ANALYSIS AND DECISION
In this case, the regulations found at 62 P.S. § 441.5 states that the Department shall impose a penalty of ineligibility for all ineligible days, whether for full months or for a partial month's period of ineligibility, or both, when an applicant, recipient or spouse of an applicant or a recipient transfers assets for less than fair market value within or after the look-back period as defined in section 1917(c) of the Social Security Act.
Consistent with section 1917(c)(1)(E)(iv) and (H) of the Social Security Act, effective March 3, 2007, a period of ineligibility for payment of long-term care services will result when a recipient disposes of assets for less than fair consideration on or after March 3, 2007. In …show more content…
Code § 178.104(b) and (c) state the Department is required to determine if an applicant of MA transferred resources for less than Fair Market Value (FMV). The Regulation at 55 Pa. Code § 178.105 states there is a presumption that transfers of resources made on or after July 30, 2004 were made to qualify for MA. The regulations state the individual must provide convincing evidence to prove the assets were transferred solely for some purpose other than to qualify for MA, and that convincing evidence must be provided which provides proof of the circumstances surrounding the transfer which include: “the purpose for transferring the asset; the means of, or plans for, self-support after the transfer; and the individual’s relationship to the person to whom the asset was transferred.” In this case the Appellant’s Representative, DB offered that he could not verify the specifics of how the $39,120.95 was disposed, but testified that his parents’ daily living, weekly recurring activities, and home improvements accounted for the disposition of the assets. The ALJ finds that, the Appellant’s Representative DB provided no written documentation; he provided his statement of the expenditures and his statement that he is unaware of any other monetary dispositions. DB provided no evidence to substantiate his claim that home improvements were made during the look back period and that a large portion of the assets were made for the purpose of paying the contractors. The ALJ also finds that DB provided no proof of the estimated amount these improvements would
In this case, the regulations found at 62 P.S. § 441.5 states that the Department shall impose a penalty of ineligibility for all ineligible days, whether for full months or for a partial month's period of ineligibility, or both, when an applicant, recipient or spouse of an applicant or a recipient transfers assets for less than fair market value within or after the look-back period as defined in section 1917(c) of the Social Security Act.
Consistent with section 1917(c)(1)(E)(iv) and (H) of the Social Security Act, effective March 3, 2007, a period of ineligibility for payment of long-term care services will result when a recipient disposes of assets for less than fair consideration on or after March 3, 2007. In …show more content…
Code § 178.104(b) and (c) state the Department is required to determine if an applicant of MA transferred resources for less than Fair Market Value (FMV). The Regulation at 55 Pa. Code § 178.105 states there is a presumption that transfers of resources made on or after July 30, 2004 were made to qualify for MA. The regulations state the individual must provide convincing evidence to prove the assets were transferred solely for some purpose other than to qualify for MA, and that convincing evidence must be provided which provides proof of the circumstances surrounding the transfer which include: “the purpose for transferring the asset; the means of, or plans for, self-support after the transfer; and the individual’s relationship to the person to whom the asset was transferred.” In this case the Appellant’s Representative, DB offered that he could not verify the specifics of how the $39,120.95 was disposed, but testified that his parents’ daily living, weekly recurring activities, and home improvements accounted for the disposition of the assets. The ALJ finds that, the Appellant’s Representative DB provided no written documentation; he provided his statement of the expenditures and his statement that he is unaware of any other monetary dispositions. DB provided no evidence to substantiate his claim that home improvements were made during the look back period and that a large portion of the assets were made for the purpose of paying the contractors. The ALJ also finds that DB provided no proof of the estimated amount these improvements would