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Eligibility Determination Policy Volume III

Eligibility Determination Policy Volume III

Section F: Resources

Entire Section F
Page 1: Section F Table of Contents
Page 6000: Role of Resources
Pages 6010-6011: Resource Limits
Pages 6020-6022: SSI Resource Policy vs Liberalized Resource Policy
Pages 6030: Valuation of Resources
Pages 6040-6042: Ownership Interests
Pages 6100: Resources vs Income
Pages 6110: Factors That Make Property a Resource
Pages 6120-6121: Cash and In-Kind Items Received for the Repair or Replacement of Lost Damaged or Stolen Excluded Resources
Pages 6130: Identifying Excluded Funds Commingled With Nonexcluded Funds
Pages 6140-6141: Uniform Gifts to Minors Act
Pages 6200-6208: Cash and Financial Accounts
Pages 6210-6224: Real Property Ownership
Pages 6230-6236: Real Property – Home or NonHome
Pages 6240-6244: Real Property Exclusions
Pages 6250-6259: Real or Personal Income – Producing Property
Pages 6260-6269: Personal Property
Pages 6270-6276: Burial Funds
Pages 6280-6295: Investments and Contracts
Pages 6300: Trust Definitions
Pages 6300: Trust Policies
Pages 6310-6325: OBRA Trusts and Annuities
Pages 6326-6327: Life Expectancy Tables
Pages 6330-6344: OBRA-93 Transfer of Assets
Pages 6350-6353: Medicaid Qualifying Trusts
Pages 6360-6364: Standard Trusts
Pages 6370-6376: Medicare Catastrophic Coverage Act (MCCA) Transfer of Resources Policy

Pages 6400: SSI First of Month Rule
Pages 6410-6411: Resource Spenddown (Liberalized Policy)
Pages 6420-6423: Deeming of Resources
Pages 6430-6431: General Verification Requirements
Pages 6440: Frequency of Verification Requirements

Section I: Institutionalization

Entire Section I
Page 1: Section I Table of Contents
Pages 9000-9001: Institutions – Public and Not Considered Public
Pages 9010-9011: Individuals Who Are Not Considered Residents of Public Institutions
Pages 9020: Public Institutions
Pages 9100: Physician Certification General
Pages 9110-9113: Policy and Procedures
Pages 9200-9201: Spousal Impoverishment General
Pages 9210-9212: IS and CS Resource Computation
Pages 9220: Assessment of Resources vs Application for Medicaid
Pages 9220-9222: Assessment of Resources vs Application for Medicaid
Pages 9300-9301: Income Computations for IS and CS Cases
Pages 9400: Current Policy-Non SI LTC Cases
Pages 9410-9411: Income and Resource Policy for Couples Prior to SI Policy
Pages 9500-9501: LTC Budgeting Process Institutional Budget Form DOM-336
Pages 9510-9512: SSI Eligibles Entering LTC
Pages 9520: SSI Eligible Enters LTC But SSI Terminates (SSI to MAO)
Pages 9530-9532: AFDC or Foster Children Entering LTC
Pages 9540: MAO Application – No Previous Eligibility
Pages 9600-9601: Medicaid Income (MI) Computation General
Pages 9610-9611: Income Used in the MI Computation
Pages 9620-9621: Averaging Income in the MI Computation
Pages 9630: Protection of Income for Month of Entry
Pages 9640-9641: Personal Needs Allowance (PNA) Deduction
Pages 9650-9652: CS Monthly Maintenance Needs Allowance (MMNA)
Pages 9660-9662: Other Family Members (MMNA)
Pages 9670-9673: Health Insurance Premium Deduction
Pages 9680-9684: Non-Covered Medical Expense Deduction

Section L: Forms

Entire Section L Forms
Page 1: Section L Table of Contents
Pages 12020 – DOM-300B, SSI Redetermination Form and Instructions
Pages 12100 – DOM-TPL-406, Third Party Liability Form and Instructions
Pages 12140 – DOM-TPL-410, Absent Parent Referral and Instructions
Pages 12150 – DOM-TPL-411, Estate Recovery Form and Instructions
Pages 12160 – DOM-TPL-412, Non-Referral Estate Recovery Form and Instructions
Pages 12200 – DOM-301, Authorization to Release Information and Instructions
Pages 12220 – DOM-302, Designated Representative Statement and Instructions
Pages 12230 – DOM-303, Notice of Delay and Instructions
Pages 12250 – DOM-305, Notice of Action and Instructions
Pages 12260 – DOM-306, Notice of Adverse Action and Instructions
Pages 12270 – DOM-307, Request for Information and Instructions
Pages 12290 – DOM-309, Second Request for Information and Instructions
Pages 12300 – DOM-310, Statement of Household Expenses and Instructions
Pages 12310 – DOM-311, Request for Medicaid Application and Instructions
Pages 12320 – DOM-312, Notice of Potential Eligibility for VA Benefits and Instructions
Pages 12370 – DOM-317, Exchange of Information Between Nursing Facility or Hospital and Regional Medicaid Office and Instructions
Pages 12380 – DOM-318, Exchange of Information Between Medicaid Regional Office and VA,SSA or DHS
Pages 12390 – DOM-319, Report or Referral to District or Branch Social Security Office and Instructions
Pages 12410 – DOM-320A, Agreement to Sell Property and Instructions
Pages 12420 – DOM-321, Countable Resource Computation Worksheet and Instructions
Pages 12430 – DOM-321A, Burial Assets Exclusion Worksheet and Instructions
Pages 12440 – DOM-321B, Designation of Burial Funds and Instructions
Pages 12450 – DOM-322, Notice of Transfer of Assets (DRA)
Pages 12460 – DOM-322A, Notice of Transfer of Resources (OBRA-93)
Pages 12470 – DOM-323, Disability or Blindness Report and Instructions
Pages 12480 – DOM-323A, Disabled Child Questionnaire and Instructions
Pages 12490 – DOM-324, Vocational Report and Instructions
Pages 12500 – DOM-325, Disability Determination and Transmittal and Instructions
Pages 12550 – DOM-330, Request for Financial Information and Instructions
Pages 12560 – DOM-331, Request for Information Concerning Insurance and Instructions
Pages 12580 – DOM-333, Request for Workers Compensation Commission Data and Instructions
Pages 12590 – DOM-334, Request for Information Regarding Unemployment Compensation and Instructions
Pages 12600 – DOM-335, Request for Verification of Wages and Instructions
Pages 12610 – DOM-336, Institutional Budget and Instructions
Pages 12620 – DOM-337, Eligible Individual – Eligible Couple and Spouse to Spouse Deeming Worksheet Instructions
Pages 12630 – DOM-338, Parent to Child Deeming Worksheet Instructions
Pages 12640 – DOM-339, Statement RE Payment of Health Ins Premiums and NonCovered Medical Expenses and Instructions
Pages 12750 – DOM-350, Request for Local Hearing and NonCovered Medical Expenses and Instructions
Pages 12760 – DOM-351, Notice of Decision on Local Hearing and NonCovered Medical Expenses and Instructions
Pages 12770 – DOM-352, Request for State Hearing and NonCovered Medical Expenses and Instructions
Pages 12790 – DOM-354, Improper Payment Report and Instructions
Pages 12800 – DOM-367, Record of Contact and Instructions

Eligibility Transmittals

Transmittal 135: Effective April 1, 2008
Transmittal 136: Effective Sept. 1, 2008
Transmittal 137: Effective April 1, 2009
Transmittal 138: Effective May 10, 2009
Transmittal 139: Effective June 1 2009
Transmittal 140: Effective Aug. 1, 2009
Transmittal 141: Effective Nov. 1, 2009
Transmittal 142: Effective April 1 2010
Transmittal 143: Effective May 1, 2010
Transmittal 144: Effective Nov. 1, 2010
Transmittal 145: Effective March 15, 2011