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.
DHS 103.063(2)(b)1.1. Divestment by any person within 2 years before or at any time after his or her most recent application for MA or any review of eligibility shall, unless shown to the contrary, be presumed to have been made in contemplation of receiving MA. Divestment bars eligibility for MA except as provided in subds.
2. and
3. and par.
(c).
DHS 103.063(2)(b)2.
2. To rebut the presumption that divestment was made in contemplation of seeking aid, the applicant shall furnish convincing evidence to establish that the transaction was exclusively for some other purpose. For example, the applicant may rebut the presumption that the divestment was done in contemplation of receiving aid by showing by convincing evidence that at the time of divesting the applicant had provided for future maintenance needs and medical care.
DHS 103.063(2)(b)3.
3. Divestment shall only be considered a barrier to eligibility when the net market value of all the resources disposed of exceeds the medically needy asset levels in s.
49.47 (4) (b) 3., Stats.
DHS 103.063(2)(b)4.
4. Division of resources as part of a divorce or separation action, the loss of a resource due to foreclosure or the repossession of a resource due to failure to meet payments is not divestment.
DHS 103.063(2)(c)1.1. Divestment is no longer a barrier to MA eligibility for persons who are determined to have divested non-homestead property:
DHS 103.063(2)(c)1.a.
a. If the divested amount is $12,000 or less, when the sum of the divestment has been expended for maintenance needs and medical care of the applicant or recipient or when 2 years have elapsed since the date of divestment, whichever occurs first; or,
DHS 103.063(2)(c)1.b.
b. If the divested amount exceeds $12,000, when the entire sum of the divestment has been expended for maintenance needs and medical care of the applicant or recipient.
DHS 103.063(2)(c)2.
2. The amount expended for maintenance needs and medical care of the applicant or recipient shall be calculated monthly, as follows:
DHS 103.063(2)(c)2.a.
a. For a non-institutionalized person, the expended amount is the medical care expenses for the person plus the appropriate medically needy income limit for either AFDC or SSI, depending upon which program the person would be eligible for under MA, were it not for the divestment; and
DHS 103.063(2)(c)2.b.
b. For a person institutionalized in a SNF, ICF or inpatient psychiatric facility, the expended amount is the total cost of the institutional care.
DHS 103.063(3)(a)
(a) Applicability. Divestment by any person of his or her homestead property is a barrier to eligibility only if he or she is a resident of an SNF, ICF or inpatient psychiatric facility.
DHS 103.063(3)(b)
(b) Amount of divestment. A person who is a resident of an SNF, ICF or inpatient psychiatric facility who disposed of his or her homestead for less than fair market value on or after July 2, 1983, but within 2 years before or at any time after his or her most recent application for MA or any review of his or her eligibility for MA, shall have the amount of divestment determined in the same manner as in sub.
(2) (a).
DHS 103.063(3)(c)1.1. Divestment of a homestead by any person residing as an inpatient in an SNF, ICF or inpatient psychiatric facility within 2 years prior to the date of his or her most recent application for MA or any review of his or her eligibility for MA, shall, unless shown to the contrary, be presumed to have been made in contemplation of receiving MA. Divestment bars eligibility for MA except as provided in subds.
2. and
3. and par.
(d).
DHS 103.063(3)(c)2.
2. To rebut the presumption that divestment was made in contemplation of receiving aid, the applicant shall furnish convincing evidence to establish that the transaction was exclusively for some other purpose. For example, the applicant may rebut the presumption that the divestment was done in contemplation of receiving aid by showing by convincing evidence that, at the time of divesting, the applicant had provided for his or her future maintenance needs and medical care.
DHS 103.063(3)(c)3.
3. Divestment shall only be considered a barrier to eligibility when the net market value of all the resources disposed of exceeds the medically needy asset levels in s.
49.47 (4) (b) 3., Stats.
DHS 103.063(3)(c)4.
4. Divestment does not occur in cases of division of resources as part of a divorce or separation action, the loss of a resource due to foreclosure or the repossession of a resource due to failure to meet payments.
DHS 103.063(3)(d)1.1. Divestment of a homestead is no longer a barrier to eligibility for institutionalized persons:
DHS 103.063(3)(d)1.a.
a. If the amount of divestment to be expended for maintenance needs and medical care is less than the average MA expenditures for 24 months of care in an SNF, when the entire amount of the divestment is expended for this care, or 2 years has elapsed since the date of the divestment, whichever occurs first; or
DHS 103.063(3)(d)1.b.
b. If the amount of divestment to be expended for maintenance needs and medical care is greater than the average MA expenditure for 24 months of care in an SNF, when the entire amount of the divestment has been expended.
DHS 103.063(3)(d)2.
2. Expended amounts shall be determined, as long as the person is institutionalized, by using the average monthly MA expenditure, statewide, for care provided in an SNF.
DHS 103.063(3)(d)3.
3. An individual who is an inpatient in a SNF, ICF or inpatient psychiatric facility who has been determined to have divested a homestead, may be found eligible if:
DHS 103.063(3)(d)3.a.
a. It is shown to the satisfaction of the department that the individual can reasonably be expected to be discharged from the medical institution and return to that homestead;
DHS 103.063(3)(d)3.b.
b. The title to the homestead was transferred to the individual's spouse or child who is under age 21 or is blind or totally and permanently disabled according to a determination made by the department's bureau of social security disability insurance;
DHS 103.063(3)(d)3.c.
c. It is shown to the satisfaction of the department that the individual intended to dispose of the homestead either at fair market value or for other valuable consideration; or
DHS 103.063(3)(d)3.d.
d. It is determined by the department that the denial of eligibility would work undue hardship on the individual.
DHS 103.063 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; renum. from HSS 103.02 and am., cr. (1),
Register, April, 1990, No. 412, eff. 5-1-90.
DHS 103.065
DHS 103.065 Divestment on or after August 9, 1989. DHS 103.065(1)(1)
Applicability. This section applies to all institutionalized applicants for and recipients of MA who dispose of resources at less than fair market value on or after August 9, 1989, except for inter-spousal transfers occurring before October 1, 1989, and to all institutionalized applicants for and recipients of MA whose spouse disposes of resources at less than fair market value on or after July 1, 1990. Section
DHS 103.063 applies to all applicants and recipients who divested before August 9, 1989 and to inter-spousal transfers occurring before October 1, 1989.
DHS 103.065(2)
(2)
Purpose. This section implements s.
49.453, Stats., which provides for a period of restricted MA coverage when an individual who is institutionalized or becomes institutionalized, or the individual's spouse, disposes of resources at less than fair market value.
DHS 103.065(3)(a)
(a) “Annuity" means a written contract under which, in return for payment of a premium or premiums, an individual or individuals have the right to receive fixed, periodic payments for life or up to a fixed point in time.
DHS 103.065(3)(b)
(b) “Community spouse" means a person who is legally married as recognized under state law to an institutionalized individual but is not himself or herself an institutionalized individual.
DHS 103.065(3)(c)
(c) “Expected value of the benefit" means the amount that an irrevocable annuity will pay to a primary annuitant or to joint annuitants during his or her expected lifetime.
DHS 103.065(3)(d)
(d) “Institutionalized individual" means an applicant or recipient who is an inpatient in an SNF or ICF, an inpatient in a medical institution and with respect to whom payment is made based on a level of care provided in an SNF or ICF, or receiving home and community-based care MA services under ss.
49.46 and
49.47, Stats.
DHS 103.065(3)(e)
(e) “Joint annuitants" means the institutionalized individual and his or her spouse named as the payees under an annuity.
DHS 103.065(3)(f)
(f) “Medical assistance" or “MA" means payment for services provided to a resident of an SNF or ICF under s.
DHS 107.09 (2) and
(4) (a), payment to a medical institution as defined under
42 CFR 435.1009 for care based on a level of care provided in an SNF or ICF, or payment for services provided under a home and community-based care waiver program authorized under
42 USC 1396n (c).
DHS 103.065(3)(g)
(g) “Medical assistance card services" means the services covered under ch.
DHS 107, except for services reimbursed as institutional care, as defined by s.
DHS 107.09 (2) and
(4) (a), services received in an SNF or ICF or a medical institution and services reimbursed under a home and community-based care waiver program authorized under
42 USC 1396n (c).
DHS 103.065(3)(h)
(h) “MA eligibility handbook" means the medical assistance program handbook issued by the department's division of economic support for use by agencies in determining eligibility for MA.
DHS 103.065(3)(i)
(i) “Primary annuitant" means the first individual, which may be either the institutionalized individual or his or her spouse, to receive payment from an annuity.
DHS 103.065(4)(a)(a) Divestment resulting in ineligibility. An institutionalized individual or someone acting on behalf of that individual who disposes of resources at less than fair market value within 30 months immediately before or at any time after the individual becomes institutionalized if the individual is receiving MA on the date he or she becomes institutionalized or, if the individual is not receiving MA on that date, within 30 months immediately before or at any time after the date the individual applies for MA while institutionalized, shall be determined to have divested. A divestment results in ineligibility for MA for the institutionalized individual unless made to an exempt party under par.
(b) or
(c) or when one of the circumstances in par.
(d) exist. An institutionalized individual may also be determined ineligible for MA if his or her spouse disposes of resources at less than fair market value on or after July 1, 1990. In this paragraph, “receiving" means entitled to receive as well as actually receiving, in the same way that “recipient" as defined in s.
DHS 101.03 (150) means a person who is entitled to receive benefits under MA as defined under s.
DHS 101.03 (95).
DHS 103.065 Note
Note: The department advises that when the transfer for less than fair market value has been made by the spouse of the institutionalized applicant or recipient, the determination of whether or not the transfer will be treated as a divestment will be made pursuant to both the divestment provisions under s.
49.453, Stats., and the spousal impoverishment prevention provisions under s.
49.455, Stats.
DHS 103.065(4)(am)
(am) Transfer of resources within same month. In determining the amount of the divestment to be satisfied, the agency shall consider all transfers by either the institutionalized individual or his or her community spouse at less than fair market value that occur within a calendar month as one divestment.
DHS 103.065(4)(at)
(at) Transfer of resources to an irrevocable annuity on or after October 1, 1993. DHS 103.065(4)(at)1.1. Whenever an institutionalized individual or his or her spouse, or another person acting on behalf of the institutionalized individual or his or her spouse, transfers funds on or after October 1, 1993, to an irrevocable annuity in an amount that exceeds the expected value of the benefit, the institutionalized individual or his or her spouse shall be determined to have divested.
DHS 103.065(4)(at)2.a.
a. Determining the life expectancy of the primary annuitant or joint annuitants using the life expectancy tables included in the MA eligibility handbook. Table I shows the age at which the male or female institutionalized individual chose the settlement option for annuitization, life expectancy for an individual of that age, and estimated remaining years of life based on the age at which the institutionalized individual chose the settlement option. Table II shows the ages at which both the male and female joint annuitants chose the settlement option for annuitization, life expectancy for each individual of that individual's age, and estimated remaining years of life based on the ages at which the joint annuitants chose this settlement option; and
DHS 103.065(4)(at)2.b.
b. Adding together the amount of all the payments from the irrevocable annuity scheduled to be made after the month in which the primary annuitant's age or joint annuitants' ages exceed the estimated remaining years of life. The divested amount is the sum of all the payments to be made from the irrevocable annuity after the month in which the primary annuitant's age or joint annuitants' ages exceed the estimated remaining years of life.
DHS 103.065 Note
Note: For a copy of the life expectancy tables included in the MA eligibility handbook, write the Bureau of Health Information Policy, Division of Public Health, P.O. Box 2659, Madison, WI 53701-2659.
DHS 103.065(4)(at)3.
3. If the agency receives a physician's statement which states that the primary annuitant or joint annuitant had a diagnosed medical condition which would shorten his or her life expectancy and that the medical condition was diagnosed before the institutionalized individual, his or her spouse, or someone acting on behalf of the institutionalized individual or his or her spouse transferred funds to an irrevocable annuity, the agency shall determine the expected value of the benefits based upon the physician's statement instead of using a life expectancy table as provided under subd.
2.
