Library: Policy
317:50-1-6. Determining financial eligibility for the Medically Fragile Waiver program
Rule text available at Oklahoma Health Care Authority website.
INSTRUCTIONS TO STAFF 317:50-1-6
Issued 3-15-17
1.When an individual eligible for the Medically Fragile Waiver applies for long-term-care services (LTC), 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 LTC services if it were not for the transfer penalty.This is normally the medical eligibility date.
(1) The Oklahoma Health Care Authority (OHCA) and/or the 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.
(2) When OHCA and/or the area nurse determines that the individual does not meet nursing facility level of care or does not recommend Home and Community Based Waiver services, the area nurse denies the authorization and a penalty period start date is not set.
(3) When 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 OHCA and/or the area nurse of the denial.
(4) When AFS LTC staff denies the LTC 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.
(5) When 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 60-calendar months from the last large transfer.This avoids the requirement of serving the complete penalty period.
(A) For example, if the individual transferred $300,000 on May 15, 2013, and $10,000 more on November 15, 2016, and applied for nursing facility level of care 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.When the individual waits until after May 15, 2018 to apply, the large transfer would have occurred over five years ago and is not considered for the January application.The individual must serve a 70-calendar day transfer penalty for the $10,000 transfer so he or she is not eligible until July 25, 2018.
(B) Contact Adult and Family Services Health Related and Medical Services staff when assistance is needed to determine the best case scenario for the individual.
