Spouse Resource Allowance; or

 

(c)The amount of resources attributed to each spouse. 

 

9802.15At the first annual renewal following the initial eligibility determination, the District shall verify that a beneficiary has transferred excess countable resources to the community spouse.

 

 

authority

An Act to enable the District of Columbia (District) to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat.774; D.C. Official Code § 1-307.02 (2014 Repl. & 2015 Supp.)), and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).

source

Final Rulemaking published at 63 DCR 1605 (February 12, 2016).