F-1300, Resource Limits

Revision 11-4; Effective December 1, 2011

A person or a couple meet resources criteria if the value of all countable resources does not exceed the appropriate established limit.

Individual limit. This limit applies to adults who are single, even if the person lives with relatives. The individual limit also applies to children and to adults whose spouses live in different households. The individual limit also applies to the institutional spouse in spousal impoverishment policy. Use the individual limit for the following:

  • An adult person who is not married, even if the person lives with relatives. Consider only the person's own resources.
  • A person with a spouse not living in the same household. If the spouse is eligible, consider the person's own resources, plus half the resources owned jointly by the person and spouse. If the spouse is not eligible, consider the person's own resources, plus any jointly owned resources available to the person.
  • A child. Consider the child's own resources, plus certain deemed resources of the parents with whom the child lives.
  • An institutional spouse using policy in Chapter J, Spousal Impoverishment.

Couple limit. This limit applies to married adults who live in the same household with their spouses, even if the spouses are ineligible. Consider the combined resources of the person and spouse. Use the couple limit for the following:

  • A married person living in the same household with his spouse, when both spouses are eligible.
  • A married person living in the same household with his spouse, when the spouse is ineligible.

The value of all countable resources must not exceed the following limits:

Year Individual Couple
1989 through present $2000 $3000
1988 $1900 $2850
1987 $1800 $2700
1986 $1700 $2550
1985 $1600 $2400
1984 $1500 $2250

See Section Q-2000, Qualified Medicare Beneficiaries (QMB) – MC-QMB, Medicare Savings Programs (MSP), where the resource limit is higher for certain MSP programs.

If the countable resources are within $100 of the resource limit, set a special review to monitor eligibility. See Section B-8430, Special Reviews.

 

F-1310 Points in Time for Establishing Resource Values

Revision 22-2; Effective June 1, 2022

Determine the value of an applicant’s or recipient’s resources as of 12:01 a.m. on the first day of a calendar month. Any changes in the value of a resource is considered in the resource determination for the month following the change.

If countable resources exceed the resource limit as of 12:01 a.m. on the first day of the month, a person or couple is not eligible for Medicaid for the entire month. Eligibility may be reestablished no sooner than the first day of the next month.

For programs that require full verification, verify resources as of 12:01 a.m. on the first day of the month of application for ongoing eligibility. For prior coverage, verify resources as of 12:01 a.m. on the first day of the month for each of the three preceding months.

For programs that allow for client statement as an acceptable verification source, verify resources as of 12:01 a.m. on the first day of the month of application or any month through the month of certification. Verification of resources is not required for all months between the month of application and certification unless the applicant reports a change in the total resources.

For redeterminations, verify resources as of 12:01 a.m. on the first day of:

  • the month the redetermination form was received;
  • either of the two months before the redetermination form was received; or
  • any month between the month the redetermination was received and the month the redetermination is completed.

Verify all resources as of 12:01 a.m. on the first day of the same month.

Related Policy

Applications, B-3000
Eligibility Determination, B-6000
Redeterminations, B-8000
Prior Coverage, G-7000
Documentation and Verification Guide, Appendix XVI

 

F-1311 Encumbered Funds

Revision 19-1; Effective March 1, 2019

When determining countable resources, a bank account balance may be reduced by the amount of funds encumbered (legally obligated) before 12:01 a.m. on the first day of the month.

Encumbered funds should be explored if the case is going to be denied due to excess resources. The account balance as of 12:01 a.m. on the first day of the month should be reduced by the amount of any outstanding checks that have not been processed by the financial institution.

Eligibility staff must:

  • not deny the case before determining if excess resources can be reduced;
  • pend using Form H1020, Request for Information or Action, to request verification of any encumbered funds that may reduce the account balance; and
  • determine the purpose of the payments for which the checks were written in advance and explore the potential for a transfer of assets.

Payments for legally owed debts, such as health care expenses, or credit card charges and recurring monthly expenses consistent with routine banking activity are not a transfer of resources.

Payments made to reduce the 12:01 a.m. balance for items or services for which a person may not receive compensation, may be a transfer of assets. For example, an institution makes advance payments for future housing expenses made by a person in a nursing facility who is unlikely to return home during that time.  

Related Policy

Missing Information Due Dates, B-6420
Failure to Furnish Missing Information, B-6510
Refunds for Payments Before Medicaid Eligibility Approval, F-1312.2
Compensation, I-4100

 

F-1312 Nursing Facility Payments and Refunds

Revision 16-4; Effective December 1, 2016

Following an individual's approval for Medicaid, a Medicaid-contracted, long-term services and supports facility, such as a nursing facility, must refund any advance payments that exceed an individual's co-payment amount  for periods  covered by Medicaid. This refund policy also applies to advance payments made to home health agencies for Community Attendant Services recipients.

A Medicaid-contracted, long-term services and supports provider may charge a private pay rate that is different from the Medicaid rate, when Medicaid is not the payer of the bill. This private arrangement may occur:

  • during a transfer of assets penalty;
  • during a substantial home equity penalty; or
  • before Medicaid eligibility is approved.

A Medicaid-contracted, long-term services and supports facility may allow a resident's family or friends to use personal funds to pay an agreed-upon amount, in addition to the Medicaid rate, in order to have a private room. These payments in excess of an individual's co-payment do not need to be refunded. However, for Medicaid eligibility purposes, if the family or friends pay the difference, consider how it is being paid:

  • If the money is given directly to the individual to pay the difference between the Medicaid rate and a private room rate, that amount is considered income to the individual.
  • If the family or friends pay the facility directly, do not consider the amount paid as income to the individual.

 

F-1312.1 Payment During a Penalty

Revision 16-4; Effective December 1, 2016

During a transfer of assets or substantial home equity penalty, Medicaid does not pay the long-term services and supports provider. Payments for long-term services and supports are a private arrangement between the recipient and the provider. Private pay rates may be collected during a penalty. In these situations, the individual is not owed a refund when the transfer of assets penalty period ends or there is no longer a substantial home equity penalty.

 

F-1312.2 Refunds for Payments Before Medicaid Eligibility Approval

Revision 19-1; Effective March 1, 2019

If a person paid a provider private pay rates or a deposit that exceeded the person's co-payment amount, once Medicaid eligibility is approved, and there is no penalty from a transfer of assets or  substantial home equity, the  excess amount must be refunded for those months Medicaid eligibility is established.

Consider the advance payment as encumbered funds in the resource test for the initial eligibility determination.

Do not consider the refund as income in the month of receipt.

Consider the refund or any remaining part of the refund as a resource as of 12:01 a.m. on the first day of the month after the month of receipt of the refund.

Related Policy

Encumbered Funds, F-1311
Special Reviews, B-8430