5111.0116 Disposal of assets under market value after look-back date.
5111.0116 Disposal of assets under market value after look-back date.
(A) As used in this section:
(1) “Assets” include all of an individual’s income and resources and those of the individual’s spouse, including any income or resources the individual or spouse is entitled to but does not receive because of action by any of the following:
(a) The individual or spouse;
(b) A person or government entity, including a court or administrative agency, with legal authority to act in place of or on behalf of the individual or spouse;
(c) A person or government entity, including a court or administrative agency, acting at the direction or on the request of the individual or spouse.
(2) “Home and community-based services” means home and community-based services furnished under a medicaid waiver granted by the United States secretary of health and human services under 42 U.S.C. 1396n(c) or (d).
(3) “Institutionalized individual” means a resident of a nursing facility, an inpatient in a medical institution for whom a payment is made based on a level of care provided in a nursing facility, or an individual described in 42 U.S.C. 1396a(a)(10)(A)(ii)(VI).
(4) “Look-back date” means the date that is a number of months specified in rules adopted under section 5111.011 of the Revised Code immediately before either of the following:
(a) The date an individual becomes an institutionalized individual if the individual is eligible for medicaid on that date;
(b) The date an individual applies for medicaid while an institutionalized individual.
(5) “Nursing facility” has the same meaning as in section 5111.20 of the Revised Code.
(6) “Nursing facility equivalent services” means services that are covered by the medicaid program, equivalent to nursing facility services, provided by an institution that provides the same level of care as a nursing facility, and provided to an inpatient of the institution who is a medicaid recipient eligible for medicaid-covered nursing facility equivalent services.
(7) “Nursing facility services” means nursing facility services covered by the medicaid program that a nursing facility provides to a resident of the nursing facility who is a medicaid recipient eligible for medicaid-covered nursing facility services.
(B) Except as provided in rules adopted under section 5111.011 of the Revised Code, an institutionalized individual is ineligible for nursing facility services, nursing facility equivalent services, and home and community-based services if the individual or individual’s spouse disposes of assets for less than fair market value on or after the look-back date. The institutionalized individual’s ineligibility shall begin on a date determined in accordance with rules adopted under section 5111.011 of the Revised Code and shall continue for a number of months determined in accordance with such rules.
(C) To secure compliance with this section, the director of job and family services may require an individual, as a condition of initial or continued eligibility for medicaid, to provide documentation of the individual’s assets up to five years before the date the individual becomes an institutionalized individual if the individual is eligible for medicaid on that date or the date the individual applies for medicaid while an institutionalized individual. Documentation may include tax returns, records from financial institutions, and real property records.
Effective Date: 03-30-2006