13-005 Code Vt. R. 13-001-005-X
Part Five describes the financial standards and methodologies, including income and resource tests, that apply to the various health-benefits programs and categories of assistance.
(10/01/2021, GCR 20-002).
[(]01/15/2019, GCR 18-063).
(01/15/2017, GCR 16-098).
For purposes of this section:
(10/01/2021, GCR 20-002).
(01/01/2018, GCR 17-047).
For the individuals who may qualify for medically-needy MCA, see §7.03(a)(8).
(01/15/2017, GCR 16-098).
(01/01/2024, GCR 23-086).
(01/15/2017, GCR 16-098).
An individual who meets the nonfinancial and categorical requirements for MABD must also meet the financial requirements specified in this section. AHS determines financial eligibility for MABD, including Medicaid coverage of long-term care services and supports under MABD.
To determine an individual's financial eligibility for MABD, AHS calculates the countable income and countable resources of the individual's financial responsibility group and compares those amounts to standards based on the size of the individual's Medicaid group. The first step in determining financial eligibility is to identify the members of the individual's financial responsibility group and the members of the individual's Medicaid group. An aged, blind, or disabled individual requesting MABD is always a member of both groups.
The rules for forming the financial responsibility group are specified in §29.03.
The rules for forming the Medicaid group are specified in §29.04.
The rules on resources are specified in §§29.07 through 29.10.
The rules on income are specified in §§29.11 through 29.15.
(01/15/2017, GCR 16-098).
As used in this §29.00, the following terms have the following meanings:
(01/15/2017, GCR 16-098).
(01/15/2017, GCR 16-098).
(01/15/2017, GCR 16-098).
(01/15/2017, GCR 16-098).
(01/15/2017, GCR 16-098).
The following are terms related to life insurance:
Retirement funds include but are not limited to IRAs, Keogh plans, 401K plans, pensions, mutual funds, stocks, bonds, securities, money market accounts, whole life insurance, and annuities. The value of a retirement fund is the amount of money that can currently be withdrawn from the fund.
See §29.08(i)(5) for information on the resource exclusion of retirement funds. See §29.08(f) for information on the exclusion of early withdrawal and surrender penalties.
(01/01/2024, GCR 23-086).
This subsection specifies the resources whose value is excluded in determining MABD eligibility.
For information on the treatment of the funds for purposes of income eligibility, see §29.13(b)(30).
(01/01/2018, GCR 17-047).
Lump sum payments and streams of income are subject to transfer penalties if given away in the month of receipt or thereafter.
(01/01/2024, GCR 23-086).
(01/15/2017, GCR 16-098).
(01/15/2017, GCR 16-098).
(01/01/2024, GCR 23-086).
(01/01/2018, GCR 17-047).
(01/15/2017, GCR 16-098).
Deductions from earned income, including self employment, and from unearned income are allowed.
(01/01/2024, GCR 23-086).
As stated in §28.04(c), the income spenddown provisions under this section apply to an individual requesting MCA, including Medicaid coverage of long-term care services and supports under MCA, whose income exceeds the applicable income standard for eligibility for MCA and who is seeking MCA eligibility as medically needy and is subject to an income spenddown in order to be eligible. For this purpose, all references to "countable income" in this section shall mean the individual's MAGI-based income as described in §28.03(d) adjusted, if applicable, by apportioning the income of financially responsible family members according to the requirements set forth in §28.04(b). Since there is no resource test for MCA eligibility, none of the resource spenddown provisions under this section apply.
See §7.03(a)(8)(i) for the individuals who may qualify for MCA as medically needy.
(01/15/2019, GCR 18-063).
An individual receiving hospice services is considered to be in a long-term care living arrangement. [32] An individual receiving hospice services is:
(01/15/2017, GCR 16-098).
(01/01/2024, GCR 23-086).
An individual who passes all nonfinancial eligibility tests may qualify for Medicaid by spending down the income or resources, if applicable, that are in excess of the maximums applicable to them. The income and resource maximums for each MABD eligibility category are specified in the descriptions found in §§8.05 and 8.06. [33] Income and resource maximums can also be found in Vermont's Medicaid Procedures Manual. The income maximums for the MCA categories are specified in the descriptions found in §7.03(a).
(01/15/2017, GCR 16-098).
(10/01/2021, GCR 20-002).
(01/01/2024, GCR 23-086).
A plan of care can be submitted to AHS using a form provided by AHS or using a statement, signed by the physician, that contains information sufficient, as determined by AHS, to document the individual's need for personal care services.
Endnotes for Part 5.
[1] 42 CFR § 435.603(a).
[2] 26 CFR § 1.36B-1(d); 42 CFR § 435.603(b). Note: The IRS rules do not include unborn children in the determination of family size.
[3] 26 CFR § 1.36B-1(e)(2); 42 CFR 435.4; 45 CFR § 155.300. These sections reference §36 B(d)(2)(B) of the Code. This is the definition found in that provision.
[4] 42 CFR § 435.4
[5] 42 CFR § 435.603(c).
[6] 42 CFR § 435.603(d).
[7] As required under section 6012(a)(1) of the Code.
[8] Id
[9] 42 CFR § 435.603(e).
[10] Bipartisan Budget Act of 2018, section 53103; CMS SHO Letter No. 19-003 (August 22, 2019).
[11] See, §6013 of the Code.
[12] 42 CFR § 435.603(g).
[13] 42 CFR § 435.603(h).
[14] 42 CFR § 435.603(i).
[15] 42 CFR § 435.603(j).
[16] 42 CFR § 435.603(k).
[17] 42 CFR § 435.602.
[18] 26 CFR § 1.36B-1(e).
[19] For the current resource maximums, see Vermont's Eligibility Standards for Healthcare Programs on the Department of Vermont Health Access website.
[20] For the current substantial home equity limit, see Vermont's Eligibility Standards for Healthcare Programs on the Department of Vermont Health Access website.
[21] 8 VSA §14212
[22] Stephen Beck, Jr., ABLE Act of 2014.
[23] 32 VSA §5830 f.
[24] 27 VSA §2(b).
[25] Id.
[26] For the current substantial home equity limit, see Vermont's Eligibility Standards for Healthcare Programs on the Department of Vermont Health Access website.
[27] For the current CSRA maximum, see Vermont's Eligibility Standards for Healthcare Programs on the Department of Vermont Health Access website.
[28] See, also, §29.08(i)(9) for income excluded by federal law.
[29] 32 VSA 5830f.
[30] Rates for mileage reimbursement are the rates established by the U.S. General Services Administration. The rates fluctuate periodically. For the current rate, refer to the U.S. General Services Administration's website at www.gsa.gov/mileage.
[31] Rates for mileage reimbursement are the rates established by the U.S. General Services Administration. The rates fluctuate periodically. For the current rate, refer to the U.S. General Services Administration's website at www.gsa.gov/mileage.
[32] For information about hospice services, see Health Care Administrative Rules (HCAR) at §4.227.
[33] For current income and resource maximums, see Vermont's Eligibility Standards for Healthcare Programs on the Department of Vermont Health Access website.
[34] For the current standard deduction, see Vermont's Eligibility Standards for Healthcare Programs on the Department of Vermont Health Access website.
13-005 Code Vt. R. 13-001-005-X
October 1, 2013 Secretary of State Rule Log #13-029
AMENDED:
July 30, 2014 Secretary of State Rule Log #14-026; July 15, 2015 Secretary of State Rule Log #15-030 [15-02]; May 11, 2016 Secretary of State Rule Log #16-E04; August 1, 2016 Secretary of State Rule Log #16-026; January 15, 2017 Secretary of State Rule Log #16-072, #16-073, #16-074, #16-075, #16-076, #16-077, #16-078, #16-079; May 2017 [Rule 13 170 001 moved from DCF to Human Services and divided into rules 13 001 001 through 13 001 008] ; January 1, 2018 Secretary of State Rule Log #17-071; January 15, 2019 Secretary of State Rule Log #18-053; October 1, 2021 Secretary of State Rule Log #21-019; January 1, 2023 Secretary of State Rule Log #22-038; January 1, 2024 Secretary of State Rule Log #23-042
STATUTORY AUTHORITY:
3 V.S.A. §§801, 3052, 3053; 33 V.S.A. §§105, 1810, 1901