7 AAC 100.606 - Recognized Medicaid trust; effect on financial eligibility

(a) A payment that would otherwise be available to an applicant or recipient that is deposited directly into a recognized Medicaid trust account, or earnings of the trust account that remain in the trust account, is not income for the purposes of determining Medicaid eligibility.

(b) A payment or deposit of an asset belonging to the applicant or recipient that is placed into the applicant's or recipient's special needs trust or pooled trust is not a countable resource for the purposes of determining Medicaid eligibility.

(c) A payment made by the trustee from the trust account to the applicant or recipient is income according to the provisions of this chapter that are applicable to the applicant's or recipient's eligibility category.

(d) For eligibility categories identified under 7 AAC 100.002(b) or (d), a payment made from a recognized Medicaid trust directly to a third-party vendor is not a transfer of asset for less than fair market value and is not income to the applicant or recipient if the payment is not accessible to the applicant or recipient and the payment is

(1) for a product or service that provides a direct and measurable contribution to the applicant or recipient under (g) of this section;

(2) to a medical facility to pay for the applicant's or recipient's cost-of-care obligation; or

(3) for medical care of a community spouse.

(e) A payment from a trust account to a third party that is not payment for a product or service that makes a direct and measurable contribution to the applicant or recipient, or that does not otherwise satisfy an independent legal obligation of the applicant or recipient, is a transfer of an asset for less than fair market value under 7 AAC 100.510.

(f) Except as provided under 7 AAC 40.320 for in-kind support and maintenance, a payment from a recognized Medicaid trust directly to a third-party vendor for food or shelter is income to the applicant or recipient up to $20 plus one-third of the SSI eligibility standard or, if applicable, up to a maximum amount determined under the presumed value rule in 20 C.F.R. 416.1140.

(g) For purposes of this section, a product or service makes a direct and measurable contribution to the applicant or recipient if the

(1) applicant or recipient is the primary beneficiary of the product or service purchased by the trust payment; and

(2) value of the contribution to the applicant or recipient of that product or service can be measured by a health care provider or assigned a monetary value based upon readily available consumer economic or market data.

Notes

7 AAC 100.606

Eff. 7/20/2007, Register 183

Authority:AS 47.05.010

AS 47.07.020

AS 47.07.040