DAR File No. 27879

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-305-2

Family Medicaid and Family Institutional Medicaid Resource Provisions

NOTICE OF PROPOSED RULE

DAR File No.: 27879
Filed: 05/11/2005, 02:00
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking is necessary to add some resource exclusions for Family Medicaid programs to coordinate with changes made for Aged, Blind and Disabled Medicaid programs. Various subsections have been reworded to make them easier to understand.

Summary of the rule or change:

Some citations have been modified to be more specific, to correct errors and to remove unneeded citations. Various subsections have been reworded for clarity and to make them easier to understand. Subsection R414-305-2(4) adds a specification and reference to another rule about the resource test for poverty level pregnant women. Subsection R414-305-2(8) has been rewritten to clarify that assets of an applicant or recipient that are controlled or managed by another person, even under an informal arrangement, are still treated as assets of that applicant or recipient. Subsection R414-305-2(9) is a clarification about legal impediments to making a resource available. Subsection R414-305-2(11) is a clarification about when household items of high value will be counted. Subsection R414-305-2(12) is an addition about excluding one wedding and engagement ring. Subsection R414-305-2(19) is being changed to extend the exclusion period to nine months for retroactive Social Security and Railroad Retirement funds. Subsection R414-305-2(20) is a clarification about counting as income any excluded funds held for burial that are used for another purpose. Subsection R414-305-2(27) is a new resource exclusion for funds an individual receives from the Earned Income Tax credit or the Child Tax credit. Such funds will be excluded from resources for nine months.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 18

45 CFR 233.20(a)(3)(i)(B)(1), (2), (3), (4), and (6); 233.20(a)(3)(iv)(A); Section 1917(d) and (e), 404(h) and 1613(a)(13) of the Compilation of the Social Security Laws, in effect January 1, 2003

Anticipated cost or savings to:

the state budget:

There should be no cost or savings because of this amendment. This change will allow current eligibles to remain eligible if the amount of Earned Income Tax credit or Child Tax credit happens to exceed the resource limit, by giving them additional time to use the tax credits. It also just extends the exclusion period for retroactive Social Security or Railroad Retirement.

local governments:

No cost or savings--This does not impact local government as it applies only to eligibility criteria for individuals.

other persons:

No cost or savings--This does not take away any benefits or add any costs. There are no compliance costs for affected persons because this does not make eligibility requirements more restrictive nor does it take away any benefits.

Compliance costs for affected persons:

There are no compliance costs for affected persons because this does not make eligibility requirements more restrictive nor does it take away any benefits.

Comments by the department head on the fiscal impact the rule may have on businesses:

These rule changes add clarity to the rule and maintain the status quo for eligibility in these programs. No fiscal impact is anticipated. A. Richard Melton, Acting Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/01/2005

This rule may become effective on:

07/02/2005

Authorized by:

Richard Melton, Deputy Director

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-305. Resources.

R414-305-2. Family Medicaid and Family Institutional Medicaid Resource Provisions.

(1) This section establishes the rules for treatment of resources to determine eligibility for Family Medicaid and Family Institutional Medicaid programs.

([1]2) The Department adopts 45 CFR [206.10(a)(vii), ]233.20(a)(3)(i)(B)(1), (2), (3), (4) and (6), and 233.20(a)(3)(vi)(A), [and 233.51(b)(2), 2001]2004 ed., which are incorporated by reference. The Department adopts Subsection 1902(k) of the Compilation of the Social Security Laws, 1993 ed., which is incorporated by reference. The Department adopts 1917(d) and (e), Subsection 404(h) and 1613(a)(13) of the Compilation of the Social Security Laws in effect January 1, [1999]2003, which are incorporated by reference. The Department [shall]does not count as an available resource [any assets that are prohibited under other]retained funds from sources that federal laws specifically prohibit from being counted as a resource to determine eligibility for federally-funded medical assistance programs.

([2]3) A resource is available when the client owns it or has the legal right to sell or dispose of the resource for the client's own benefit.

([3]4) Except for pregnant women who meet the criteria under Sections 1902(a)(10)(A)(i)(IV) and 1902(a)(10)(A)(ii)(IX) of the Social Security Act in effect January 1, 2003, [T]the resource limit is $2,000 for a one person household, $3,000 for a two [member]person household and $25 for each additional household member. For pregnant women defined above, the resource limit is defined in R414-303-11.

([4]5) Except for the exclusion for a vehicle, the agency uses the same methodology for treatment of resources [is the same ]for all medically needy and categorically needy individuals.

([5]6) To determine countable resources for Medicaid eligibility, the agency considers [is based on ]all available resources owned by the client. The agency does not consider a resource unavailable [Eligibility cannot be granted ]based upon the client's intent to or action of disposing of non-liquid resources.

([6]7) The agency counts resources of a sanctioned household member[ are counted].

([7]8) [The resources of a ward that are controlled by a legal guardian are counted as the ward's resources.]If a legal guardian, conservator, authorized representative, or other responsible person controls any resources of an applicant or recipient, the agency counts the resources as the applicant's or recipient's. The arrangement may be formal or informal.

([8]9) If a resource is potentially available, but a legal impediment to making it available exists, [it is not countable ]the agency does not count the resource until it can be made available. Before an applicant can be made eligible, or to continue eligibility for a recipient, [T]the applicant or recipient must take appropriate steps to make the resource available unless one of the following conditions exist:

(a) Reasonable action would not be successful in making the resource available.

(b) The probable cost of making the resource available exceeds its value.

([9]10) Except for determining countable resources for 1931 Family Medicaid, the agency excludes a maximum [exemption for the equity ]of [one car is ]$1,500 in equity value of one vehicle.

([10]11) The agency does not count as resources the value of [Maintenance items ]household goods and personal belongings that are essential for day-to-day living[ are not countable resources]. Any single household good or personal belonging with a value that exceeds $1000 must be counted toward the resource limit. The agency does not count as a resource the value of any item that a household member needs because of the household member's medical or physical condition.

(12) The agency does not count the value of one wedding ring and one engagement ring as a resource.

([11]13) The agency does not count the value of a life[Life] estate[s are not countable] as an available resource[s] if the life estate is the applicant's or recipient's principal residence[ of the applicant or recipient]. If the life estate is not the principal residence, [see ]the rule in Subsection R414-305-1(25) applies.

([12]14) The agency does not count the resources of a[an ineligible] child [are not counted]who is not counted in the household size to determine eligibility of other household members.

([13]15) The agency does not count as a resource, the value of the lot on which the excluded home stands [is not counted ]if the lot does not exceed the average size of residential lots for the community in which it is located. The agency counts as a resource the value of the property in excess of an average size lot[ is a countable resource].

([14]16) [W]The agency does not count as a resource the value of water rights attached to an excluded home and lot[ are not counted].

([15]17) [A]The agency does not count any resource, or interest from a resource held within the rules of the Uniform Transfers to Minors Act[ is not countable]. [A]The agency counts as a resource any money from such a resource that is given to the child as unearned income and retained beyond the month received[ is countable].

([16]18) Lump sum payments received on a sales contract for the sale of an exempt home are not counted if the entire proceeds are committed to replacement of the property sold within 30 days and the purchase is completed within 90 days. The individual shall receive one extension of 90 days, if more than 90 days is needed to complete the actual purchase. Proceeds [is]are defined as all payments made on the principal of the contract. Proceeds [does]do not include interest earned on the principal.

([17]19) Retroactive benefits received from the Social Security Administration and the Railroad Retirement Board are not counted as a resource for the first [6]9 months after receipt.

([18]20) The agency excludes from resources, a [A $1,500 ]burial and funeral fund or funeral arrangement up to $1500[exemption is allowed] for each [eligible ]household member who is counted in the household size. Burial and funeral agreements include burial trusts, funeral plans, and funds set aside expressly for the purposes of burial. All such funds must be separated from non-burial funds and clearly designated as burial funds. Interest earned on exempt burial funds and left to accumulate does not count as a resource. If exempt burial funds are used for some other purpose, remaining funds will be counted as an available resource as of the date funds are withdrawn.

([19]21) Assets shall be deemed from an alien's sponsor, and the sponsor's spouse, if any, when the sponsor has signed an Affidavit of Support pursuant to Section 213A of the Immigration and Nationality Act on or after December 19, 1997. Sponsor deeming will end when the alien becomes a naturalized U.S. citizen, or has worked 40 qualifying quarters as defined under Title II of the Social Security Act or can be credited with 40 qualifying work quarters. Beginning after December 31, 1996, a creditable qualifying work quarter is one during which the alien did not receive any federal means-tested public benefit.

([20]22) Sponsor deeming does not apply to applicants who are eligible for Medicaid for emergency services only.

([21]23) Business resources required for employment or self employment are not counted.

([22]24) For 1931 Family Medicaid households, the [state shall either disregard]agency will not count as a resource either the equity value of one vehicle that meets the definition of a "passenger vehicle" as defined in 26-18-2(6), or $1,500 of the equity of one vehicle, whichever provides the greatest disregard for the household.

([23]25) For eligibility under Family-related Medicaid programs, the agency will not count as a resource retirement funds held in an employer or union pension plan, retirement plan or account including 401(k) plans and Individual Retirement Accounts of a disabled parent or disabled spouse who is not included in the coverage[ shall be excluded from countable resources].

([24]26) The [Department shall exclude from]agency will not count as a resource[s] the contributions made by an individual and the interest accrued on funds held in an Individual Development account as defined in Sections 404-416 of Pub. L. No. 105-285, effective October 27, 1998.

(27) The agency will not count as a resource, funds received from the Child Tax credit or the Earned Income Tax credit for nine months following the month received. Any remaining funds will count as a resource in the 10th month after being received.

KEY: Medicaid

[May 7, 2004]2005

Notice of Continuation January 31, 2003

26-18

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For questions regarding the content or application of this rule, please contact Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.