DHS 103.06(1)(1)
Special situations of institutionalized persons. DHS 103.06(1)(a)
(a) In determining the eligibility of an institutionalized person, only the assets actually available to that person shall be considered.
DHS 103.06(1)(b)
(b) The homestead property of an institutionalized person is not counted as an asset if:
DHS 103.06(1)(b)1.
1. The institutionalized person's home is currently occupied by the institutionalized person's spouse or a dependent relative. In this subdivision,“dependent relative" means a son, daughter, grandson, granddaughter, stepson, stepdaughter, in-law, mother, father, stepmother, stepfather, grandmother, grandfather, aunt, uncle, sister, brother, stepbrother, stepsister, halfsister, halfbrother, niece, nephew or cousin who is financially, medically or otherwise dependent on the institutionalized person;
DHS 103.06(1)(b)2.
2. The institutionalized person intends to return to the home and the anticipated absence from the home, as verified by a physician, is less than 12 months; or
DHS 103.06(1)(b)3.
3. The anticipated absence of the institutionalized person from the home is for more than 12 months but there is a realistic expectation, as verified by a physician, that the person will return to the home. That expectation shall include a determination of the availability of home health care services which would enable the recipient to live at home.
DHS 103.06(1)(c)
(c) If none of the conditions under par.
(b) is met, the property is no longer the principal residence and becomes non-homestead property.
DHS 103.06(1)(d)
(d) When income that has been protected for institutionalized recipients accumulates to the point that the asset limit is exceeded, MA eligibility shall terminate. Eligibility may not be reinstated until the assets are below the limit at which time a new application shall be required.
DHS 103.06(1)(e)
(e) To maintain continuous MA eligibility the recipient may apply assets as a refund of MA benefits to the department. In no instance may refunds exceed benefits received.
DHS 103.06(2)(a)1.
1. “Motor vehicle" means a passenger car or other motor vehicle used to provide transportation of persons or goods and which is owned by a person in the MA or fiscal test group.
DHS 103.06(2)(a)2.
2. “Equity value" means the fair market value minus any encumbrances which are legal debts.
DHS 103.06(2)(a)3.
3. “Fair market value" means the wholesale value shown in a standard guide on motor vehicle values or the value as estimated by a reliable expert.
DHS 103.06(2)(b)
(b) For persons whose eligibility is being determined according to AFDC categorically needy financial standards, the following conditions shall apply:
DHS 103.06(2)(b)1.
1. If one vehicle is owned, up to $1,500 of equity value is exempt; and
DHS 103.06(2)(b)2.
2. If more than one vehicle is owned, up to $1,500 of equity value of the vehicle with the greatest equity value is exempt. The equity value of the vehicle with the greatest equity value in excess of $1,500 and the equity value of any other vehicle is counted as an asset.
DHS 103.06(2)(bm)
(bm) For persons whose eligibility is being determined according to AFDC medically needy financial standards, the following conditions shall apply:
DHS 103.06(2)(bm)1.
1. If one vehicle is owned, it is exempt from consideration as an asset regardless of value;
DHS 103.06(2)(bm)2.
2. If more than one vehicle is owned, a second vehicle is exempt from consideration as an asset if the agency determines that it is necessary for the purpose of employment or to obtain medical care; and
DHS 103.06(2)(bm)3.
3. The equity value of any nonexempt vehicle owned by the applicant is counted as an asset.
DHS 103.06(2)(c)
(c) For persons whose eligibility is being determined according to SSI categorically needy or medically needy financial standards, the following conditions shall apply:
DHS 103.06(2)(c)1.
1. If one vehicle is owned it is exempt if it meets one of the following conditions:
DHS 103.06(2)(c)1.b.
b. It is necessary for medical treatment of a specific or regular medical problem.
DHS 103.06(2)(c)1.c.
c. It is modified for operation or transportation of a person with a disability.
DHS 103.06(2)(c)1.d.
d. It is necessary because of climate, terrain, distance or similar factors to provide transportation to perform essential daily activities.
DHS 103.06(2)(c)2.
2. If no automobile is exempt under subd.
1., one automobile is not counted as an asset to the extent that its current fair market value does not exceed $4,500. Fair market value in excess of $4,500 counts toward the asset limit.
DHS 103.06(2)(c)3.
3. If more than one vehicle is owned, the equity value of the nonexempt vehicle is counted as an asset.
DHS 103.06(3)(a)
(a) Joint accounts. A joint account shall be deemed available to each person whose name is on the account or listed as an owner. The value of a joint savings or checking account shall be determined as follows in determining eligibility for MA:
DHS 103.06(3)(a)1.
1. For persons who receive MA who are not age 65 or over, or not blind or disabled, the division of a joint account shall be determined according to applicable federal law; and
DHS 103.06(3)(a)2.
2. For persons who receive MA who are age 65 or over or who are blind or disabled, joint accounts shall be divided as follows:
DHS 103.06(3)(a)2.a.
a. If both owners of the joint account receive MA, equal shares of the joint account shall be included for the purpose of determining MA eligibility; and
DHS 103.06(3)(a)2.b.
b. If only one owner of the joint account receives MA, the full amount of the joint account shall be included for the purpose of determining MA eligibility.
DHS 103.06(3)(b)
(b) Jointly held property. If the applicant or recipient is a joint owner of property with a person who refuses to sell the property and who is not a legally responsible relative of the applicant or recipient, the property shall not be considered available to the applicant or recipient and may not be counted as an asset. If the property is available to the applicant or recipient, it shall be divided equally between the joint owners.
DHS 103.06(4)(a)(a) A home owned and lived in by an applicant or recipient is an exempt asset.
DHS 103.06(4)(b)
(b) Net proceeds from the sale of homestead property shall be treated as assets as follows:
DHS 103.06(4)(b)1.
1. For AFDC-related MA the proceeds are considered available assets in the month of receipt and, if retained, in any of the following months; and
DHS 103.06(4)(b)2.
2. For SSI-related MA the proceeds are disregarded if they are placed in an escrow account and used to purchase another home within 3 months. After 3 months the proceeds are considered available.
DHS 103.06(5)(a)(a) If the equity value of the non-homestead property together with all other assets does not exceed the asset limit, the person may retain the property and be eligible for MA.
DHS 103.06(5)(b)
(b) If the value of non-homestead property together with the value of the other assets exceeds the asset limit, the non-homestead property need not be counted as an asset if it produces a reasonable amount of income. In this paragraph, “reasonable amount of income"means a fair return considering the value and marketability of the property.
DHS 103.06(5)(c)
(c) If the total value of non-homestead property and non-exempt assets exceeds the asset limit, the person who owns the non-homestead property shall list the property for sale with a licensed realtor at a price which the realtor certifies as appropriate. If the property is listed for sale, it may not be counted as an asset. When the property is sold, the net proceeds shall be counted as an asset.
DHS 103.06(6)
(6)
Life estate. The applicant or recipient may hold a life estate without affecting eligibility for MA. If the property or the life estate is sold, any proceeds received by the applicant or recipient shall be considered assets. In this subsection, “life estate" means a claim or interest a person has in a homestead or other property, the duration of the interest being limited to the life of the party holding it with that party being entitled to the use of the property including the income from the property in his or her lifetime.
DHS 103.06(7)(a)(a) Trust funds shall be considered available assets, except that:
DHS 103.06(7)(a)1.
1. Trust funds payable to a beneficiary only upon order of a court shall not be considered available assets if the trustee or other person interested in the trust first applied to the court for an order allowing use of part or all of the trust fund to meet the needs of the beneficiary and the court denied such application;
DHS 103.06(7)(a)2.
2. Trust funds held in a trust which meets the requirements of ss.
701.0501 and
701.0502, Stats., shall not be considered available assets unless the settlor is legally obligated to support the beneficiary;
DHS 103.06(7)(a)3.
3. For SSI-related MA applicants and recipients, the pertinent SSI standards on the treatment of trusts as resources shall apply; and
DHS 103.06(7)(a)4.
4. For AFDC-related applicants and recipients, the pertinent AFDC standards on the treatment of trusts as resources shall apply.
DHS 103.06(8)
(8)
Personal property. Household and personal effects of reasonable value, considering the number of members in the fiscal test group, shall be exempt.
DHS 103.06(9)
(9)
Loans. Money received on loan shall be exempt unless it is available for current living expenses, in which case the money shall be treated as an asset even if a repayment schedule exists.
DHS 103.06(10)
(10)
Life insurance policies. The cash value of a life insurance policy shall be considered an asset, except that for SSI-related persons it is an asset only when the total face value of all policies owned by the person exceeds $1,500. In this subsection, “cash value" means the net amount of cash for which the policy could be surrendered after deducting any loans or liens against it, and“face value" means the dollar amount of the policy which is payable on death.
DHS 103.06(11)
(11)
Lump sum payments. All lump sum payments, unless specifically exempted by federal statute or regulation, shall be treated as assets instead of income. In this subsection, “lump sum payment"means a nonrecurring payment such as retroactive social security benefits, income tax refunds, and retroactive unemployment benefits.
DHS 103.06(12)
(12)
Work-related items. Work-related items essential to the employment or self-employment of a household member, except motor vehicles, are exempt from being counted as assets. For business or farm operations, internal revenue service (IRS) returns shall be used to determine whether or not the operation is profitable or moving toward becoming profitable. If the operation is not profitable or becoming profitable, all assets related to the operation shall be counted in the determination of eligibility.
DHS 103.06(13)
(13)
Special exempt assets for blind or disabled persons. The following assets shall be exempted in determining the eligibility of blind or disabled persons:
DHS 103.06(13)(a)
(a) Assets essential to the continuing operation of the person's trade or business;
DHS 103.06(13)(c)
(c) Funds conserved for a departmentally approved plan for self-support of a blind or disabled person. The conserved funds shall be segregated from other funds. Interest earned on conserved funds is exempt so long as the conserved funds do not exceed the provision of the approved plan.
DHS 103.06(14)(a)(a) The applicant or recipient shall obtain a written estimate of the fair market value of a land contract from a source active in the market for land contracts in Wisconsin.
DHS 103.06(14)(b)
(b) If the applicant's or recipient's vendor interest in a land contract exceeds the medically needy asset limit under s.
49.47 (4) (b), Stats., the applicant or recipient shall offer the land contract for sale. The applicant's or recipient's vendor interest in a land contract shall be counted as an available asset unless he or she provides written documentation from a source active in the market for land contracts in Wisconsin proving that his or her interest in the land contract cannot be sold.
DHS 103.06(15)(a)1.1. Contributions to any of the recipient's registered independence accounts are subject to the rules described in this section and to any policies of the respective financial institution governing the account.
DHS 103.06(15)(a)2.
2. All contributions to the recipient's independence account or accounts, including interest, dividends, or other gains from the principal, shall be treated as an exempt asset for the purpose of calculating eligibility for any SSI-related MA.
DHS 103.06(15)(a)3.
3. The purpose of an independence account is to allow the recipient to purchase any items or services that may aid in his or her pursuit of personal or financial independence.
DHS 103.06(15)(a)4.
4. The medicaid purchase plan recipient shall be the sole owner of any account registered as an independence account.
DHS 103.06(15)(a)5.
5. Retirement or pension accounts registered as independence accounts are not required to remain as separate holdings from the recipient's other non-exempt retirement or pension assets.
DHS 103.06(15)(a)6.
6. The county agency shall monitor the recipient's independence account as described in the medicaid review period for the medicaid purchase plan. The review process shall include verifying all contributions to the recipient's independence account with the financial institution holding the recipient's account.
DHS 103.06(15)(a)7.
7. The sum total a medical assistance recipient deposits in all independence accounts may not exceed an amount equal to 50% of the recipient's gross earned income for the medicaid review period. If a recipient's contributions to his or her independence accounts total more than an amount equal to 50% of his or her gross earned income within the medicaid review period, an amount equal to one-twelfth of the contributions greater than an amount equal to 50% of gross earned income shall be added to the recipient's monthly premium payment under s.
DHS 103.087 for the next 12 months of eligibility.
DHS 103.06(15)(b)1.
1. A person shall register each independence account with the county agency. A person shall re-register the independence account with the county agency if the financial institution or other information for the independence account changes.
DHS 103.06(15)(b)2.
2. A medicaid purchase plan recipient shall complete an account registration form to register the account as an independence account.
DHS 103.06(15)(b)3.
3. The applicant or recipient shall report any changes in personal or financial status that may affect his or her eligibility for medical assistance to the county agency as described in s.
DHS 104.02 (6).
DHS 103.06(15)(b)4.
4. For all registered independence accounts that are not retirement or pension accounts, the date of account creation may be no earlier than the date a medicaid purchase plan recipient is determined eligible for medical assistance under this section. For all registered independence accounts that are not retirement or pension accounts, the funds in the independence account shall be held separate from a recipient's non-exempt assets.
DHS 103.06 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; am. (1) (d), r. and recr. (1) (e),
Register, January, 1987, No. 373, eff. 2-1-87; am. (6), cr. (14),
Register, July, 1989, No. 403, eff. 8-1-89; am. (2) (b), cr. (2) (bm), r. and recr. (2) (c),
Register, December, 1990, No. 420, eff. 1-1-91; am. (1) (b) 1., r. and recr. (4) (b),
Register, March, 1993, No. 447, eff. 4-1-93; cr. (15),
Register, November, 2000, No. 539, eff. 12-1-00; correction in (15) (b) 3. made under s.
13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636; correction in (7) (a) 2. made under s.
13.92 (4) (b) 7., Stats.,
Register June 2017 No. 738;
CR 20-068: am. (2) (c) 1. a. to c.
Register December 2021 No. 792, eff. 1-1-22;
CR 23-046: am. (15) (a) 2. Register April 2024 No. 820, eff. 5-1-24.
DHS 103.063
DHS 103.063 Divestment prior to August 9, 1989. DHS 103.063(1)(1)
Applicability. This section applies to all applicants for MA and recipients of MA who disposed of a resource at less than fair market value prior to August 9, 1989 and to all inter-spousal transfers occurring before October 1, 1989. Section
DHS 103.065 applies to all institutionalized applicants and recipients who divest on or after August 9, 1989, except for inter-spousal transfers occurring before October 1, 1989.
DHS 103.063(1m)
(1m)
Purpose. This section implements s.
49.45 (17), 1987 Stats., which makes an applicant for or recipient of MA ineligible when the applicant or recipient disposed of a resource at less than fair market value within 2 years before or at any time after his or her most recent application for MA or any review of eligibility for MA.
Section 49.45 (17) (d), 1987 Stats., is specifically concerned with an applicant for or recipient of MA who resides as an inpatient in a skilled nursing facility (SNF), intermediate care facility (ICF) or inpatient psychiatric facility and who disposed of homestead property at any time during or after the 2 year period prior to the date of the most recent application or any review of eligibility.
DHS 103.063(2)(a)
(a) Amount of divestment. For any person who disposed of a resource, except a homestead or other exempt resource, at less than fair market value within 2 years before or at any time after his or her most recent application for MA, or any review of eligibility, the agency shall determine the amount of the divestment in the following manner:
DHS 103.063(2)(a)1.
1. If the compensation received is less than net market value, the difference between the compensation received and the net market value is the divested amount and shall be considered an asset.
DHS 103.063(2)(a)2.
2. If the divested amount plus other nonexempt assets are equal to or less than the appropriate assets limit, the divestment shall not be considered a bar to eligibility.
DHS 103.063(2)(a)3.
3. If the divested amount plus the other nonexempt assets are greater than the appropriate assets limit, the excess over this limit shall be the amount of divestment to be expended for maintenance needs and medical care.
