A licensed vehicle is exempt if it is used more than fifty percent (50%) of the time for income-producing purposes. Example: a self employed applicant uses a tow truck, welding truck or tractor trailer to make a living. The following are suggestions for determining the fair market value of a vehicle: The average trade-in value listed in the current National Automobile Dealer’s Association (NADA) Car Guide is used. The loan value of the vehicle is used only if other sources are unavailable. If the household thinks that the average trade-in value listed in the NADA is incorrect because of the vehicle’s condition (body damage), the household may provide verification from a reliable source, such as a bank loan officer or licensed car dealer. Increased value due to low mileage or optional equipment is not counted. The household must prove the value of antique, custom-made, or classic vehicles if an accurate appraisal cannot be made by staff. The household’s estimated value of vehicles no longer listed in NADA is accepted unless the value is questionable and would affect eligibility. In this case the household should provide an appraisal from a licensed car dealer or some other evidence of the value, such as a tax assessment or newspaper ad showing the sale price of a similar vehicle. For new vehicles not yet listed in the NADA, the household should provide an estimate of the trade-in value from a new car dealer or a bank loan officer. If this is not possible, the household’s estimate is accepted unless it is questionable and would affect eligibility. PENALTY FOR TRANSFERRING RESOURCES - A household is ineligible if within three months before application or any time after certification it transferred a countable resource for less than the fair market value to qualify for county medical assistance. The household is ineligible for two years beginning with the date that the resource was transferred. If spouses are legally separated, transfer of separate property by one spouse does not affect the eligibility of the other spouse. THIS PENALTY APPLIES ONLY IF THE VALUE OF THE TRANSFERRED RESOURCE PLUS THE HOUSEHOLD’S OTHER COUNTABLE RESOURCES WOULD HAVE AFFECTED ELIGIBILITY. ADDENDUM 3 EXCLUSIONS AND LIMITATIONS GENERAL EXLUSIONS The following services and supplies are excluded: Not specifically provided by the Ector County Hospital or an approved provider. Not medically necessary
Provided to a patient before or after the date the patient is eligible for the program Provided outside the United States Not claimed (billed) by the provider within 90 days from the date of service or 90 days from the date of eligibility, if the patient was eligible in one or more of the three months before the application month Elective surgeries Provided by a patient’s immediate relative or household member Payable by or available under any health, accident or other insurance coverage, by any private or other governmental benefit system, by any legally liable third party or under other contract Provided by military medical facilities, or Veterans provided by military medical facilities, or Veterans Administration facilities, or United States public health service hospitals Related to any condition covered under the worker’s compensation laws. SPECIFIC EXCLUSIONS The following specific services or supplies are excluded: Separate payments for services and supplies to an institution that receives a vendor payment or has a reimbursement formula that includes the services and supplies as a part of institutional care. Whole blood or packed red cells available at no cost to the patient Take home items and drugs or non-prescribed drugs Treatment of flatfoot conditions, subluxations of the foot, and routine foot care and hygiene, including cutting or removal of corns, warts, calluses, and nail trimming Prosthetic and orthopedic devices Social and educational counseling with the exception of diabetic teaching/counseling provided at Medical Center Hospital Custodial care Autopsies Recreational therapy Separate fees for completing or filing a claim under the program Services or supplies that are not reasonable and necessary for diagnosis and/or treatment Dentures Prescriptions for and the cost of supportive devices and special shoes Eyeglasses and examinations for the prescription and fitting of eyeglasses Hearing aids Medical transportation unless ECHDA approved for emergency medical services as an optional service Chiropractors LIMITED SERVICES Exclude the following services and supplies unless the specified conditions are met: