Section 144-336-8 - ESTABLISHING A PENALTYOnce it has been established that a transfer of assets for less than Fair Market Value occurred within the look back period, the penalty period must be determined.
Any penalty imposed under this Chapter will apply only to State-Funded Assistance. No penalty under this Chapter will be applied to other state services or Medicaid services for which the individual qualifies.
There are three different methods of calculating the penalty period as follows.
I. If there has been only one transfer during the look back period: A. Determine the date that each transfer occurred.B. Determine the amount of the transfer.C. Divide the amount of the transfer by the average monthly private rate for a semi-private room for a nursing facility at the time of application (see Chapter 332, Charts, Chart 4.3). This determines the number of whole months of ineligibility based on the transfer.D. When the value of the transfer is less than the average monthly private rate for a semi-private room for a nursing facility in (see Chapter 332, Charts, Chart 4.3), or the penalty calculation includes a partial month, the partial month shall be counted and implemented as a period of ineligibility using the following method: 1. After determining the amount of transfer and dividing that amount by the average monthly private rate for a semiprivate room for a nursing facility, impose a period of ineligibility for the whole months.2. Convert the remaining partial month into a dollar amount by multiplying the number of whole months by the monthly private rate used in the calculation above, and subtracting that figure from the total amount of the transfer.3. This remainder is added to the cost of care for the first month of eligibility after imposing the penalty period. Example:
If the monthly private rate is $6,000 and the transfer amount is $56,400, this would result in a transfer penalty of 9.4 months. To determine the remainder amount, you would take $6,000 X 9 months = $54,000. $56,400 - $54,000 = $2,400. You would add $2,400 to the cost of care for one month. If the penalty period begins March 1st, it would end November 30th. $2,400 would be added to the cost of care for December.
In an instance where the penalty period is less than a full month, the partial month penalty will be added to the cost of care in the first month a cost of care is due.
Example:
The individual enters a Residential Care Facility on November 27th. There is a partial month transfer penalty of $3000. A cost of care will be due beginning with the month of December. The $3000 partial month transfer penalty will be added to the December cost of care.
II. If there has been more than one transfer in the same month, the penalty period is determined as follows: A. Determine the total, cumulative, value of all transfers in the same month.B. Divide the amount by the average monthly private rate for a semiprivate room for a nursing facility at the time of application (see Chapter 332, Charts, Chart 4.3). This determines the number of whole months of ineligibility.C. When the value of the transfer is less than the average monthly private rate for a semi-private room for a nursing facility (see Chapter 332, Charts, Chart 4.3), or the penalty calculation includes a partial month, the partial month shall be counted and implemented as a period of ineligibility using the following method:1. After determining the amount of transfer and dividing that amount by the average monthly private rate for a semiprivate room for a nursing facility, impose a period of ineligibility for the whole months.2. Convert the remaining partial month into a dollar amount by multiplying the number of whole months by the monthly private rate used in the calculation above, and subtracting that figure from the total amount of the transfer.3. This remainder is added to the cost of care for the first month of eligibility after imposing the penalty period. In an instance where the penalty period is less than a full month the partial month penalty will be added to the cost of care in the first month a cost of care is due.III. If there have been multiple transfers in more than one month during the look-back period, all transfers can be added together into one penalty period using the following method: A. Add all transfer amounts together.B. Divide the amount by the average monthly private rate at the time of application for a semiprivate rate for a nursing facility (see Chapter 332, Charts, Chart 4.3). This determines the number of whole months of ineligibility.C. The transfer is treated as one transfer and is treated as if it occurred on the earliest date of the multiple transfers.D. When the value of the transfer is less than the average monthly private rate for a semi-private room for a nursing facility (see Chapter 332, Charts, Chart 4.3), or the penalty calculation includes a partial month, the partial month shall be counted and implemented as a period of ineligibility using the following method: 1. After determining the amount of transfer and dividing that amount by the average monthly private rate for a semiprivate room for a nursing facility, impose a period of ineligibility for the whole months.2. Convert the remaining partial month into a dollar amount by multiplying the number of whole months by the monthly private rate used in the calculation above, and subtracting that figure from the total amount of the transfer.3. This remainder is added to the cost of care for the first month of eligibility after imposing the penalty period. In an instance where the penalty period is less than a full month the partial month penalty will be added to the cost of care in the first month a cost of care is due.IV. The penalty period for transfers begins with the later of: A. the first day of a month in which the transfer for less than Fair Market Value occurred;B. the first day of the month the individual is eligible for Medicaid and would otherwise be receiving State-Funded Assistance based on an approved MaineCare application were it not for the Department imposing an asset transfer penalty period; orC. the first day which does not occur during any other period of ineligibility.V. In the case of a married couple which is assessed a penalty at the time both spouses reside in a Residential Care Facility, Cost Reimbursed Boarding Home, or Adult Family Care Home and have applied for and are otherwise eligible for State-Funded Assistance, and there is a penalty period in effect for either spouse, the remaining penalty period can be divided between the spouses into any combination of full months. Whether there is a division of the penalty and, if so, how it will be divided, is a decision of the spouses. When, for some reason, one spouse is no longer subject to a penalty (for example, no longer lives in a Residential Care Facility or dies), the remaining period applicable to both spouses must be served by the remaining spouse.
10- 144 C.M.R. ch. 336, § 8