Purpose: To explain which resources are excluded when determining eligibility for SSI-Related Apple Health programs.
- To determine the fair market value of a vehicle, check the current value as listed in the Kelley Blue Book or N.A.D.A. for a vehicle condition "Good" unless you have evidence to support a different vehicle condition. The amount owed on the vehicle is subtracted from the value to determine the amount of equity the person has in the vehicle. The amount of the resource is the equity value.
- If the SSI-Related applicant qualifies for one or more vehicle exclusions, apply the exclusion(s) to the vehicles in the order of how much equity the applicant (or household members) have in the vehicles, starting with the greatest equity.
- Confirm that the vehicles listed in the application match the vehicles listed in SPIDER. If the individual declares that they no longer have a vehicle, direct them to the Department of Licensing to get the vehicle(s) removed from their files.
Remember to review the CSV for whole life policies at every review, because CSVs change all the time.
- The Individual needs to complete the HCA 14-539 (for a revocable fund) or the HCA 14-540 (for an irrevocable fund) Burial Fund Provision, to declare the amount of funds set aside for burial.
- Allow up to two months from the end of the application month to cash in or physically separate funds.
- The Individual’s statement is acceptable as verification for the planned use of the funds for burial when commingled with other counted funds.
- When completing the Irrevocable Burial Fund provision, which does not include funds for burial that are commingled with funds that are counted toward the resource limit, the individual or a tribal representative for the individual completes the form identified above.
Example: Laurie owns a life insurance policy on her husband with a face value of $1,500 and a cash surrender value (CSV) of $1,000. The CSV is excluded. The burial funds exclusion is reduced by the face value of this life insurance policy, so Laurie cannot set aside additional excluded funds toward his burial. Any other funds she sets aside for his burial will count against the resource limit.
Example: Jack is applying for medical assistance. He bought a life insurance policy on his own life with a face value of $10,000 and a CSV of $1,600. He did not want to designate the policy as burial funds. Since the CSV exceeds the $1,500 life insurance face value (FV) limit and is not designated as burial funds, the $1,600 is applied to the resource limit. Jack also has set aside a bank account of $1,200 for his burial. The $1,200 is excluded for his burial since the cash surrender value of the life insurance policy was not designated as burial funds.
Example: Jack (from Example Two), has the same life insurance policy and burial funds ($10,000 FV, $1,600 CSV, burial funds of $1,200). However, he states he wants to designate the life insurance policy as burial funds. He now can exclude $300 of the CSV from the life insurance policy as burial funds, but the other $1,300 is a countable resource. The $1,200 from his other burial funds were excluded previously and remain excluded. Jack has now reached his entire allowable $1,500 burial funds exclusion. He has $1,300 in countable resources and $1,500 in burial funds exclusions, if he has no other resources.
Example: Jack (from the previous 2 examples) owns the policies already mentioned and his wife owns a life insurance policy on his life with a face value of $100,000 and a CSV of $1,000. Jack’s wife is not applying for any benefits from Medicaid, but because her assets count, we must look at all resources of the couple. She may designate this life insurance policy for a burial funds set-aside, and the entire CSV is excluded. She may also have an additional $500 face value life insurance policy to be used for either life insurance or burial funds exclusion.
Example: Jill has a life insurance policy with a face value of $10,000 and a CSV of $500. She has $1,500 in a savings account set aside for her burial. She also has an irrevocable burial trust valued at $6,000. The irrevocable burial trust does not count as a resource in itself, but it reduces her remaining burial funds exclusion to zero, since it exceeds $1,500. This means the $500 in CSV from the life insurance policy counts toward the resource limit. The $1,500 in the savings account burial fund cannot be excluded as a resource because the $1,500 burial set-aside exclusion was used by the irrevocable burial trust. Jill has $2,000 in countable resources, assuming these accounts are the total resources she owns: $500 from CSV and $1,500 from her burial funds savings account.
Example: Derek recently bought two $50,000 whole life insurance policies on his wife, with a total current CSV of $500. He also owns a term insurance policy on himself, his wife and on each of his three children. The term insurance policies do not count toward the resource limits, since there is no possibility of accruing CSV. If the burial funds set-aside has not been used, Derek could designate the $500 CSV from the whole life policies toward that exclusion.
Example: John has a $2,000 CD. He states that $1,500 is set aside as burial funds and he also plans to use the remaining $500 for burial related expenses. The CD does not have to be cashed or physically separated, because all of the CD is designated for burial related expenses. Five hundred dollars of the CD are countable resources. If any of the funds from the CD were designated or used for anything other than burial related expenses, the entire CD would be countable as a resource and none of it could be excluded under the burial funds exclusion.
Example: Sarah has an irrevocable burial fund established for her to which the representative of her tribe has attested to by completing the appropriate form. Sarah has been an elder in the tribe for many years, and the ceremony of her life at its end will follow the traditions of her culture. At this time the fund includes $8,000, which will be used to help feed the many who will participate for several days. Blankets and other gifts may be offered to tribal elders and extended family members, according to the long-held traditions of her tribe.