Excess Resources
If the equity in capital resources is in excess of the standards but less than the amount of one month’s vendor payment, certification is delayed up to 30 days providing plans are made for the applicant to utilize the excess resource. Certification is made at the point excess resources have been exhausted, with the effective date of the certification being shown as the date on which the resources came within the standard, which is the day after the spending that brought the resources within the standard. If the excess capital resources, along with excess income to be considered against the vendor payment, are in excess of the vendor payment, the application is denied.
Oklahoma is a state that certifies all Medicaid cases back to the first day of the month and we sometimes cover Medicaid services that took place prior to the long-term care eligibility date. When a client has spent their resources to less than the individual Maximum Resource Standard as shown on Appendix C-1, Schedule VIII, D.1, the client becomes eligible for long-term care.
There may be questions regarding what is appropriate for the client to buy/purchase while spending down to meet the resource guidelines. The client must be spending the money for their own needs. A lot of times the client is just private paying for their care until the resources come within standard. The client’s resources should NOT be given away as it could be considered a transfer of resources, thus potentially incurring a penalty period. For any case specific questions regarding what are allowable purchases during a spenddown, contact HRMS for guidance.
Example:
Judy applies for nursing care on October 1. Judy has $1200 RSDI and a checking account with a countable balance of $2400. Judy is told she cannot be certified until she spends down her resources to $2000. 16 days later she submits a receipt showing she paid $450 for a recliner on October 17. Medical tab will be certified effective 10/01 and the nursing home authorization is approved effective 10/18.
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