Kan. Admin. Regs. § 129-7-16

Current through Register Vol. 44, No. 2, January 9, 2025

Section 129-7-16 - State fair hearings for income and resource allowance determinations

(a) For purposes of this regulation, "significant financial duress" shall mean circumstances in which expenses are unforeseen or are ongoing and are reasonable and necessary for the health, safety, or well-being of the community spouse, as specified in K.A.R. 129-6-106(k). "Expenses" shall include the costs of medical or other necessary support services or the costs associated with unforeseen circumstances, including a fire or flood.

(b) Any applicant or beneficiary may request a state fair hearing when challenging any adverse consequence of any of the following department determinations:

(1) The income allowance in accordance with K.A.R. 129-6-106(k)(2) ;

(2) the amount of monthly income available to the community spouse as specified in K.A.R. 129-6-106(k)(2)(B) ;

(3) the share of resources for the institutionalized and community spouse in accordance with K.A.R. 129-6-106(k)(6) ;

(4) the consideration of resources in determining the eligibility of the institutionalized spouse as specified in K.A.R. 129-6-106(k)(4) ; or

(5) the community spouse resource allowance in accordance with K.A.R. 129-6-106(k)(6).

(c) The presiding officer shall determine the accuracy of the initial determination described in subsection (b).

(d) The presiding officer shall increase the amount of the community spouse income allowance if either spouse establishes that a greater allowance is necessary due to exceptional circumstances resulting from significant financial duress. The community spouse income allowance shall be increased sufficient to cover the expenses and based on whether the condition is temporary or ongoing.

(e) If the community spouse income allowance determined to be needed for exceptional circumstances resulting from significant financial duress has not been reached after application of subsection (d), the presiding officer may consider and grant an increase to the community spouse resource allowance if either the community or institutionalized spouse establishes that additional income producing resources from the institutional spouse need to be provided to the community spouse in order to raise the community spouse's income to the allowable community spouse income allowance amount determined in accordance with K.A.R. 129-6-106(k)(2) or as determined through a state fair hearing under subsection (d). Each decision to grant an increase in the community spouse resource allowance shall require that all of the following criteria be met:

(1) The institutionalized spouse has allocated the maximum amount of available income to the community spouse.

(2) The additional income producing resources allocated to the community spouse does not exceed an amount necessary to generate income sufficient to raise the total community spouse income to the allowable amount.

(3) The income value of both the current resources allowed and the additional resources to be allocated are based on the income that could be generated by the sale of the property and the investment of the proceeds into a single premium life annuity.

Kan. Admin. Regs. § 129-7-16

Authorized by and implementing K.S.A. 65-1,254 and 75-7403; adopted by Kansas Register Volume 43, No. 50; effective 12/27/2024.