SI DAL01150.111 Transfer Of Resources For Less Than Fair Market Value July 1, 1988 Or Later
See SI 01150.111
SI 01150.110 instructs field offices (FOs) to obtain transfer of resources information during an initial claim or redetermination interview and to forward this information to the State Medicaid agency. SI 00520.012 imposes the $30 SSI Payment limit to SSI recipients who are ineligible for Medicaid coverage while in an institution due to the transfer of resources provision.
Exhibit 1 and Exhibit 2 provide transmittal memorandums for exchange of information between the local Social Security FO and the Medicaid agency. Exhibits 1 and 2 should be photocopied as needed.
B. Procedures — SSA FO
Exhibit 1 is to be completed by the SSA claims representative when an initial claim or redetermination interview is completed and information is obtained that a resource was transferred for less than fair market value on or after July 1, 1988.
Attach a copy to Exhibit 1 of the responses to question 27 of the SSA-8000-BK SSI application concerning the transfer of resources. If a MSSICS claim is taken, attach a printout of the RMEN and RGIV screens. For redeterminations, completing the information shown on Exhibit 1 will meet the documentation requirements explained in SI 01150.110E.3. In addition to transmitting an MN diary, mail Exhibit 1 with attachments to the following addresses:
For Arkansas, Louisiana, New Mexico and Texas residents, use the State agency addresses in SI DAL01730.045
For Oklahoma residents: Oklahoma Department of Human Services
Family Support Services
Attn: Health Related & Medical Services
P. O. Box 25352
Oklahoma City, Oklahoma 73125
C. Procedures — state medicaid office
Upon receipt of Exhibit 1, the State Medicaid office will take whatever action is required according to internal State operating procedures.
D. Procedures — local medicaid caseworker
Exhibit 2 is to be completed by the local Medicaid caseworker only at the point that the SSI recipient is determined to be ineligible for institutional services under Medicaid because of the transfer of resources policy.
The information used to apply the transfer of resources provision may come to the Medicaid agency from a variety of sources, including the Social Security Administration.
The Medicaid caseworker will provide both the first month and the projected last month of ineligibility for institutional services under Medicaid.
The Medicaid caseworker will mail Exhibit 2 to the local Social Security office.
TO: State Medicaid Agency Date: _____________ _____________________
FM: Social Security Administration
SUBJECT: Transfer of Resources - PL 100-360
This memorandum provides information on a transfer of resources for less than the current market value on or after July 1, 1988, obtained by the Social Security Administration during an SSI (check one):
Initial Claim Redetermination
SOCIAL SECURITY NUMBER: _______________
Information Regarding Transfer (See Attached Photocopy of Question 27 from SSI Form SSA-8000-BK or printout of the RMEN and RGIV screens for a computer-generated SSI application)
Date of Transfer _______________
Description of Transferred Resource _________________________
Value of Transferred Resource $ ____________________________
Compensation (if any) Received or Expected $ ______________
Recipient or Purchaser of Resource _________________________
Relationship to Recipient/Purchaser ________________________
Co-owners (if any) of Resource at Time of Transfer _________
The current living arrangement for SSI purposes is (circle one):
A B C D
Name of Social Security Representative: _____________________