Library: Policy
317:35-5-41.8. Eligibility regarding long-term care services
Rule text available at Oklahoma Health Care Authority website.
INSTRUCTIONS TO STAFF
Revised 9-1-16
1.Refer to Schedule VIII.D(2) of Oklahoma Department of Human Services (DHS) Appendix C-1 for the home property standard.
2.The worker requests an undue hardship by sending a memo and documentation to Adult and Family Services Health Related and Medical Services staff for approval.
(1) When the undue hardship exists because the client was placed in the nursing facility due to a life or death situation, the memo includes information about the situation and the SoonerCare (Medicaid) application date.A statement from a medical professional verifying the life-threatening situation must be attached.
(2) When the undue hardship exists because the applicant was exploited, the alleged perpetrator's access to the client's income and resources must end and legal action must be pursued.
(A) The memo requesting undue hardship must include:
(i) the SoonerCare (Medicaid) application date;
(ii) what actions were taken to stop the exploitation and what legal action is or was pursued;
(iii) the date the alleged perpetrator's access to the client's income and resources ended;
(iv) the date the client is otherwise eligible if not for the resource transfer; and
(v) the name or names of persons that have current access to the client's income and resources and the date access was requested and received.
(B) The worker attaches proof that legal action is being pursued against the alleged perpetrator.Pursuing legal action means an Adult Protective Services (APS) referral was made to the district attorney's office or a lawsuit was filed against the alleged perpetrator. Proof may include, but is not limited to, providing:
(i) a copy of a signed and completed APS investigation report showing a substantiated finding of exploitation or other confirmation from APS;
(ii) correspondence from the client's or his or her representative's attorney confirming how legal action is being pursued;
(iv) court document showing current guardianship or power-of-attorney information;
(v) court petitions or orders; or
(E) police reports.
3.Effective September 1, 2016, home property in a revocable trust is considered an available resource.When a client's home property is in a revocable trust, the worker informs the client or his or her representative that the home property exemption does not apply unless the property is removed from the revocable trust.The worker provides the client or his or her representative with Form 08AD092E, Client Contact and Information Request, giving the client 10-calendar days to provide proof the property was removed from the trust.When the client does not remove the property from the trust and the value exceeds the resource limit per Schedule VIII.D of the Oklahoma Department of Human Services Appendix C-1, Maximum Income, Resource, and Payment Standards, the worker denies or closes the SoonerCare (Medicaid) benefit.
4.When the home is put on the market for sale, it indicates the individual does not plan to return home.The worker submits lien paperwork to the Oklahoma Heath Care Authority (OHCA), Third Party Liability (TPL) Unit.Lien paperwork includes:
(1) a completed Form 08MA025E, Medicaid Estate Recovery Lien;
(2) a completed Form 08MA024E, Acknowledgement of Intent to Return Home;
(3) a copy of the property deed; and
(4) proof the property is on the market for sale.
5.The home is a countable resource and lien paperwork must be completed and sent to the OHCA, TPL Unit.Lien paperwork includes a completed Form 08MA024E and Form 08MA025E and a copy of the property deed.For example, when the client:
(1) was admitted to the facility in October of last year and applies for nursing home care in October of this year, the 12-month home property exclusion has expired.The worker and the client or client representative complete Form 08MA024E at application and the worker submits Form 08MA024E, Form 08MA025E, and a copy of the property deed to OHCA, TPL Unit upon certification.
(2) is admitted to the nursing facility and applies for nursing home care beginning the date of admission, the home is exempt for 12 months when the client intends to return home.Lien paperwork is completed and submitted to OHCA no later than the 11th month of the exemption period to allow time for the lien to be filed before the 12 month exemption period expires.
6.When the home property is sold after the lien is filed, refer to OAC 317:35-19-4(b)(6) for information on dissolving the lien.
7.Refer to DHS Appendix M-13, Medicaid Life Expectancy Table.
