10.09.24.10-2

.10-2 Substantial Home Equity and Exclusion of Long-Term Care Coverage.

A. Subject to §E of this regulation, an institutionalized individual is not covered by Medical Assistance for long-term care services in a nursing facility, medical institution with a level of care equivalent to a nursing facility, or home and community-based services waiver if:

(1) The individualís equity interest in the individualís home property, reduced by any bona fide, legally binding, documented encumbrances secured by the home, exceeds the amount specified in §D of this regulation; and

(2) The individual does not have, lawfully residing in the home, the individualís spouse or the individualís son or daughter who is:

(a) Younger than 21 years old; or

(b) Blind or disabled as determined under Regulation .05-4 of this chapter.

B. For all applications received on January 1, 2007 or after, the Department shall evaluate the institutionalized individualís equity interest in the individualís home property if the individual is determined eligible for Medical Assistance based on:

(1) An initial determination of nursing facility or waiver eligibility;

(2) A reapplication for nursing facility or waiver eligibility after a break in nursing facility or waiver eligibility; or

(3) A redetermination after an initial determination or reapplication in accordance with §B(1) or (2) of this regulation.

C. The institutionalized individualís equity interest in the individualís home property shall be evaluated by the Department, in accordance with §§A and B of this regulation, at:

(1) The determination of nursing facility or waiver eligibility; and

(2) Each subsequent redetermination of nursing facility or waiver eligibility.

D. The maximum allowable equity interest specified at §A(1) of this regulation shall be $543,000 in calendar year 2014, adjusted annually as set forth in section 6014 of the Deficit Reduction Act of 2005, Pub. L. 109-171 (DRA) by the percentage increase in the consumer price index for all urban consumers, rounded to the nearest $1,000.

E. Reductions to Equity Interest.

(1) If the individual has ownership interest in no property other than the home, the benefit payment amount shall be applied to reduce an equal amount of home equity.

(2) A mortgage, reverse mortgage, home equity loan, lien, or other bona fide encumbrance received by the individual and secured by the home property may be considered by the Department to reduce the individualís equity interest in the home.

F. An exclusion of long-term care coverage, in accordance with §A of this regulation, shall be applied even if there is a legal impediment to transferring or selling the home property.

G. The Department may waive the application of §F of this regulation if the Department determines that denial of eligibility for long-term care coverage would work an undue hardship.