TO STAFF 317:35-17-10
1. When an individual applies for ADvantage
Waiver services, the transfer of assets look-back period starts with the
application date. When the individual
transferred assets without receiving fair market value within the last
60-calendar months, the penalty period starts with the date the individual is
determined financially and medically eligible for long-term care (LTC) services
if it were not for the transfer penalty.
This is normally the medical eligibility date.
area nurse determines medical eligibility at the same time as Adult and Family
Services (AFS) LTC staff determines financial eligibility. When the individual is receiving SoonerCare
(Medicaid), AFS staff only needs to determine if the individual transferred
assets without receiving fair market value.
the area nurse determines the individual does not meet nursing facility level
of care or does not recommend ADvantage Waiver services, the area nurse denies
the authorization and a penalty period start date is not set.
the individual is not financially eligible for a reason other than transfer of
resources, AFS LTC staff denies the application and a penalty period is not
set. AFS LTC staff notifies the area
nurse of the denial.
AFS LTC staff denies the ADvantage Waiver application because of the asset
transfer and sets a penalty period, the individual is eligible for SoonerCare
(Medicaid) only benefits during the penalty period unless the individual
requires a Medicaid Income Pension Trust (MIPT) to be eligible. When a MIPT is
required in order for the individual to be income eligible for LTC, the individual
must establish and fund a MIPT for at least one month to start the penalty
period. After one month, the individual
may stop contributing to the MIPT in order to have money to pay bills until the
penalty period ends. When the individual
chooses not to fund the MIPT after the first month of SoonerCare (Medicaid)
eligibility, the worker closes the SoonerCare (Medicaid benefit.
the penalty period exceeds the 60-calendar month look back period, AFS LTC
staff explains the benefit of withdrawing the LTC application and not
reapplying until the 60-calendar months from the last large transfer. This avoids the requirement of serving the
complete penalty period.
example, if the individual transferred $300,000 on May 15, 2013, and $10,000
more on November 15, 2016, and applied for ADvantage Waiver services on January
2, 2017, it is better to withdraw the application and wait to apply until after
May 15, 2018. When the individual waits
until after May 15, 2018 to apply, the 60-calendar month look back period will
have ended for the large transfer. Using
the Transfer of Assets Calculator, $310,000 divided by the current average
daily cost of nursing home care, that for this example is $144.67, equals 2143
days. 2143 days equals a transfer
penalty period lasting until November 15, 2022.
This exceeds 60 months or 365 days times 5 that equals 1825 days. If the individual waits until after May 15,
2018 to apply, the large transfer occurred over five years ago and is not
considered for the January application.
The individual must serve a 70-day transfer penalty for the $10,000
transfer so he or she is not eligible until July 25, 2018.
Adult and Family Services Health Related and Medical Services staff when
assistance is needed to determine the best case scenario for the individual.