Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.065 - Divestment on or after August 9, 1989

Current through June 24, 2024
(1) APPLICABILITY.
				This section applies to all institutionalized applicants for and recipients of
				MA who dispose of resources at less than fair market value on or after August
				9, 1989, except for inter-spousal transfers occurring before October 1, 1989,
				and to all institutionalized applicants for and recipients of MA whose spouse
				disposes of resources at less than fair market value on or after July 1, 1990.
				Section
				DHS
				103.063 applies to all applicants and recipients who
				divested before August 9, 1989 and to inter-spousal transfers occurring before
				October 1, 1989.
(2) PURPOSE. This
				section implements s.
				49.453,
				Stats., which provides for a period of restricted MA coverage when an
				individual who is institutionalized or becomes institutionalized, or the
				individual's spouse, disposes of resources at less than fair market
				value.
(3) DEFINITIONS. In this
				section:
(a) "Annuity" means a written
				contract under which, in return for payment of a premium or premiums, an
				individual or individuals have the right to receive fixed, periodic payments
				for life or up to a fixed point in time.
(b) "Community spouse" means a person who is
				legally married as recognized under state law to an institutionalized
				individual but is not himself or herself an institutionalized
				individual.
(c) "Expected value of
				the benefit" means the amount that an irrevocable annuity will pay to a primary
				annuitant or to joint annuitants during his or her expected lifetime.
(d) "Institutionalized individual" means an
				applicant or recipient who is an inpatient in an SNF or ICF, an inpatient in a
				medical institution and with respect to whom payment is made based on a level
				of care provided in an SNF or ICF, or receiving home and community-based care
				MA services under ss.
				49.46
				and
				49.47,
				Stats.
(e) "Joint annuitants" means
				the institutionalized individual and his or her spouse named as the payees
				under an annuity.
(f) "Medical
				assistance" or "MA" means payment for services provided to a resident of an SNF
				or ICF under s. DHS and 107.09(2) (4) (a), payment to a medical institution as
				defined under
				42 CFR
				435.1009 for care based on a level of care
				provided in an SNF or ICF, or payment for services provided under a home and
				community-based care waiver program authorized under
				42 USC
				1396 n (c).
(g) "Medical assistance card services" means
				the services covered under ch. DHS 107, except for services reimbursed as
				institutional care, as defined by s. DHS and 107.09(2) (4) (a), services
				received in an SNF or ICF or a medical institution and services reimbursed
				under a home and community-based care waiver program authorized under
				42 USC
				1396 n (c).
(h) "MA eligibility handbook" means the
				medical assistance program handbook issued by the department's division of
				economic support for use by agencies in determining eligibility for
				MA.
(i) "Primary annuitant" means
				the first individual, which may be either the institutionalized individual or
				his or her spouse, to receive payment from an annuity.
(j) "Resource" has the meaning given in
				42 USC
				1382 b, except that the home, as defined in
				s.
				DHS
				101.03(75), is a nonexempt
				resource.