10A NCAC 23E .0202       RESERVE

(a)  North Carolina has contracted with the Social Security Administration under Section 1634 of the Social Security Act to provide Medicaid to all SSI recipients.  Resource eligibility for individuals under any Aged, Blind, and Disabled coverage group shall be determined based on standards and methodologies in Title XVI of the Social Security Act except as specified in Paragraphs (k) and (l) of this Rule.  Applicants for and recipients of Medicaid shall use their own resources to meet their needs for living costs and medical care to the extent that such resources can be made available.

(b)  The value of resources currently available to any budget unit member shall be considered in determining financial eligibility.  A resource shall be considered available when it is actually available and when the budget unit member has a legal interest in the resource and he, or someone acting in his behalf, can take any necessary action to make it available.

(c)  Resources shall be excluded in determining financial eligibility when the budget unit member having a legal interest in the resources is incompetent unless:

(1)           A guardian of the estate, a general guardian or an interim guardian has been lawfully appointed and is able to act on behalf of his ward in North Carolina and in any state in which such resources are located; or

(2)           A durable power of attorney, valid in North Carolina and in any state in which such resource is located, has been granted to a person who is authorized and able to exercise such power.

(d)  When there is a guardian, an interim guardian, or a person holding a valid, durable power of attorney for a budget unit member, but such person is unable, fails, or refuses to act promptly to make the resources actually available to meet the needs of the budget unit member, a referral shall be made to the county department of social services for a determination of whether the guardian or attorney in fact is acting in the best interests of the member and if not, the county department of social services shall contact the clerk of court for intervention.  The resources shall be excluded in determining financial eligibility pending action by the clerk of court.

(e)  When a Medicaid application is filed on behalf of an individual who:

(1)           is alleged to be mentally incompetent,

(2)           has or may have a legal interest in a resource that affects the individual's eligibility, and

(3)           does not have a representative with legal authority to use or dispose of the individual's resources, the individual's representative or family member shall be instructed to file within 30 calendar days a judicial proceeding under G.S. 35A to declare the individual incompetent and appoint a guardian.  If the representative or family member either fails to file such a proceeding within 30 calendar days or fails to timely conclude the proceeding, a referral shall be made to the services unit of the county department of social services for guardianship services.  If the allegation of incompetence that has lasted, or is expected to last 30 consecutive days or more, or until the individual's death, is supported by competent evidence, as specified in Paragraph (h) of this Rule, the resources shall be excluded beginning with the date that such evidence indicates that he became incompetent, except as provided in Paragraphs (f) or (g) of this Rule. 

(f)  The budget unit member's resources shall be counted in determining his eligibility for Medicaid beginning the first day of the month following the month a guardian of the estate, general guardian or interim guardian is appointed, provided that after the appointment, property that cannot be disposed of or used except by order of the court shall continue to be excluded until completion of the applicable procedures for disposition specified in G.S. 1 or G.S. 35A.

(g)  When the court rules that the budget unit member is competent or no ruling is made because of the death or recovery of the member, his resources shall be counted except for periods of time for which it can be established by competent evidence specified in Paragraph (h) of this Rule, that the member was in fact incompetent for at least 30 consecutive days, or until his death.  Any such showing of incompetence is subject to rebuttal by competent evidence as specified in Paragraph (h) of this Rule.

(h)  For purposes of this Rule, competent evidence is limited to the written statement or testimony at a competency hearing of a physician, psychologist, nurse, or social worker with knowledge of the condition of the individual, the basis of that knowledge, the beginning date of incompetence, the reason the individual is incompetent, and if no longer incompetent, when the individual recovered competence.

(i)  The limitation of resources held for reserve for the budget unit shall be as follows:

(1)           for Family and Children's related categorically and medically needy cases, three thousand dollars ($3,000.00) per budget unit;

(2)           for aged, blind, and disabled cases, two thousand dollars ($2000.00) for a budget unit of one and three thousand dollars ($3000.00) for a budget unit of two.

(j)  If the value of countable resources of the budget unit exceeds the reserve allowance for the unit, the case shall be ineligible:

(1)           For Family and Children's related cases and aged, blind or disabled cases protected by grandfathered provisions, and medically needy cases not protected by grandfathered provision, eligibility shall begin on the day countable resources are reduced to allowable limits or excess income is spent down, whichever occurs later;

(2)           For categorically needy aged, blind or disabled cases not protected by grandfathered provisions, eligibility shall begin no earlier than the month countable resources are reduced to allowable limits as of the first moment of the first day of the month.

(k)  Resources counted in the determination of financial eligibility for categorically needy aged, blind and disabled cases, and Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, Qualifying Individual and Qualified Disabled Working Individual cases shall be based on resource standards and methodologies in Title XVI of the Social Security Act except for the following methodologies:

(1)           The value of personal effects and household goods shall be not counted.

(2)           Value of tenancy in common interest in real property shall be not counted.

(3)           Value of life estate interest in real property shall be not counted.

(4)           Value of burial plots shall be not counted.

(5)           The cash value of life insurance when the total face value of all cash value bearing life insurance policies does not exceed ten thousand dollars ($10,000.00) shall be not counted.

(l)  Resources counted in the determination of financial eligibility for medically needy aged, blind and disabled cases is based on resource standards and methodologies in Title XVI of the Social Security Act except for the following methodologies:

(1)           The value of personal effects and household goods shall be not counted.

(2)           Value of tenancy in common interest in real property shall be not counted.

(3)           Value of life estate interest in real property is not counted.

(4)           Individuals with resources in excess of the resource limit at the first moment of the month may become eligible at the point that resources are reduced to the allowable limit.

(5)           Value of burial plots shall be not counted.

(6)           The cash value of life insurance when the total face value of all cash value bearing life insurance polities does not exceed ten thousand dollars ($10,000.00) shall be not counted.

(m)  Resources counted in the determination of financial eligibility for categorically needy Family and Children's related cases shall be:

(1)           Cash on hand;

(2)           The balance of savings accounts, including savings of a student saving his earnings for school expenses;

(3)           The balance of checking accounts less the current monthly income that had been deposited to meet the budget unit's monthly needs when reserve was verified;

(4)           The portion of lump sum payments remaining after the month of receipt;

(5)           Cash value of life insurance policies owned by the budget unit;

(6)           Stocks, bonds, mutual fund shares, certificates of deposit and other liquid assets;

(7)           Patient accounts in long term care facilities;

(8)           Equity in non-essential personal property limited to:

(A)          Mobile homes not used as home;

(B)          Boats, boat trailers and boat motors;

(C)          Campers;

(D)          Farm and business equipment;

(E)           Equity in vehicles in excess of one motor vehicle per adult;

(n)  Resources counted in the determination of financial eligibility for medically needy Family and Children's related cases are:

(1)           Cash on hand;

(2)           The balance of savings accounts, including savings of a student saving his earnings for school expenses;

(3)           The balance of checking accounts less the current monthly income that had been deposited to meet the budget unit's monthly needs when reserve was verified or lump sum income from self‑employment deposited to pay annual expenses;

(4)           Cash value of life insurance policies when the total face value of all policies that accrue cash value exceeds one thousand five hundred dollars ($1,500.00);

(5)           Stocks, bonds, mutual fund shares, certificates of deposit and other liquid assets;

(6)           Patient accounts in long term care facilities;

(7)           Equity in non-essential, non-income producing personal property limited to:

(A)          Mobile home not used as home,

(B)          Boats, boat trailers and boat motors,

(C)          Campers,

(D)          Farm and business equipment,

(E)           Equity in motor vehicles in excess of one vehicle per adult if not income-producing.

 

History Note:        Authority G.S. 108A-54; 108A-55; 108A-58; 42 U.S.C. 703, 704 1396; 42 C.F.R. 435.121; 42 C.F.R. 435.210; 42 C.F.R. 435.711; 42 C.F.R. 435.712; 42 C.F.R. 435.734; 42 C.F.R. 435.823; 42 C.F.R. 435.840; 42 C.F.R. 435.841; 42 C.F.R. 435-845; 42 C.F.R. 445.850; 42 C.F.R. 435.851; 45 C.F.R. 233.20; 45 C.F.R. 233.51; S.L. 2002-126;

Eff. September 1, 1984;

Temporary Amendment Eff. September 1, 1985, for a period of 92 days to expire on December 1, 1985;

Amended Eff. January 1, 1995; November 1, 1994; September 1, 1993; March 1, 1993;

Temporary Amendment Eff. September 13, 1999;

Temporary Amendment Expired June 27, 2000;

Temporary Amendment Eff. September 12, 2000;

Amended Eff. March 19, 2001;

Temporary Amendment Eff. April 16, 2001;

Amended Eff. August 1, 2002;

Temporary Amendment Eff. March 1, 2003;

Amended Eff. August 1, 2004;

Transferred from 10A NCAC 21B .0310 Eff. May 1, 2012.