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GA Program Manual

E. Financial Requirements

Effective 7/1/16

Program reinstated effective July 1, 2016.

1. Overview of Assets

To determine eligibility, find out what assets the individual has. Assets can be earned/unearned income or resources. Determine if the asset is available, unavailable, or excluded. Count only available assets for the budget month. Do not count unavailable and excluded assets.

If an asset is counted as income, it is not counted as a resource in the same budget month. If any of the income counted in the budget month is unspent the following month, count it as a resource.

For information on the availability and value of assets, see Counting Client Assets A.

461-140-0010

2. Payment Standard

The payment standard for a individual living in the community is $314 for a one-person benefit group and $628 for a two-person benefit group.

The payment standard for a client living in a community-based care setting is $297 for room and board, plus $40 personal allowance for clothing and personal incidentals.

For individuals in a nursing facility, intermediate care facility for the mentally retarded, psychiatric training center, or an acute hospital for greater than 30 days, the payment standard is $30 for clothing and personal incidentals.

Ongoing special needs are used to determine benefit amount as specified in 461-160-0500.

Use of payment standard to establish need: 461-155-0010
Payment standard: 461-155-0210

3. Use of Income

A financial group's countable and adjusted income (see 461-140-0010 and 461-160-0020) are used to determine eligibility and benefit as follows:

• If the financial group's countable income equals or exceeds the payment standard for the need group, the need group is ineligible. If the countable income is less than the standard, the need group meets the income standard.
• The benefit amount is determined by subtracting the financial group's adjusted
  income from the sum of the payment standard for the need group and its ongoing special needs.
• The benefit cannot exceed the sum of the payment standard for the benefit group plus the ongoing special needs.

461-160-0500

Income Deductions

Clients who live in the community. The following deductions are used to determine the adjusted income for clients that live in the community AND do not receive waivered services. Deductions from the financial group's income are made in the following order:

• One standard deduction of $20.
• One standard earned income deduction of:
  • $65 for clients who are not blind; or
  • $85 for clients who are blind.
  • One half of the remaining earned income.

461-160-0550

Clients who receive waivered services or nursing facility care. Allow one standard earned income deduction of $85 for clients who are blind or $65 for clients who are not blind.

4. Lump-Sum Income

Income received too infrequently or irregularly to be reasonably anticipated, or received as a one-time payment, is called lump-sum income. This includes, but is not limited to:

• Retroactive benefits covering more than one month, whether received in a single payment or several payments.
• Income from inheritance, gifts, winnings and personal injury claims.

Income that can be received in a lump-sum is considered lump-sum income even when the individual chooses to receive it in monthly installments.

461-140-0100

5. Periodic Income

Income received on a regular basis (but not monthly) such as quarterly, semi-annually, annually or as a contract employee is called periodic income. Count periodic income as income in the month received. Depending on the source, count it either as earned or unearned income (unless excluded).

Determining: 461-140-0100
Periodic Income: 461-140-0110

6. Prorating Initial Month Cash Benefits

Benefits are normally issued for the entire month. If it is determined that the individual was eligible for a portion of the initial eligibility month, prorate the benefits by:

• Determining the number of days in the initial benefit month.
• Divide a full month’s benefit by the number of days in that month.
• Multiply that amount by the number of days that the individual was eligible for benefits.

For the calculating prorated benefits chart see SPD Worker Guide F.7.

7. Resource Limits

The resource limit is $2000 for individuals and $3000 for couples.

461-160-0015

8. Resource Transfer; General Information

The financial group members who transfer a resource must do all the following in order to be eligible for benefits:

• Report any transfer of resources for all members of the financial group at application, redetermination and when the transfer occurs.
• Provide documentation of the terms of the sale or disposal of the resources.
• Provide evidence that the transfer was not disqualifying.

A transfer of a resource may be disqualifying if it occurs:

• On or after the date that is 60 months prior to the date of application—for assets that are transferred without compensation equal to or greater than fair market value from a revocable trust established on or after October 1, 1993 (see 461-145-0540(8)(c)).
• On or after the date that is 60 months prior to the date of application—for assets that are transferred without compensation equal to or greater than fair market value to an irrevocable trust established on or after October 1, 1993 (see OAR 461-145-0540(9)(a)).
• On or after the date that is 60 months prior to the date of application—when there is a change in circumstances that makes assets in an irrevocable trust established on or after October 1, 1993 unavailable to the client (see OAR 461-145-0540(9)(d)).
• On or after the date that is 36 months prior to the date of application—for assets transferred without compensation equal to or greater than fair market value from an irrevocable trust established on or after October 1, 1993 (see OAR 461-145-0540(9)(b) and (c)).
• On or after the date that is 36 months prior to the date of application—for other asset transfers made on or after October 1, 1993, without compensation equal to or greater than fair market value.

The client may be required to present collateral evidence to corroborate the client’s contention that a transfer was not made for the purpose of establishing eligibility for benefits.

461-140-0210

9. Transfer of Resources; Overview

A transfer of a resource is not disqualifying if:

• The transferred item was an excluded resource or personal property, such as jewelry or furniture, and the financial group resource total was less than allowable limits at the time of the transfer.
• The resource was sold or traded for compensation equal to or greater than fair market value.
• The resource was transferred between members of the same financial group, including members who are ineligible aliens or disqualified people.
• The transfer settled a legally enforceable claim against the resource of the client.
• A court ordered the transfer and:
  • The transfer occurs more than 36 months or 60 months before the date of application, whichever is applicable under 461-140-0210(3)(c); or
  • There is an institutionalized spouse who began a continuous period of care on or after October 1, 1989 and - after performing the calculations required in OAR 461-160-0580(1) - the amount of resources allocated to a community spouse does not exceed the largest of the four amounts set forth in OAR 461-160-0580(1)(f).
• The client was a victim of fraud, misrepresentation, or coercion and legal steps have been taken to recover the resource.
• The resource is an annuitized annuity for the benefit of the client or the client’s spouse where the entire amount of principal and earned interest is paid over the life expectancy or less (of the person receiving monthly payments).

461-140-0220

10. Disqualifying Transfer of Resources

The transfer of resources (including a home) by a client or the client’s community spouse on or after October 1, 1993, is not a disqualifying transfer if there is convincing evidence that the resource was transferred as described below or that the title was transferred:

• To the person’s spouse or to another for the sole benefit of the client’s spouse
• To a trust described in rule 461-145-0540 (10)
• To or for the sole benefit of the client's child who is blind or disabled under the disability criteria of SSA.

Additionally, the transfer of a home after October 1, 1993, is not a disqualifying transfer if there is convincing evidence that the title was transferred to the person’s:

• Child is under age 21;
• Sibling who has equity interest in the home and was residing in the home for at least one year immediately before the client’s admission to long term care
• Son or daughter who resided with the client for at least two years immediately prior to the client’s admission to long-term care and provided care that permitted the client to reside at home rather than in an institution or long-term care facility. A son or daughter provides the care required by this subsection by doing most of the following for the client, without receiving payment from the Department, on a regular basis:
  • Prepares meals
  • Shops for food and clothing
  • Helps maintain the home
  • Assists with financial affairs
  • Runs errands
  • Provides transportation
  • Provides personal services
  • Arranges for medical appointments
  • Assists with medication

The transfer of resources (including a home) by a client or the client's community spouse on or after April 1, 1995, is a disqualifying transfer unless:

• The transfer was made exclusively for purposes other than establishing eligibility or maintaining benefits;
• The title to such resources was transferred to the person's spouse or child who is blind or disabled under the disability criteria of the SSA, or to another for the sole benefit of the spouse, blind or disabled child; provided the transfer is arranged in such a way that no individual or entity except the spouse, blind or disabled child can benefit from the resources transferred in any way, whether at the time of transfer or any time in the future. A direct transfer, transfer instrument or trust that provides for funds or property to pass to a beneficiary who is not the spouse, blind or disabled child is not considered to be established for the benefit of one of those individuals. In order for a transfer or a trust to be considered for the sole benefit of one of these individuals, the instrument or document must provide for the spending of the funds involved for the benefit of the individual on a basis which is based on the life expectancy of the individual. When this condition is not present, a transfer penalty will be imposed (this does not apply to a resource transferred to a trust);
• The transfer is a transfer described in 461-160-0580(2); or
• The community spouse transfers a resource that was the subject of the community spouse's resource allowance calculated in accordance with 461-160-0580. Notwithstanding this subsection, a transfer of a resource by a community spouse who is receiving or applying for benefits remains subject to all rules regarding the transfer of resources by a client.

A transfer described above made for less than fair market value is presumed to be for the purpose of establishing or maintaining eligibility. To rebut the presumption, the client must use evidence other than his or her own statement. To meet the burden, it is sufficient for the client to show that:

• The decision to make the transfer was not within the client's control;
• At the time of transfer, the client could not reasonably have anticipated applying for medical assistance;
• Unexpected loss of resources or income occurred between the time of transfer and the application for medical assistance;
• Because of other, similarly convincing, circumstances, it appears more likely than not that the transfer was not made, in whole or in part, for the purpose of establishing or maintaining eligibility for benefits.

461-140-0242

11. Determining the Value of Compensation for a Transferred Resource

The uncompensated value of a disqualifying transfer of a resource is used in OAR 461-140-0260 and following to calculate the ineligibility period of the financial group.

To determine uncompensated value:

• Determine fair market value
• Subtract the amount of compensation received for the resource.

The compensation received for a transferred resource includes encumbrances assumed by the buyer and goods or services provided to the client, limited to their true value, if there was a prior agreement to exchange the resource for the goods or services.

461-140-0250

12. Disqualification Due to a Resource Transfer

• Note: Be sure to allow the resource limit before calculating the disqualifying transfer of resources.

A financial group containing a member disqualified due to the transfer of a resource is disqualified from receiving benefits if the group filed an application for benefits on or after October 1, 1998.

The length of a disqualification period resulting from a transfer is the number of months equal to the uncompensated value (see 461-140-0250) divided by the factor listed below in this section, rounded down to the next whole number. The first month of a disqualification period is the month the resource was transferred except as provided below (when transfers overlap). The factor used in the calculation is:

• For an application filed prior to October 1, 2000—$3,320. |
• For an application filed on or after October 1, 2000 and prior to October 1, 2002—$3,750.
• For an application filed on or after October 1, 2002 and prior to October 1, 2004 —$4,300.
• For an application filed on or after October 1, 2004—$4,700.

If disqualification periods overlap, they are applied sequentially so that no two penalty periods overlap. For instance, suppose a transfer in January results in a disqualification of three months, and a transfer in February results in a disqualification of two months. The penalty period is applied so that it starts in January and runs through May for a total of five months.

If a resource is owned by more than one person, by joint tenancy, tenancy in common or similar arrangement, the share of resource owned by the client is considered transferred when any action is taken either by the client or any other person that reduces or eliminates the client's control or ownership in the client's share of the resource.

If an annuity is purchased that pays benefits beyond the life expectancy of the client, as determined by the annuity, a disqualification period will be assessed for the value of the annuity beyond the life expectancy of the annuitant.

10/1/93 thru 9/30/98: 461-140-0295
On or after 10/1/98: 461-140-0296

Ending the Disqualification for Resource Transfer. Financial groups disqualified for transferring resources remain disqualified until one of the following occurs:

• The disqualification period ends.
• The transfer that caused the disqualification is rescinded. The duration of the disqualification is recalculated if the terms of the transfer are modified.
• Full equity and rights in the resource are transferred back to the client or the client receives adequate compensation.
• The branch office may end the disqualification if clients are in extreme need and denying benefits would create an undue hardship.

461-140-0300

13. Prospective/Retrospective Eligibility and Budgeting

Click here for definitions used in determining retrospective/prospective eligibility and budgeting

Prospective Eligibility or Budgeting: The budget month and payment month are the same.

In the prospective eligibility and budgeting system, the client’s estimated income, household composition, and other relevant factors are used to determine the client’s eligibility and benefit level . The client and Department jointly estimate the client’s income based on the income already received and the income the client expects to receive.

When prospective budgeting is used and the actual income differs from the amount determined in accordance with section above, there may be a client-caused overpayment only if the financial group withheld information, failed to make a required change report, or provided inaccurate information. In that event, the Department uses the actual income to determine whether there is, and the amount of, an overpayment.

The client is not entitled to a benefit supplement if the estimated income exceeds the actual income.

461-150-0020

Retrospective Eligibility or Budgeting: The budget month is the month before the payment month.

To determine eligibility retrospectively:

• Use information from the last day of the budget month to evaluate all eligibility factors except income and resources.
• Use information from the entire budget month to evaluate income and resources.

To determine benefit amount retrospectively (budgeting), use all information from the entire budget month. Financial information includes income and resources actually available and income available per 461-140-0020 and 461-140-0040 in the budget month.

Use of Prospective or Retrospective Budgeting for GA(M): Determine how and when to use prospective or retrospective eligibility and budgeting as follows:

• For the initial month, use prospective eligibility and budgeting. Exclude any money received from nonrecurring sources before the date of application. If any money remains after the date of application, count it as a resource.
• For ongoing months, use prospective eligibility and prospective budgeting for unearned income and stable earned income. Use retrospective budgeting for varying earned income.

Deduct from the following month’s benefits any unearned income received during the budget month that was not used to reduce the current month’s benefit. Do not supplement the benefit to restore lost benefits if anticipated income is not received.

461-150-0050

Prospective Use of Stable Income/Converted: Stable income is income that is the same amount each time it is received. To count stable income for prospective budgeting and eligibility, treat stable income as follows:

• If a financial group receives stable income once a month, use the monthly amount to anticipate what the group’s income will be for each month.
• If a financial group receives stable income once a week, convert it to a monthly amount by multiplying it by 4.3. Use the monthly amount to anticipate what the group’s income will be for each month.
• If a financial group receives stable income once every other week, convert that biweekly amount to a monthly amount by multiplying it by 2.15. Use the monthly amount to anticipate what the group’s income will be for each month.

461-150-0070

Prospective Use of Income That Varies/Averaged; Not MRS: Depending on how often income is paid and the type of income, there are different methods for anticipating how much to count each month. The following explains these methods.

For stable income that is received in the same amount once a month, use that monthly amount.

For stable income that is received in the same amount once a week, convert it to a monthly amount by multiplying by 4.3. Similarly, for stable income that is received in the same amount once every other week, convert it to a monthly amount by multiplying by 2.15.

Individuals with income that varies monthly will have their income calculated as follows. If the individual receives an hourly wage, determine with the individual the average number of hours the individual works each week. If their weekly hours in the past month do not represent the future, use the weekly hours that the individual would work in the months of the certification period. Document the reason for the change in hours, especially when the weekly hours are significantly different from the past. Calculate the monthly income by multiplying the hourly wage by the average number of hours, plus tips or commissions, if any, that the individual may receive and multiply the amount by 4.3. Document the calculation. The following is an example of how to narrate the calculation:

Marcia reported on August 21 that she is working at McDonalds. Start date: August 17, paid $6.00 an hour and expects 25 hours a week. The first pay date will be August 28 for pay period ending August 22. EML = $645 ($6.00 X 25 = 150 X 4.3). Too late to send notice for September, send FS reduction notice effective October 1.

If the individual does not receive an hourly wage or receive income from work done on an hourly basis, e.g. piece work and certain farm work, the individual has the choice of either changing the amount monthly, or averaging over the redetermination period. When looking at variable income to count, it is very important to consider only income that is reasonably certain to be available. Also consider the dates income will be received and the amount of each payment. For work income, this includes an evaluation of rate of pay, tips, draws, commissions, and fluctuating work hours.

Individuals who choose to have variable income averaged over the redetermination period, have that average based on the current month and the last 2 months, if that is representative of what they expect will continue. If the case is switching from monthly reporting to prospective budgeting, another option is to average income from the preceding two months' and the current month. If past income is not representative of what income is expected to continue, the worker and individual jointly determine what income is reasonable to anticipate for the redetermination period.

Do not put these cases in the MRS. If the individual reports an income change for any of the months, act on the change according to the policy on change reporting described in section F.2 of this manual.

Income must be annualized when it is:

• Received in less than 12 months but is intended as a full year's income (such as school system employees, farmers and fishermen).
• From a business that has operated for a full year and the previous year is representative of what income is expected for the next year. (Businesses with less than a year's history may be anticipated and averaged over a period shorter than a year).
• Periodic income.

Annualized means the income for a year is divided by 12 to arrive at a monthly amount. Always use a verified amount from the past (such as the most recent income tax returns) when it is representative of the income expected for the current year. When it is not representative, anticipate the current yearly amount and divide it by 12.

Educational income from work study, fellowships and doing teaching assistant work is treated like earned income. Other countable educational income is prorated over the months it is intended to cover. Always subtract excluded educational income and educational expenses first. See 461-145-0150.

Variable income: 461-150-0080
Annualizing: 461-150-0090

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