Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 00 - Long-Term Services › Part 6 - Medicaid Long-Term Services and Supports: Financial Eligibility › Section 210-RICR-50-00-6.10 - Asset Transfer Involving Personal Service/Caregiver Contracts

Current through June 14, 2024
A. A personal service or caregiver contract
				  is a formal written agreement between an applicant or beneficiary and an
				  individual service/care provider. Under the terms of the contract, the
				  service/care provider agrees to provide personal and/or managerial services in
				  exchange for compensation paid by applicant or beneficiary who receives the
				  services over a set period of time. Typically, the caregiver is, but is not
				  required to be, an adult family member or friend of the applicant and the
				  services covered range from home chores (such as housecleaning, grocery
				  shopping, laundry, shoveling and like) to assisting with personal care needs
				  (transportation to medical appointments, aiding in dressing and grooming, and
				  so forth).
B. Personal
				  service/caregiver contracts are not a countable resource for Medicaid LTSS
				  purposes. The purchase price - the amount to be paid over the life of the
				  contract - is a treated as a transfer of assets under the DRA. Accordingly, the
				  State is required to determine whether a personal service/caregiver contract is
				  a transaction made for less than FMV that constitutes a disqualifying transfer.
				  The State makes this determination as follows:
1. Disqualifying transfer - A personal
				  service/care contract is a disqualifying transfer if the payments are for
				  services performed before the date of the transaction. A lump sum payment for
				  services provided in the past is, therefore, a transfer for less than FMV. A
				  contract for requires payment at the time the services/care are rendered is a
				  disqualifying transfer if the services/care are covered by Medicaid or another
				  third (3rd) party payer, or for a person other than
				  a non-LTSS spouse, dependent child, or dependent with disabilities that has no
				  alternative form of coverage. In addition, a contract that requires payment
				  upfront at the time of the transaction for service/care to be provided at some
				  point in the future is treated as a disqualifying transfer unless proof is
				  provided that the services/care will not be covered by Medicaid or another
				  third (3rd) party at the time they are rendered. All
				  contracts based on the promise of services performed in the future are treated
				  as disqualifying transfers if FMV cannot be discerned in accordance with
				  §6.6.1(H) of this Part.
2.
				  Allowed transfer - A personal service/caregiver contract is an allowed transfer
				  if the agreement is in writing, the payment is for services/care provided
				  prospectively (after the contract is executed) and at the time they are
				  performed, and the compensation for services/care provided is reasonable --
				  commensurate with the wage scale or customary fees that would be paid typically
				  to a third (3rd) party performing for the same
				  services/care in the State. Also, the services/care to paid for under the
				  contract must not be covered by Medicaid or another third
				  (3rd) party payer. To ensure there is no overlapping
				  coverage, the contract must specify the types of services/care to be provided,
				  the location, and how often, as well as a start and end date, the form and
				  frequency of compensation, the terms for altering the contract and the
				  signatures of the parties involved. An agreement that include these elements
				  may be treated as a disqualifying transfer if the State determines the payments
				  are being used for purposes other than those specified in the contract or made
				  to persons or entities other than the persons or entities identified as the
				  service/care provider(s) under the contract.