MS Manual 11/01/95

3100 General Information

3110 Facilities Which Provide Services

Facilities which provide medically necessary care and services 24 hours per day on a long term basis include private nursing facilities, Benton Services Center, Arkansas Human Development Centers, private intermediate care facilities for the mentally retarded (ICF/MR's), and ICF/MR facilities with both over and under 15 beds.

MS Manual 11/01/95

3120 Services Provided Under Medicaid

In addition to facility vendor payments, all services listed in the pamphlet, "Your Guide to Medicaid Services in Arkansas", are available to individuals under the Long Term Care Program, with the following exception: Individuals in the State Human Development Centers are not eligible for the Prescription Drug Program.

MS Manual 11/01/95

3130 Licensing and Classification of Facilities

To receive vendor payment under the Medicaid Program, a facility must be licensed and certified by the Office of Long Term Care (OLTC), and must execute a provider agreement with the Division of Medical Services.

The OLTC publishes a directory listing all participating facilities. Changes to the directory are issued periodically. The directory and updates are provided to each county office.

MS Manual 11/01/95

3135 Nursing Facility

Section 1919 (a) of the Social Security Act defines a nursing facility as an institution which is primarily engaged in providing:

·         Skilled nursing care and related services for residents who require medical or nursing care,

·         Rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or

·         Health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities,

and is not primarily for the care and treatment of mental diseases.

MS Manual 07/01/99

3140 Personal Allowance for Facility Residents

Each recipient in a facility is allowed to retain $40 per month from their income for personal expenses. (EXCEPTION: Recipients whose only income is SSI will have their monthly payment reduced to $30. They are allowed to keep this amount as a personal allowance.) Upon written authorization of a resident, the facility must hold, safeguard and account for the personal funds of the resident deposited with the facility. If the resident's personal funds are in excess of $50, the facility must deposit the funds in excess of $50 in an interest bearing account (or accounts), separate from any of the facility's operating accounts, that credits all interest earned on the resident's account to his or her account. A resident's personal funds may not be commingled with facility funds or with any person's funds other than another resident. The resident's individual financial record must be available on request to the resident or his/her legal representative.

In addition to the $40 personal needs allowance, ICF/MR residents, including residents of State Human Development Centers, who have income from employment are allowed to keep all of their earnings up to an amount equal to the current SSI SPA.

A resident with earnings who is receiving intermediate care in a nursing facility may keep up to $100 increased personal needs allowance if his/her physician has stated that a period of employment activity is necessary as a therapeutic or rehabilitative measure. If a resident receiving skilled care in a nursing facility becomes employed, the Utilization Review Section of the OLTC should be contacted and requested to reevaluate medical necessity.

Certain SSI recipients whose stay in a nursing facility is not expected to exceed 3 months and who have a home to maintain will be allowed to retain full SSI benefits for personal expenses for three calendar months following the month of entry. The SSI payment, in these instances, will not be considered in eligibility or payment determination (Re. MS 3401).

A $90 personal needs allowance will be given to a veteran receiving a VA pension in a facility who has no spouse or dependent children. A veteran's surviving spouse who has no dependents and who receives a VA pension will also be given a $90 allowance. The full $90 allowance will be allowed only when VA has reduced the pension to $90. (Re. MS 3348.1). Veterans receiving VA compensation do not qualify for the $90 PNA.

MS Manual 07/01/99

3150 Special Charges to Recipients in Facilities

The facility must inform the patient prior to or at the time of admission or application, and during his/her stay, of services available in the facility and of related charges, including charges for services not covered by Medicare or the per diem rate. Recipients may be charged only for optional services (services not necessary or consistent with the normal care of the patient). When such services are provided, documentation must be on file with the OLTC. The refusal of a recipient to accept optional services offered by a facility must not effect a decrease or alteration in the services required or necessitated by his/her condition or otherwise considered as normal care. Inquiries from recipients or family members concerning special charges will be referred to the OLTC.

MS Manual 11/01/95

3160 Nondiscrimination

The Division of County Operations complies with all provisions of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and the

Americans With Disabilities Act of 1990. All facilities authorized to participate in the LTC program must also comply with these provisions. No person will be prevented from participation, denied benefits, or otherwise subjected to discrimination based upon race, color, sex, national origin, disability, age, religion, political affiliation, or veteran status.

The Division of County Operations has the responsibility of informing applicants and recipients that assistance is provided on a nondiscriminatory basis and of their right to file a complaint with the Division, the Department of Health and Human Services, the Department of Justice, and/or the United States Civil Rights Commission if they feel they have been discriminated against on the basis of one of the above.

The OLTC is responsible for securing a statement of compliance from all hospitals and facilities authorized to participate in the Medicaid program, and for assuring that the Statement of Compliance is officially adopted and posted on the premises. The OLTC will also assure that copies of the policy are provided to all employers and staff, and to all referral agencies. The OLTC will conduct annual reviews of facilities to insure compliance with these provisions.

MS Manual 11/01/95

3170 Freedom of Choice

Residents of nursing and ICF/MR facilities, and AABD recipients whose primary insurance is Medicare, are not required to participate in the Medicaid Primary Care Physician Managed Care Program.

These recipients will have freedom of choice in the selection of facilities, physicians, pharmacies, and other medical providers. The recipient should be informed that payment under the Medicaid program can be made only to medical providers authorized to participate in the Medicaid program. If the recipient wishes to utilize the services of a personal physician or other medical practitioner who does not participate in the Medicaid program, the recipient will be advised that payment cannot be made by the Agency for these services, and that the cost will be his/her responsibility.

MS Manual 11/01/95

3180 Placement

Relatives or friends of a facility applicant should help in making the selection of a Medicaid certified and licensed facility. Names and addresses of facilities that can provide the appropriate care and services will be given to the patient or his/her family.

If the applicant is unable to make this choice and if there are no relatives or friends to assist in the decision, the county office will assist with the placement. If placement cannot be made, a request for assistance should be made to the OLTC.

MS Manual 11/01/95

3200 Application Process

3210 Initial Application for Facility Payment

An application for facility services may be made by the applicant, designated representative, next of kin, or person(s) acting responsibly for the individual. Applications should be made in the county where the facility chosen by the individual is located. If an application is made in the applicant's home county before facility entry, but the applicant enters a facility in another county, the application will be denied by input to WIMA, using denial Reason 53. A DCO-700 will then be completed, advising the client or the representative that the application has been sent to the appropriate county. All records will then be transferred to the county where the facility is located. A new application will not be needed by the receiving county, and the original date of application will be entered in ACES when the application is reregistered.

NOTE: If a period of eligibility has been, or will be, established in a facility in the county of initial application, that county will certify the case for the eligible period before transferring the case to the second county.

Applications may be processed for deceased persons. Application may be made by any person with responsibility for the medical debts of the deceased person.

Application for facility services will be made on Form DCO-777. This form will be completed for all applications for facility vendor payment unless the individual is currently receiving assistance as an AFDC, U-18, or Foster Care (Cat. 91 or 92) recipient. No new application is needed for these categories.

MS Manual 11/01/95

3220 Reapplication for Facility Payment

Reapplication for facility services is made in the same manner as initial applications. Previous records will be reviewed. If the applicant comes from another county where his case was closed, the record will be secured from that county.

MS Manual 11/01/95

3230 Distinction Between Application and Inquiry

Every person has the right to apply for Medicaid. No application or inquiry may be ignored.

The distinction between an application and an inquiry is as follows:

1.      An application is the action by which an individual indicates in writing to the Agency his desire to receive services.

2.      An inquiry is simply a request for information about eligibility requirements for services. An inquiry may be followed by an application.

MS Manual 11/01/95

3240 Steps in Application Process

3241 Initial Contact

Initial contact may be made in person, by telephone, or by letter. Contact may be made by the applicant, a designated representative, the next of kin, or another person acting responsibly for him. The following tasks will be completed by the county worker during the initial contact:

1. Completion of Forms DCO-777 and DCO-727 (except for active AFDC, U-18, or Foster Care, Cat. 91 or 92 recipients). If the applicant or his representative is not present at the initial contact, Forms DCO-777 and DCO-727 may be mailed. The county worker will inform the applicant or his representative that he has not officially made application until the signed DCO-777 is received, and that all correspondence is available in different formats, such as large print;
2. Explanation of the process for determining medical necessity by the Long Term Care-Utilization Control Committee for all facility applicants. If the applicant has not selected a facility, a DCO-703 will be given or mailed to the applicant or his representative for him to take to his physician. If a Title IV-E or other Foster Care child is placed in an ICF-MR, the facility will mail the DCO-703 to the ES Supervisor of the county where the facility is located. The ES Supervisor will sign the DCO-703, and return the form to the facility for completion;
3. Explanation of the Medicaid program and facility care;
4. Explanation of the SSN enumeration requirement;
5. Explanation of the Agency's responsibility to carry out policy in determining eligibility; of the applicant's responsibility to cooperate in determining eligibility; of the mandatory assignment of rights to medical support/third party liability (Re. MS 1350); of the obligation to file third party resource claims within a reasonable period of time; of child support enforcement requirements (when applicable); of the information needed to determine eligibility; and of the confidential way in which the Agency treats information;
6. Explanation of the applicant's right to request a hearing if he is dissatisfied with the handling of his case; and
7. Explanation of the Agency time limit for disposing of the application.

MS Manual 11/01/95

3242 Referrals from Arkansas State Hospital and George W. Jackson Center

Persons in the Arkansas State Hospital, Little Rock, or the George W. Jackson Center, Jonesboro, may be eligible for long term care placement under Medicaid. The State Hospital will refer the patient by DHS-3300 to the county office.

If the applicant does not have a guardian or custodian and a need for one is indicated, the Hospital staff will determine need and be responsible for the preparation of necessary documents. If no need is established, the individual's transfer record must indicate "No need for Guardian or Custodian". The Hospital staff will coordinate efforts with the Agency's Office of Chief Counsel for the filing of the documents, when appropriate. Long term care patient referrals will be made by Hospital staff to the county in which placement will be made. It is the responsibility of that county office to mail Form DCO-777 to the applicant or his representative and to process any subsequent application.

The ES Supervisor of the domiciliary county will be responsible for corresponding with the county where the guardian or custodian is located, the county where information indicates possible resources, or the county where relatives may be contacted, as may be required to determine eligibility.

MS Manual 11/01/95

3243 Referrals from Arkansas Human Development Centers

The following procedures apply to those individuals currently in an Arkansas Human Development Center who are referred for assistance:

1.      Patient referrals will be made by Center staff to the county office in the county where the patient is domiciled;

2.      It is the responsibility of the county office to send Form DCO-777 to the parent or guardian of the child and to process any subsequent application. A new application is not needed for a current recipient of AFDC, U-18, or Foster Care (Cat. 91 or 92). If the Agency has legal responsibility for a Category 96 or 97 Foster Child, Form DCO-777 will be completed by the ES Supervisor, or Family Service Worker in charge of the case, for AB or AD determination.

3.      The Center will determine if the Agency has legal custody or guardianship of the child. If custody of a child is vested with the Agency, the DCO-703 will be mailed to the ES Supervisor for signature for release of medical information.

MS Manual 11/01/95

3244 Case Record and Control Card

A case record will be established in the County Office as soon as an application is received. Copies of all documents and correspondence will be placed in this record.

Form DCO-87 (Control Card) will be completed for each application at the time the case record is established.

MS Manual 11/01/95

3245 Entry of Application to WIMA

All applications will be entered into WIMA, with the date of application being the date the application was received in the County Office. The system generated application number will be entered on the DCO-777 by the terminal operator. All formal requests for LTC must be registered.

MS Manual 11/01/95

3247 Denial of Application at Intake

When information presented by the applicant or his representative during initial contact establishes that the applicant is ineligible, the application will be denied at that time. The county worker will complete all tasks required for denial of the application (Re. MS 3500 #2).

MS Manual 11/01/95

3248 Recording of Applications on Control Sheet

The county worker will maintain a Control Sheet (DCO-88) of all applications assigned to him or her for processing. The worker will list on the Control Sheet:

1.      All applications pending at the beginning of the month, arranged by date of application (oldest first), and

2.      Applications assigned to the worker during the month in order of receipt.

As applications are completed, the action and the date of completion will be indicated on the DCO-88.

MS Manual 11/01/95

3249 Referral to SSI

All AABD applicants with countable income less than the SSI SPA may be referred to SSA by Form RVI-302 for determination of SSI eligibility. If individuals with countable income of less than the current SSI/SPA ($30.00 for Title XIX facility residents) allege a disability and apply in the AD category, current disability guidelines will be followed. Information must be sent to MRT if an SSI application is pending (Re. MS 3322). AD applications for these individuals will be approved if found eligible by MRT and if otherwise eligible, when SSA has not yet made a decision on the SSI disability. If SSI disability is later denied, the facility case will be closed (Action Reason 040). If SSI is later approved, facility services may be continued.

Applications for individuals whose countable income is above the current SSI/SPA ($30.00 for Title XIX facilities) will be processed by the County office for AABD eligibility determination (without referral to SSI), including eligibility determination by MRT, if appropriate.

SSA approved individuals with income of less than $50.00 will be eligible for an SSI payment while in a facility. SSA approved individuals with income between $50.00 and the SSI SPA will be eligible for an SSI payment for the month they enter a facility. After they have been in the facility for a full calendar month, the SSI payment will be suspended.

It is not necessary for the County Office to determine whether SSA referrals are later certified or denied for SSI or to report certification for SSI on the DCO-57. This information is communicated to the Office of Information Systems by SSI on the SDX tape, and changes are made automatically.

MS Manual 11/01/95

3250 Securing Information

The county worker will inquire into the circumstances of the applicant in order to ascertain the facts supporting the application and to obtain other information necessary to establish eligibility.

Primary responsibility for obtaining all information necessary to establish eligibility rests with the applicant or his representative. The worker will offer assistance whenever possible.

Collateral information (evidence provided by persons other than the applicant or by written documents) will be obtained when necessary to establish eligibility of the applicant. Collaterals with knowledge of the applicant will be contacted. If necessary, the county worker will use Form DHS-81 (Consent for Release of Information) to secure essential information from a collateral. This form must be signed by the applicant, or by his parent, guardian, or other person acting for the applicant, so that information may be released to the Agency.

The worker will check records or conduct inquiries by correspondence only when information can best be obtained in these ways. Routine record checking or correspondence which will not likely bring forth additional evidence needed to establish eligibility will be avoided.

The worker will protect the rights of the applicant during collateral interviews and will give only the information necessary to enable the person interviewed to understand the need for the information requested.

When an original, photocopy, or certified copy of a document used as evidence is not a permanent part of the case record, it will be necessary for the narrative to contain definitive information as follows:

1.      The location of the document, e.g., where or by whom the document is kept, and

2.      The pertinent facts contained in the document which establish authenticity (date document was made, where registered or filed, registration or filing identification, serial number).

Conflicting evidence must be resolved.

MS Manual 11/01/95

3251 Time Limit on Disposition of Application

With the exception of an AD application, the county worker will have up to 45 days from the date of application to make disposition by one of the following actions: approval, denial, or withdrawal. The worker will have up to 90 days from the date of application to dispose of AD applications.

MS Manual 11/01/95

3252 Delayed Action on Application

3253 County Office

When action on an application has been delayed by Agency staff, the applicant will be notified by Form DCO-002 of the reason for the delay and of his right to an appeal.

MS Manual 11/01/95

3254 Applicant

If the applicant has been given notice via the DCO-002 to provide information to clear eligibility but fails to do so by the end of the specified time, the application will be denied. If the applicant is having difficulty providing essential information and requests additional time, the county worker will acknowledge the request by sending a second DCO-002 that clearly specifies what information is needed by the end of the extended time period and will assist the applicant in obtaining information, if possible. If the information has not been provided by the end of the extended time period, the application will be denied.

MS Manual 11/01/95

3300 Eligibility Determination

Eligibility determination is the joint responsibility of the applicant, or his representative, and the county worker. The county worker has the responsibility of advising the applicant/representative of the eligibility requirements and for offering assistance whenever possible. The applicant/ representative has the final responsibility for supplying all information necessary to establish eligibility.

MS Manual 10/1/97

3301 Eligibility Requirements

Eligibility requirements for facility services are:

1.      Categorical eligibility, and

2.      Medical necessity (Re. MS 3350).

The case record must document that both these requirements have been met before facility services can be authorized.

MS Manual 3/1/00

3310 Establishing Categorical Eligibility

Current recipients of U-18, SSI, and Foster Children (Cat. 91 and 92) for whom the Agency has legal responsibility automatically meet the categorical eligibility requirement.

However, if, during the processing of an LTC application, any question regarding the categorical eligibility of these individuals should arise, the question will be resolved with either Agency or SSA personnel before proceeding further with the application. The question and resolution should be documented in the case record.

If the eligibility of an SSI recipient is questionable, a statement will be obtained from SSA (preferably written) to document its awareness and treatment of the eligibility factor. If there appears to be a policy conflict between DCO and SSA, the DCO Medicaid Eligibility Unit will be contacted.

Categorical eligibility for individuals other than U-18, SSI, or Foster Children will be determined according to SSI-related AABD facility eligibility criteria as follows:

1.      Institutional Status - It must be verified that the individual has been institutionalized for 30 consecutive calendar days (an exception to the 30 days is made when death occurs prior to 30 days). Re. MS 3320. The period of 30 days is defined as being from 12:01 a.m. of the day of admission to 12:00 midnight of the 30th day following admission. For example, an individual enters a facility anytime on July 18th. The 30 day count begins at 12:01 a.m. of the morning of July 18th, and ends at midnight of August 16th. Hospitalization will count toward meeting the institutional status requirement if the individual enters a facility on the date of discharge from the hospital. This includes hospitalization at Arkansas State Hospital in Little Rock, and the George W. Jackson Center in Jonesboro. It also applies to individuals who enter an Arkansas institution directly from an out-of-state institution;

2.      Categorical Relatedness - In order to meet the requirement of categorical relatedness, the individual must meet one of the following:

a.      Aged - Age 65 or older (Re. MS 3321);

b.      Blind - Central visual acuity of 20/200 or less in the better eye (with correction) or a limited visual field of 20 degrees or less in the better eye (Re. MS 3322); or

c.      Disabled - Physical or mental impairment which prevents the individual from doing any substantial gainful work (for a child under age 18, an impairment of comparable severity), and which meets the following criteria:

1.      has lasted or is expected to last for a continuous period of at least 12 months, or

2.      is expected to result in death (Re. MS 3322 or MS 3322.1, and MS 3323);

3.      Citizenship or Alien Status (Re. MS 6700);

4.      Residency - It must be verified that the individual is an Arkansas resident (Re. MS 2200);

5.      Resources - Countable resources cannot exceed $2000 for an individual and $3000 for a couple.

NOTE:  The resource standards above apply to all AABD Medicaid categories (the  resource standards for QMBs, SMBs, and QDWIs), except when one spouse enters LTC and the other does not (Re. MS 3337-3338) or when both spouses enter LTC in the same month.  When both spouses enter LTC in the same month, the couple's standard will apply for the month of entry, but the resources of each will be compared to the individual standard in the month after entry into LTC (Re. MS 3330.1);

6.  Income - The individual's gross income cannot exceed the maximum income limit allowed for federal financial participation.  The income limit for LTC is three times the SSI payment standard (Re:  SSI Chart at Appendix S).  However, individuals with income over the limit may be eligible if they have established an income trust (Re. MS 3336.9);

                              7.   Assignment of Medical Support (Re. MS 1350);

                              8.  Cooperation with Child Support Enforcement Activities (Re. MS 1310); and

                              9.  Social Security Enumeration (Re. MS 1390).

MS Manual 10/1/97

3320 Verification of Institutional Status

Evidence of institutional status includes any written document, record, etc. from a hospital and/or nursing facility which verifies that the individual was in the hospital and/or nursing facility for 30 consecutive calendar days (Re. MS 3310).

When an individual cannot meet the institutional status requirement, the application will be denied, unless the individual dies before meeting the 30 day requirement. In that case, certification may be made for the actual days spent in the facility.

When an individual has met the institutional status requirement of 30 consecutive days, eligibility for facility services will be effective the date of entry into the facility if all other eligibility requirements are met, unless the individual is in an ICF/MR or was subject to PASARR (Re. MS 3420).

Note: The institutional status requirement does not apply to individuals who were certified for SSI, U-18, or Foster Care (Cat. 91 or 92) in the month of facility entry.

Individuals who become ineligible for SSI, U-18, or Foster Care (Cat. 91 or 92) following the month of LTCF entry, will have their categorical eligibility determined according to SSI-related AABD facility eligibility criteria, with the exception of the institutional status requirement.

MS Manual 10/1/97

3321 Verification of Age

Use primary evidence when possible; if not, use alternative evidence.

1.      Primary evidence of age consists of a birth certificate established before age five.

2.      Alternative evidence of age consists of any other record which shows age or date of birth (e.g., Social Security record established at least five years before application date, family Bible recorded before age 36, school record, census record, delayed birth certificate, insurance policy taken out before age 21, arrival record, newspaper birth announcement, driver's license, etc.)

3.      Best Evidence

       To overcome a material discrepancy in the age of an individual, usually the earliest    recorded document is used. (Note: Written documentation is necessary).

4.Proof of Age by Social Security Administration

The County Office will accept SSA date of birth when:

a.      It has a State Data Exchange Record on ACES with the date of applicant's birth (i.e. the applicant has received SSI and a record exists on ACES for that eligibility);

b.      It has a statement from the local SSA Office stating that SSA has verified date of birth; or

c.      It has a WTPY Response verifying date of birth.

MS Manual 10/1/97

3322 Verification of Blindness or Disability

Blindness or disability must be established by one of the following means:

1.      Receipt of SSI (AB or AD), or receipt of a letter of entitlement to SSI with begin date of entitlement, when the individual has not received the first check. Verify by SSI Award Letter, SSA-1610, "SSI Recipients" printout, or WTPY Response;

2.      Receipt of Social Security based on disability, or receipt of a letter of entitlement to Social Security based on disability, showing a begin date of entitlement, when the individual has not received the first check. Verify by SSA Award Letter, SSA-1610, or WTPY Response;

3.      Receipt (or anticipation) of SSI or Social Security Disability based on a disability benefit continuation, when an individual has requested continuation within 10 days of SSA determination that a physical or mental impairment has ceased, has not existed, or is no longer disabling;

4.      Nonreceipt of SSI cash benefits for reasons other than disability, but verification of an established disability that is current and continuing; e.g. TEFRA child (Re. MS 2090); or

5.      Blindness or Disability determination by the Medical Review Team. The DCO-109 (Report of Medical Review Team decision) must be filed in the record.

The type of documentation used will be entered into the case narrative and a copy filed in the case records, if available.

MS Manual 10/1/97

3322.1 SSA vs. MRT Disability Decisions

The following disability guidelines will apply to all AD Medicaid applicants where disability is an eligibility factor and disability has not been determined. A disability decision made by SSA on a specific disability is controlling for that disability until the decision is changed by SSA. When DCO makes a disability determination, a later contrary SSA determination will supersede the state determination. If SSA has made a decision that a person is not disabled, that decision is binding on DCO for one year with exceptions noted in 3322.3.

MS Manual 10/1/97

3322.2 Referrals to SSA

Because SSA decisions are controlling, any new evidence or allegations relating to previous SSA determinations must be presented to SSA for reconsideration within 60 days of the SSA denial notice. If the decision has not been appealed within 60 days, the individual may still request a reopening of the decision within one year.

Therefore, the Agency must refer to SSA, for reconsideration or reopening of a determination, all applicants who allege new information or evidence which affects previous SSA determinations of "not disabled", except in cases specified in 3322.3. When the conditions in 3322.3 are met, counties will be required to make an eligibility determination for Medicaid.

Counties may also refer to SSA, for SSI application, those individuals whose income and resources are below SSI limits, because it would be to their advantage to receive both cash assistance and Medicaid.

MS Manual 10/1/97

3322.3 Applications Which Will Require An MRT Decision

When individuals apply for Medicaid and meet one or more of the conditions below, the DCO-106, DCO-107's and/or DHS-81's, and DCO-108, along with copies of the Social Security Disability or SSI denial letter (if applicable and available) and WTPY, if appropriate, will be submitted to MRT (Re. MS 3323), provided it appears that the other eligibility factors are met.

The Agency will determine eligibility if any one of the following conditions exists:

a.      The individual has NOT applied for Social Security Disability or SSI;

b.      The individual has been found NOT eligible for Social Security Disability or SSI for reasons other than disability (e.g., income);

c.      The individual has applied for Social Security Disability or SSI, and SSA has NOT made a determination;

d.      The individual alleges a NEW disabling condition which is different from (or in addition to) the condition considered by SSA in its previous determinations;

e.      More than 12 months have elapsed since the most recent Social Security Disability or SSI denial decision, and the individual alleges that the condition upon which SSA made the decision is worse or has changed, and he or she has not reapplied; or

f.        Less than 12 months have elapsed since the most recent Social Security Disability or SSI denial, and the individual alleges that the condition upon which SSA made the decision has changed or deteriorated, AND;

1.      He or she has asked SSA for a reconsideration or reopening of its previous determination and SSA has refused to consider the new allegations,

OR

2.      The individual no longer meets the non-disability Social Security Disability or SSI requirements (e.g., income).

AD applicants who do not meet a criterion specified above will be denied without further development. The DCO-106 will be used to document the applicant's statements/ allegations regarding his disability status.

MS Manual 10/1/97

3322.4 Verification of Social Security Disability or SSI Status

To verify the Social Security Disability or SSI status of an individual the county will:

a.      Request from the applicant all denial letters or other correspondence received from SSA. The denial letter is a 2-page letter which states on the 2nd page what disability was alleged and what the SSA determination was.

b.      Check the WSSN and WASM Screens to determine whether the individual has an open or closed SSI case.

c.      Utilize the WQRY screen if the client does not have a denial letter or other SSA correspondence and the individual is not shown on WASM as an eligible SSI recipient. The WTPY response will usually show the date of Social Security Disability or SSI application, if one has been made within the past year, and the disposition of that application (sometimes denials are purged from the SSA system in less than a year from application).

The pay status code series beginning with "N"s are the denial codes on WTPY. A brief description of the denial code is included on the query response.

MS Manual 01/15/09

3322.5 Dual Applications

When an individual applies for both Medicaid and Social Security Disability or SSI, and the application with SSA is still pending, the county should initiate an MRT determination of disability if the individual appears to meet all other eligibility requirements. The agency will have 90 days from the date of the Medicaid application to make this determination. While an MRT decision is pending, the county office worker should check the Social Security Disability or SSI status of the applicant 30 days after the Medicaid application has been made, and again at certification, if found eligible by MRT. If MRT finds that the individual meets the disability requirements and SSA has not yet made a decision, the county may certify the case for Medicaid. To verify that no SSA decision has been made, the WASM and SOLQ screens will be checked, if appropriate, and the individual or authorized representative will be contacted by mail or telephone prior to certification.

Additional case action is indicated as follows:

If application for Social Security Disability is approved first:

·         Notify MRT

·         Approve Medicaid application (if all other requirements have been met)

If application for SSI is approved first:

·         Notify MRT

·         Deny Medicaid application, except for LTC, which may be approved for facility payment on WNHU (if all other requirements have been met)

If SSA determines the applicant is NOT disabled:

·         Notify MRT

·         Deny Medicaid application

If the county certifies a case based on an MRT disability decision and later learns the individual has been denied by SSA, the Medicaid case will be closed after appropriate notice, unless the recipient appeals the closure. If the appeal is made within the 10-day time frame, the Medicaid case will remain open pending the outcome of the DHS appeals process. In no case, will the Medicaid case remain open pending the outcome of the SSA appeals process if the recipient has appealed the SSA decision.

 If an approved Medicaid recipient is approved for SSI, the system will automatically convert the Medicaid case to an SSI category and no further action will be required of the county, except to notify MRT that no future reexamination is required, if appropriate.

If the county denies an application based on a MRT decision and later learns that SSA has approved the disability, the original application will be re-registered regardless of the time frame as Medicaid claims will be paid if the provider files claims timely, refer to MS 1400.  Process the application with the original application date provided all other eligibility criteria were met for this time period.

MS Manual 11/01/99

3323 Procedure for Verification by Medical Review Team

The following procedures will be followed for verification of blindness or disability through the Medical Review Team. The disability onset date will be indicated on the

MS Manual 11/01/99

3323.1 For Blindness

The county office worker will give the applicant or his representative a DCO-701, Report on Eye Examination, for completion by the ophthalmologist or optometrist who is to conduct the eye examination. In addition, a self-addressed envelope with the County Office address will be provided for return of the DCO - 701 after completion.

Upon receipt of the completed DCO-701, the county office worker will check it to assure that all items of identifying information are completed. If necessary, the worker will complete the name, address, race, sex, and date of birth blanks on the form before forwarding to MRT. In addition to checking the DCO-701 for completeness, the worker will complete the DCO-108 and attach it to the DCO-701 and forward it to MRT. A notation of the date that the forms are forwarded to MRT will be made in the case narrative.

MS Manual

01/15/09

3323.2 For Disability

1.      Determine if the individual is engaged in a substantial gainful activity (SGA), following the guidelines at MS 3323.7.

If the individual is found to be engaged in SGA, deny the application, using action reason 070, denied due to employment. Do not send the application to MRT.

2.      If the applicant has been a patient in a private or state hospital, a VA hospital, or the University of Arkansas for Medical Sciences within the past year (the past five years for the Arkansas State Hospital), complete form DHS-4000 (Authorization to Disclose Health Information). The Medical Review Team will request medical information from these institutions. A separate form DHS-4000 must be completed for each institution.

3.      If the applicant has not been hospitalized within the past year and does not regularly see a physician, form DCO-107 must be completed.  If the applicant has been hospitalized within the past year, form DCO-107 may also be completed if the applicant chooses to supply medical information in addition to that which can be obtained from the institution by form DHS-4000.  If an applicant goes to a physician regularly, in lieu of another physical examination, form DHS-4000 may be used to obtain copies of the records from the physician (no DCO-107 needed).

The county office worker will complete Part 1 of Form DCO-107, when the form is needed. The applicant must sign and date the form in Part 2. The form will then be given to the applicant to take to the medical practitioner of his or her choice. A stamped envelope addressed to the county office will be provided with the DCO-107. The medical practitioner will complete Part 3 of the form and return the form to the county office.

If an applicant states he or she does not have the funds for payment of a physician's examination, the applicant should be informed that MRT can arrange and pay for an examination. If the applicant wishes MRT to do this, the county office worker should report this on the DCO-108 Social Report.

4.      Complete Forms DCO-106 and DCO-108 (Social Report). These must be completed for all cases submitted to the Medical Review Team.

5.      Attach the following to the completed forms DCO-108 and DCO-106: form DCO-107 and/or form DHS-4000, and any other medical information which the applicant wishes to provide or which is available in the county office files. Send these to the Medical Review Team.

MS Manual 11/01/99

3323.3 Medical Review Team (MRT) Decision

The Medical Review Team (MRT) will report the decision regarding physical or mental incapacity to the county office on Form DCO-109.

If MRT finds that the medical information is not adequate to make a decision, further medical/psychiatric/psychological examinations may be recommended by MRT at the expense of the Agency.

Arrangements for such evaluations will be made by MRT only. When medical and social evidence has been resubmitted on questioned cases, the Medical Review Team will make a decision as to disability and notify the county office on Form DCO-109. This decision of MRT will be final, subject to the regular appeal process, unless a later decision by SSA finds the individual not disabled.

MS Manual 11/01/99

3323.4 Reapplication Due to Mental or Physical Incapacity

If a reapplication is filed and the case has been closed within the past five years for reasons other than disability and the last Form DCO-109 stated, "Reexamination not necessary" or the date for reexamination has not yet been reached, new medical and social information will not be submitted to MRT. If the case has been closed for more than five years, new medical and social information must be submitted. In all cases of reapplication, a DCO-106 will be completed to determine the applicant's SSA disability status.

MS Manual 11/01/99

3323.5 Reexamination of Disability by the Medical Review Team (MRT)

When medical and social information indicates that an individual may recover in a year or more and/or be rehabilitated to the point where he could meet substantial gainful employment, MRT will require reexamination. Whether or not required by MRT, reexamination may be requested by the county office at any time for the aforementioned reasons.

In either case, it is the responsibility of the county office to initiate the re-exam by submitting current medical and social information (DCO-106, DCO-108A, and DCO-107 and/or DHS-81) to MRT.

MS Manual 11/01/99

3323.6 Reexamination Required by the Medical Review Team (MRT)

When indicated on the DCO-109, the county office will key the appropriate date to WALR for future action. The county office will contact the individual in a timely manner that will allow all necessary medical and social information to reach MRT by the first of the month of reexamination. When the reexamination decision is not received in the county office by the end of month in which the reexamination was required, the case will remain open pending receipt of the MRT decision.

MS Manual

11/01/99

3323.7 Substantial Gainful Activity

Substantial gainful activity (SGA) is defined as the performance of significant physical and/or mental work activities for pay or profit, or work activities generally performed for pay or profit.

Countable monthly earnings are obtained by deducting any employer subsidy and any impairment related work expense (not payroll deductions) from the gross income (gross income includes payment in-kind for the performance of work in lieu of cash). Then, if earnings are irregular, they will be averaged over the period of months being considered to obtain countable monthly earnings.

Employer subsidy is the payment of wages that is more than the value of the actual services performed.

If the work is sheltered or if there is marked discrepancy between the amount of pay and the value of services, there exists the strong possibility of a subsidy that requires development of specific evidence.

Sheltered Employment is work performed by disabled individuals in a protected environment under an institutional program; nonsheltered employment is any work performed by individuals in an unprotected environment.

Impairment Related Work Expenses are items or services needed in order to maintain employment, such as attendant services, prostheses, or other devices. Drugs and medical services are not deductible unless it can be shown they are necessary to control the disability to enable the individual to work. Deductible expenses must be paid for by the individual, and cannot be reimbursable from any source. Legitimate expenses may include installation, repair, or maintenance. The payments may be deducted in one month or prorated over 12 months.

The expenses must be considered "reasonable," i.e., not more than Medicare would allow or than would ordinarily be charged in the individual's community.

The following SGA Earnings Guidelines provide the basis for evaluating whether an individual is engaged in SGA:

1. Countable Earnings of Less Than $300 Per Month - When average countable monthly earnings are less than $300 per month, an assumption may be made that the work is not SGA. This assumption may be made for both sheltered and nonsheltered employment; specific evidence does not need to be developed for either sheltered or nonsheltered employment.
2. Countable Earnings of $300 to $700 Per Month - When average countable monthly earnings from nonsheltered employment fall within the $300 to $700 per month range, an assumption may be made that the work is not SGA unless:

1. The work is comparable to that of unimpaired individuals engaged in similar occupations as their means of livelihood; or
2. The work, although significantly less than that done by unimpaired individuals, is reasonably worth over $700 per month according to pay scales in the community.

When "a." or "b." occurs in a nonsheltered employment situation (or if gross earnings include a subsidy), current medical and social information will be submitted to MRT.

When average countable monthly earnings from sheltered employment fall within the $300 to $700 per month range, the work is not ordinarily SGA. However, if earnings include a subsidy, current medical and social information will be submitted to MRT.

3. Countable Earnings of More Than $700 Per Month - When average countable monthly earnings are more than $700 per month, an assumption may be made that the work is SGA unless impairment causes the individual to quit work or reduce employment within a short time (6 months or less) under circumstances that would justify the employment being termed an unsuccessful work attempt. Specific evidence must be developed for both sheltered and nonsheltered employment.

When there is no subsidy involved in gross pay and when there is no marked discrepancy between the amount of pay and the value of the services, an assumption will be made that pay from employment is fully earned. Action will be taken to deny the application or close the case as the individual does not meet the criteria for disability (Re. MS 3310). Advance notice will be given on the DCO-700.

NOTE: If an applicant reports earnings of more than $700 per month, the county office worker may deny the application due to employment without making a referral to MRT.

MS Manual

3324-This section of policy has been deleted.

MS Manual

3324.1 This section of policy has been deleted.

MS Manual 07/01/08

3330 RESOURCES – AABD

Resources are generally defined as those assets, including both real and personal property, which an individual, or couple, possesses. Resources include all liquid assets as well as those assets which are not presently in liquid form.

In order for assets to be considered as resources, property or an interest in property must have a cash value that is available to the individual upon disposition.

Countable resources will be determined on the first day of the month. When resource eligibility exists at the beginning of a month, it continues for the full month. A resource change that occurs during a month in which resource eligibility exists will not be considered for determination of countable resources until the first of the month following the change.

When an individual is ineligible at the beginning of a month due to excess resources, ineligibility due to resources exists for the full month.

Assets which have been received during the month and considered as income may not also be counted with resources during the same month (unless the income received is given away during the month it is received - Re. MS 3336.6). For example, if an individual had a checking account balance of $1,950 as of June 1, the receipt of a $300.00 SSA check during June would not cause the individual's $2,000 resource limit to be exceeded during June even if the entire check was deposited in the checking account. The individual's resource eligibility would not be affected by the receipt of income during the month. It would only be affected if the income was retained to the extent that it caused the $2,000 limit to be exceeded as of the beginning of July.

SSI lump sum benefits (never counted as income) will be excluded from resource consideration for 9 full months after the month of receipt (Re. MS 3332.3 #6). SSA lump sum payments also have the 9 month resource exclusion, but will count as income in the month of receipt (Re. MS 3341).  Interest earned on the excluded funds will be counted as income in the month accrued and, if retained, as a resource in the month following.

Each individual must be advised of how countable resources are determined and how resource changes can affect eligibility.

     *         Asset Disregard for Long Term Care Insurance Partnership Policy

An amount up to the amount of benefits paid out by a Qualified Long Term Care Insurance Partnership policy may be used as an asset disregard when determining eligibility for Medicaid (Re. MS 20000-20070 & 21700).

Example:  An individual purchased a qualified policy with a benefit of $100,000.  Application is made for Medicaid and the policy has paid out $90,000 in benefit.  The policyholder’s assets can be protected up to $90,000. 

Requests for Legal Opinions Regarding Resources

A legal opinion from the Office of Chief Counsel (OCC) will be requested when the worker, the ES Supervisor, and the DCO Program Support Specialist are unsure of whether a resource should be considered or disregarded.

If the equity value of the questionable resource, when combined with other resources, appears to exceed the resource limit, OCC will be contacted if:

1.     Ownership of the resource is questionable, or

2.      The applicant's right to transfer the resource is questionable.

*     If a legal opinion is needed, a memorandum will be submitted to the Office of Program Planning and Development, P. O. Box 1437, Slot S333, Little Rock, AR, 72203. The memo will be from the ES Supervisor and will contain a complete description of the circumstances and copies of all pertinent documents.

A copy of any OCC opinion received must be filed in the case record.

NOTE: When an individual is unaware of ownership of an asset, the asset is not counted as a resource. The asset will be counted as income in the month of discovery and as a resource in the months following.

MS Manual 11/01/95

3330.1 Countable Resource Limitations

To be eligible for assistance under AABD categories the countable resources of an aged, blind, or disabled individual or couple may not exceed certain limitations. The countable resource limitations for AABD eligibility are as follows:

Note: The resource standards above apply to all AABD Medicaid categories (the resource standards are doubled for QMBs, SMBs and QDWIs), except when one spouse enters LTC and the other does not (spousal rules at MS 3337-3338 apply) or when both spouses enter LTC. When both spouses enter LTC, the couple's standard will apply for the month of entry, but the resources of each will be compared to the individual standard in the month after entry into LTC.

For a married couple in Waiver cases, the couple's standard will apply.

MS Manual 11/01/95

3330.2 Incapacitation

A person is presumed to possess legal capacity unless declared incapacited by a probate court.

Arkansas Statutes define a person as "incapacitated" when by reason of minority or of impairment due to a disability such as mental illness, mental deficiency, physical illness, chronic use of drugs, or chronic intoxication, he is lacking sufficient understanding or capacity to make or communicate decisions to meet the essential requirements for his health or safety or to manage his estate.

Whenever a person is incapable of caring for himself or his property , a need for a guardian is indicated. A guardian of the estate may be appointed if the person is incapable of managing property, money or his legal affairs. A guardianship of the person is indicated if the person is incapable of taking care of his person.

Normally, the question of incapacitation will not be considered in an eligibility determination. If a person has been adjudicated incapacitated and has had a guardian appointed for him, it will be necessary for the guardian to make application for benefits since the individual does not have that legal power.

If a person's incapacitation has not been determined, it will not be considered in an eligibility determination as long as the person is able to make his wants or application known. If a person has excess resources and a claim is made that his resources are not available due to incapacitation, it will be the responsibility of the person alleging the incapacitation to furnish proof of the incapacitation and to find a person able and willing to serve as guardian of the person and/or estate. The person alleging the incapacitation will be required to provide a medical affidavit attesting to the incapacitation of the individual.

Advance Notice

When the medical statement has been obtained, the county office will inform the person alleged to be incapacitated and the person who has made the allegation that:

1.      A period of 120 days will be allowed to find a person who will serve as guardian, to present the guardianship request to probate court, and to finalize the guardianship proceedings;

2.      The resources in question will be excluded for 120 days or until the first day of the month following the month in which the court order establishing guardianship is filed, whichever occurs earlier;

3.      A copy of the court order establishing guardianship must be given the county office within ten days of filing the order; and that

4.      Any LTC payments made on behalf of the person alleged to be incapacitated during the exclusion period will be subject to recovery in accordance with overpayment policy if the probate court fails to find the individual incapacitated or if the person alleging incapacitation fails to initiate and finalize action for the appointment of a guardian within the allotted time.

If the guardianship has not been finalized within 120 days and if the parties involved maintain that diligent and good faith efforts have been taken to obtain the guardianship, the county office will submit the case record to the Office of Chief Counsel (OCC) along with all related documents and a cover memorandum summarizing the facts and requesting a review to determine if an extension of time is warranted.

If the written opinion obtained from OCC states that circumstances justify an extension of the 120 day period and specifies the duration of time for the extension, the extension will be granted. If no time extension is found justifiable, the county will proceed as instructed below.

Case Closures

Case closures, when applicable, will be made on the first day of the month following the month in which:

1.      The court order establishing guardianship is filed and reported, or

2.      The allotted 120 days has ended (when OCC did not grant an extension or when no guardianship action was initiated), or

3.      The time extension granted by OCC has expired and guardianship has not been finalized.

Advance notice of closure is not required.

Overpayments

1.      If LTC services have been paid, an overpayment will be written when:

2.      The individual was not found to be incapacitated by the court;

3.      The person making the allegation failed to initiate action and to establish guardianship within the allotted time, or to finalize guardianship within the OCC extension of time, or OCC did not find an extension of the 120 days was warranted.

No overpayments will be written when the court has found that the individual is incapacitated. A copy of the court order will be obtained by the county office for the case record, and the guardian will be responsible for petitioning the court to dispose of excess resources. A redetermination of LTC eligibility will not be made until disposition of the excess resources has been made.

MS Manual 11/01/95

3331 Real Property

Real property is land, including houses or immovable objects attached permanently to land. It also includes burial plots and crypts.

In order for real property to be a resource, it must be convertible to cash. If the individual has the right, authority, or power to liquidate the property or his share or interest in property, it is considered a resource unless otherwise excluded (Re. MS 3331.5). If a property right cannot be liquidated, it will not be considered a resource.

Certain types of property may have special restrictions, which include the following:

1.      Burial Plot - Burial Plots or crypts which are not intended for the use of the applicant/recipient or his immediate family may be a countable resource. If the deed indicates that the contract is irrevocable, the plot or crypt is not a countable resource. If any co-owner refuses to permit sale of the plot or the burial company requires the individual to move from the state in order to sell the plot, it is not a countable resource. Document the file regarding restrictions with a statement from the co-owner or with a copy of the burial contract, whichever is applicable.

If the deed indicates that the contract is revocable, it is a countable resource. In this case it will be necessary to contact the burial company, etc. (i.e., original seller of the plot) to determine the value of the specific plot. Document the file regarding value with a statement from the burial company, etc.

2.      Land Held by a Member of Indian Tribe - Land which is held by an enrolled member of an Indian tribe may be excluded from resources if it cannot be sold or transferred without the permission of other individuals, the tribe, or a Federal Agency. If permission is needed, determine whether it can be obtained. If permission to sell is granted, treat the property as a resource. If permission to sell is not granted, the property is excluded as a resource.

MS Manual 11/01/95

3331.1 Evidence of Ownership

The following official records will be utilized in establishing real property ownership:

1.      Assessment Notice

2.      Recent Tax Bill

3.      Current Mortgage Statement

4.      Deed

5.      Report of Title Search

Questions of title, ownership, and property interest which cannot be resolved by the county office will be submitted to the Office of Chief Counsel. The memorandum will present the question involved and any relevant facts. Originals or copies of wills, deeds, contracts of purchase, or other documents affecting the property must be attached. If the applicant does not have the necessary documents, he will be advised of his responsibility to obtain them.

MS Manual 10/01/06

3331.2 Forms Of Ownership

1.      Fee Simple Ownership - When property is held in fee simple, the owner has sole ownership interest. He alone (or his legal guardian if mentally incompetent) may sell or transfer ownership interest without conditions imposed by others.

2.      Shared Ownership - Shared ownership means that ownership interest in property is vested with more than one person. Shared ownership may be by "joint tenancy", "tenancy in common" or, for a married couple, "tenancy by the entirety".

a.      Joint Tenancy -In joint tenancy, each of two or more joint tenants has an equal interest in the whole property for the duration of the tenancy. On the death of one of two joint tenants, the survivor becomes sole owner.

b.      Tenancy-in-Common - In tenancy-in-common, two or more persons have an undivided fractional interest in the whole property for the duration of the tenancy. There is no right to survivorship to a tenancy-in-common.

c.      Tenancy-by-the-Entirety - Tenancy-by-the-entirety results when a conveyance is made to a husband and wife, whereupon each becomes possessed of the entire estate, and after death of one, the survivor takes the whole. Real estate owned by a married couple by the entirety is marketable only by consent of both parties. When a marriage has been legally dissolved, former spouses become tenants-in-common of the property, and either person can market his half share, unless conditions in the divorce decree specify otherwise.

3.      Life Estates

a.        Life Estates ‑ A life estate conveys to an individual or individuals certain rights in property which expire upon the death of the owner or of another person.  The owner of a life estate has the right of possession, the right to use the property, the right to obtain profits from the property and the right to sell his life estate interest.  (However, the document establishing the life estate may restrain one or more of the individual's rights.)  He can only sell his life estate, and cannot sell any remainder interest.

                                    The purchase of a life estate will be treated as an uncompensated transfer of assets if the purchaser does not live on the property for at least 12 consecutive months after the property is purchased.  Also, if an individual purchases a life estate in someone else’s home the individual must live in that home for a period of 12 consecutive months after the date of purchase.

If less than one (1) year of occupancy would result in treatment as a transfer for less than fair market value, the penalty must be applied.  The full amount of the purchase price will be considered as the uncompensated transfer.

If more than one (1) year of occupancy, the case worker will need to look at the purchase price of the life estate to determine if the purchase price was for fair market value.  If the person’s life expectancy is less than the life estate purchased, a transfer penalty is imposed.

Refer to MS 3336.10 for determination of uncompensated value and period of ineligibility.

b.         Remainder Interest ‑ When an individual conveys property to another for life (life estate) and to a second person(s) (remainder man) upon the death of the life estate holder, both a life estate interest and a remainder interest have been created in the property. Upon death of the life estate holder, the remainder man will own full title.  Several individuals may be designated as remainder men who would hold ownership jointly or in common, as specified by will or deed.

4.      Ownership Interest in Unprobated Estate

An individual may have ownership interest in an unprobated estate if he is an heir or relative of the deceased, or has acquired rights on the property due to the death of the deceased, in accordance with a will or state intestacy laws.

5.      Dower/Curtesy

State law for dower and curtesy gives a spouse an interest in the other spouse's property. When the deceased leaves no will, dower or curtesy may be claimed. When the deceased leaves a valid will, a widowed spouse can elect to take against the will when he would have a greater right by dower or curtesy than the will provides.

If there are questions regarding the dower or curtesy interest, the Office of Chief Counsel will be contacted, according to procedures established in MS 3330. When requesting an opinion, indicate whether or not there are direct descendents (children, grandchildren, etc.)

6.      Rights to Use

An individual may have ownership of certain property rights such as:

a.      Mineral Rights - A mineral right is an ownership interest in certain natural resources which are usually obtained from the ground such as coal, sulphur, petroleum, sand, natural gas, etc.

b.      Timber Rights - Timber rights permit an individual to cut and remove freestanding trees from property owned by another. A life tenant also has certain timber rights in keeping with good husbandry.

c.      Easement - An easement is a property right whereby one has the right to use of the land of another for a special purpose.

d.      Leasehold - A leasehold conveys to an individual, at the owner's will and usually for an agreed rent, the control of property for a definite period of time. It does not designate rights of ownership. Leaseholds may be carved out of life estates.

MS Manual 11/01/95

3331.3 Determining Value of Ownership Interest

In determining the equity value (i.e. current market value less encumbrances) of real property, the type of ownership, the number of additional owners, and the individual's actual ownership interest must all be taken into consideration.

1.      Fee Simple Ownership (Sole Ownership) - If the individual is the sole owner of property and has the right to dispose of it, the equity value of the property is a countable resource when the property is nonexcludable.

2.      Shared Ownership -If the property is jointly owned by two or more individuals, the equity value of the property is charged to the individual in proportion to his ownership interest.

a.      Joint Tenancy - The property's equity value is divided by the number of owners in proportion to the ownership interest of each to determine the individual's ownership interest. When the individual's ownership interest plus other countable resources exceed the resource limit, determine if the individual is free to sell his interest.

When consent to sell joint tenancy property can be obtained from the other owner(s), the property will be considered a countable resource.

When it is established (in writing) that consent to sell joint tenancy property cannot be obtained from the other owner(s), the property will not be considered a countable resource.

b.      Tenancy-in-Common - The property's equity value is divided by the number of owners in proportion to the ownership interest of each to determine the individual's ownership interest. The value of the individual's interest will be considered a countable resource, regardless of the other owners' desire to sell.

c.      Tenancy-by-the-Entirety (Applicable to a married couple)

1.      Married Couple Living Together in the Community - For any month in which a married couple lives together in the community, the total equity value of nonexcludable property held by the couple is a countable resource, whether one or both members of the couple apply for assistance. After the month in which one or both enter a facility, each member of the couple is considered individually as a married couple living apart.

2.      Married Couple Living Apart in LTC - When both members of a "living apart" married couple in LTC are applying for or receiving LTC assistance, half of the equity value of nonexcludable property is a countable resource to each individual.

When only one member of a "living apart" married couple in LTC is applying for or receiving LTC assistance, half of the equity value of the tenancy-by-the-entirety property is a resource to that individual unless he alleges that he cannot obtain consent to sell from the spouse.

When the individual indicates that he wishes to sell his share of the property and indicates that he cannot obtain consent to sell from the spouse, request him to obtain a statement to that effect.

If it is established in writing that the spouse refuses to consent to the sale of the tenancy-by-the-entirety property, it cannot be considered a countable resource to the individual who has applied for LTC.

3.      Married Couple Living Apart - Only One In LTC - If only one member of a married couple is in LTC, the Spousal Impoverishment rules at MS 3337-3338 will apply in determining the attribution of resources to each spouse. The equity value of nonexcludable property will be included in the initial assessment and in the attribution of resources, regardless of the community spouse's consent or refusal to sell.

3.      Life Estate or Remainder Interest Held in Nonhome Property

Examine the deed which granted the life estate or remainder interest. If there is a restriction which prevents the life estate holder or remainder holder from disposing of his interest, the value of the life estate or remainder interest is not a countable resource.

If there is no restriction to prevent the disposal of the life estate interest or remainder interest, the following steps will be used to determine its resource value.

a.      Determine the value of the nonhome property (Re. MS 3331.4).

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