The CAO will not count certain resources when determining eligibility for MA LTC. See Section 440.61, Excluded Resources - SSI-Related.
The CAO may exclude additional resources when determining eligibility for MA LTC for LTC services if the resource is kept separate and identifiable. See Section 440.62, Excluded Resources That Must Be Kept Separate And Identifiable.
55 Pa. Code § 178.1(b) 20 CFR § 416.1236(b)
These resources are excluded:
Disaster relief assistance
Any money and interest received as a result of a catastrophe declared as a major disaster by the President under the Disaster Relief Act of 1974 or another Federal law is not counted for nine months. The nine month period begins on the date the individual received the disaster assistance and ends on the last day of the ninth full month after the month the cash was received. The CAO will verify the receipt date and amount.
This initial nine month period may be extended to 18 full months if the individual shows good cause for not repairing or replacing the property for which the disaster relief was given. It is proof of good cause when circumstances beyond the individual’s control prevent repair or replacement within the nine month period.
NOTE: The individual must present proof from at least two contractors. Proof must show that the individual made a reasonable effort have the damaged property repaired or replaced within the initial period. If the disaster has resulted in a large volume of work needed in the area, the CAO may contact area contractors to determine the minimum time needed to complete the work. The CAO may give an extension if the individual shows that he still intends to make the repairs.
The CAO will keep the proof in the record, note any verbal evidence from the personal contact and create an alert to review the situation before the end of the exclusion period.
The CAO will count as a resource any remaining cash and interest not used to repair or replace destroyed property beginning with the month after the nine month or 18 month period expires.
The CAO will determine if there is an overpayment due to excess resources if the money is spent for something other than the intended purpose.
Earned income tax credit
The CAO will not count the advance monthly EIC payment and the year-end EIC payment refunded as part of Federal income taxes. The CAO will exclude the payment in the month it is received and the next month. Any part of the EIC remaining after the exclusion period is counted as a resource. This includes EIC payments received for:
Supplemental Young Child Credit - Available at the end of the year to a family with an infant who does not qualify for the dependent care credit. It is refunded in addition to the EIC payment.
Child Health Insurance Tax Credit - A refund of the amount paid by an employee for health insurance premiums if the coverage is for at least one child who is receiving TANF related MA. It is a refund in addition to the EIC payment.
Household goods and personal effects
The CAO will not count the value of these resources:
Household goods including furnishings and equipment commonly found in or around a home and used in connection with the operation, maintenance and occupancy of the home
Personal effects including, but not limited to, clothing, jewelry, items of personal care, recreation equipment, musical instruments and hobby items
Any items required because of a person’s physical condition, such as, but not limited to, prosthetic devices, dialysis machines, motorized wheelchairs, hospital beds and similar items regardless of value
Housing assistance
The CAO will not count Section 8 housing or utility subsidies, rehabilitation grants, or other Federal housing subsidies paid under:
United States Housing Act of 1937
National Housing Act, Section 101 of the Housing and Urban Development Act of 1965,
Title V of the Housing Act of 1949, as provided by Section 2(h) of the Housing Authorization Act of 1976
Income producing property
The CAO will not count real or personal property used in a trade or business that is essential to self-support. See Section 440_432, Exclusion of Property Which Produces Income or is Essential to Self-Support.
Irrevocable burial reserve
The CAO may not count an irrevocable burial reserve if the irrevocable reserve is within the allowable limits. See Section 440.51, Irrevocable Burial Reserve.
Life insurance
The CAO will not count term insurance or other life insurance that does not accumulate a cash value. See Section 440_33, Life Insurance.
The CAO will not count life insurance policies that have a total face value of $1,500 for each insured person. Any cash value accumulated on these excluded life insurance policies is also excluded. See Section 440_33, Life Insurance.
Motor vehicle
The CAO will not count one motor vehicle. See Section 440_34, Motor Vehicles.
Non-business property essential to self-support
The CAO will not count tools, equipment, uniforms, and similar items required by an employer. 55 Pa. Code § 178.65
The CAO will not count non-business property needed for self-support including produce items for home consumption. See Section 440_432, Exclusion of Property Which Produces Income or is Essential to Self-Support.
Payments/benefits provided by Federal statutes
The CAO will not count payments or benefits provided under a Federal statute other than Title XVI of the Social Security Act where Federal statute requires exclusion from resources. See Section 440.62, Excluded Resources That Must Be Kept Separate And Identifiable.
20 CFR §§ 416.1201 20 CFR § 416.1210(j) 20 CFR § 416.1236(b)
Pennsylvania Uniform Gifts to Minors Act (PUGMA)
The CAO will not count a PUGMA gift made to an individual under age 21. The exclusion applies until the person reaches age 21. The gift is made under these conditions:
The donor must be at least age 18.
The gift is irrevocable.
The gift and any earnings from the gift must be under the control of a custodian who manages, invests and dispenses the funds.
In most cases, control transfers to the minor when the minor reaches age 21.
The CAO will count any disbursements by the custodian to the beneficiary as income in the month disbursed. If any of the disbursed funds remain in the next month, the CAO will count the remaining amount as a resource.
When an individual reaches age 21, he CAO counts as a resource any funds remaining from a gift made previously under PUGMA.
Pension funds of the ineligible spouse
The CAO may exclude the pension fund owned by the spouse who lives in the community. Pension funds are funds held in an Individual Retirement Account (IRA), as described by the Internal Revenue Code, or in a work-related pension plan including such plans for self-employed individuals, sometimes referred to as Keogh plans.
55 Pa. Code § 178.91(e) 20 CFR §§ 416.1201(a)
Proceeds from the sale of an excluded home
The CAO will not count proceeds used or obligated to buy another excluded home. The person must buy the new excluded home within three months. See Section 440_428, Sale of resident property.
Real property used as a principal place of residence
Under certain conditions, the CAO will not count resident property the person owns. See Section 440_42, Resident Property.
Replacement assistance
The CAO will not count in-kind replacement assistance received for the purpose of repairing or replacing an excluded resource.
The CAO will not count assistance received to replace an excluded resource that is lost, damaged, or stolen.
The CAO will not count the cash and interest earned on the cash received for repair or replacement for the nine calendar months after the date the individual received the cash. The initial nine month period may be extended for up to an additional nine months if the person has good cause for not replacing or repairing the resource.
NOTE: The CAO will count as a resource any remaining cash and interest beginning with the month after the end of the nine calendar month period. If the initial nine month period is extended, the CAO will count any remaining cash and interest beginning with the month after the good cause extension period ends.
If the good cause period is extended and the individual decides not to repair or replace the excluded resource, the CAO will count the funds as a resource, beginning the month he reports the change in intent.
Retroactive SSI or RSDI payments/benefits
The CAO will not count retroactive SSI or RSDI benefits for the month the individual received retroactive benefits. The retroactive benefits are excluded for nine calendar months after the month the individual received the retroactive payment. The funds do not need to be in a separate account.
NOTE: The money, if put with other funds, must be identifiable using items such as personal records or institutional accounts.
Example: Ms. K. received a retroactive SSI payment on January 16. The payment is excluded for nine months, beginning on February 1.
Under this provision, the CAO will not exclude a resource bought with the money unless that resource is excluded. If part of the payment remains after the end of the ninth month period, the CAO counts it as a resource.
Revocable burial reserve
The CAO will not count a revocable burial reserve with a value of $1,500 or less. The amount of this exclusion depends on whether there is life insurance and/or an irrevocable burial reserve. See Section 440.52, Revocable Burial Reserve. See Appendix B of this Chapter for worksheet to compute the countable part of the revocable Burial Reserve.
State and local relocation assistance
The CAO will not count relocation assistance from a state or local government. The payment is excluded for nine calendar months beginning with the month after the receipt month.
20 CFR § 416.1210(q) 20 CFR §§ 416.1239
Victims’ compensation payments
The CAO will not count payments received as compensation for expenses incurred or losses suffered as a result of a crime. The payment is excluded for nine calendar months beginning with the month after the receipt month.
The individual or spouse must give proof that the amount received was compensation for expenses incurred or losses suffered as the result of a crime.
The CAO will not exclude interest earned on unspent victim's compensation payments from income or resources.
20 CFR §§ 416.1210(p) 20 CFR §§ 416.1229
The CAO will not count the value of these resources as long as the resource is kept separate and identifiable:
Agent Orange settlement payments
The CAO will not count payments made from the Agent Orange Settlement Fund or any other fund established due to the settlement of the Agent Orange Product Liability litigation. 55 Pa. Code § 178.83
Austrian reparation payments
The CAO will not count payments made under Section 500-506 of the Austrian General Social Insurance Act. These payments are made to persons who suffered imprisonment or unemployment or were forced to flee Austria during the period March 1933 to May 1945 for political, religious, or ethnic reasons. The CAO will count the interest as income. OBRA 1990 (P.L. 101-508)
Corporation for National and Community Services (CNCS) (formerly Action programs)
The CAO will not count these payments made to persons who have or are actively participating in volunteer service programs including:
Volunteers In Service To America (VISTA) (Now Americorps*VISTA)
University Year for Action
Special and Demonstration Volunteer Programs
Retired Senior Volunteer Programs (RSVP)
Foster Grandparent Program
Senior Companion Program
Dedicated financial institutional accounts
The CAO will not count an account in a financial institution established for the sole purpose to receive and maintain SSI past-due benefits. Any accrued interest or other earnings on such accounts are excluded from resources. This exclusion will apply only if the SSI benefits plus interest earned on the SSI benefit are not combined with any other funds.
Section 1631(a)(12)(F) of the Social Security Act
Department of Defense (DOD) payments to certain persons captured and interned by North Vietnam
The CAO will not count DOD payments to a person who receives a payment because he or she was captured and interned by North Vietnam during the Vietnam Conflict. If the person who was captured and interned is deceased, payment may be made to a surviving spouse or, if there is not spouse, to surviving child(ren), including the deceased person’s biological and adoptive child(ren). Interest earned on unspent payments is excluded.
Food stamp benefits
The CAO will not count the value of food stamps a individual receives.
Food assistance
The CAO will not count the value of supplemental food assistance from the Women's, Infants', and Children's (WIC) program or the National School Lunch Act.
Federal loans and grants to undergraduate students
The CAO will not count a grant or loan to an undergraduate student made or insured under a program administered by the Commissioners of Education under Section 507 of the Higher Education Amendments of 1968.
German reparation payments
The CAO will not count payments made to survivors of the Holocaust under the Republic of Germany's Federal Law for Compensation of National Socialist Persecution, also known as the "German Restitution Act". The payments may be made periodically or in a lump sum.
Home Energy Assistance (HEA) benefits
The CAO will not count home energy assistance (HEA) benefits. HEA benefits include, but are not limited to, payments for heating and cooling, storm doors, weatherization service and blankets.
Incentive allowances
The CAO will not count incentive allowances under Title 1 of the Comprehensive Employment and Training Act of 1973 (87 State 849, 29 U.S.C. 821(a))
Japanese American and Aleut restitution payments
The CAO will not count payments made under P.L. 100-383, Title I - Civil Liberties Act of 1988 and Title II -The Aleutian and Pribilof Island Act enacted 8/10/88. This exclusion includes payments to the survivors of Japanese Americans.
The exclusion continues as long as the payments are kept separate and identifiable. If the payment is used to buy real or personal property, the CAO will count the new resource unless it can be excluded. The CAO will count interest on the payment as income.
LIHEAP
The CAO will not count benefits for home energy assistance received under the Low Income Home Energy Assistance Program (LIHEAP).
Netherlands WUV payments to victims of persecution
The CAO will not count these payments to persons who were victims of persecution during World War II because of their race, religion, belief, or homosexuality during the German and Japanese Occupation of the Netherlands and the Netherlands East Indies (now the Republic of Indonesia). As a result of that persecution, the persons are suffering from illness.
Payments from energy employees occupational illness compensation program
The CAO will not count lump sum payments and reimbursement of medical expenses paid to employees of the Department of Energy (DOE), or of private companies under contract with DOE, who suffer from specified diseases as a result of work in the nuclear weapons industry. Interest on the unspent payment is not excluded.
Payments received as restitution for misuse of benefits by a representative payee
The CAO will not count the unspent portion of any payment received by a person as restitution for Title II, Title VIII or Title XVI benefits misused by a representative payee. The payment is excluded for nine calendar months beginning with the month after the receipt month. A payment is made in the amount equal to the benefits misused because of the Social Security Administration’s (SSA) negligent failure to investigate or monitor a representative payee or because an organizational or individual payee misused the benefits, regardless of whether SSA was negligent.
Payments to Indian tribes
The CAO will not count these payments to Indian tribes:
Judgment payments under the March 18, 1972 act and the October 18, 1976 act.
Funds distributed per capita to, or held in trust for, members of any Indian tribe under the act of October 19, 1973.
Receipts distributed to members of certain Indian tribes referred to in Section 6 of the act of October 17, 1975.
Funds, assets or income under Section 6(b) of the Puyallup Tribe of Indians Settlement Act of 1989, P.L. 100-41 (25 U.S.C. 1773 h(c)).
Payments, funds, distributions, or income derived from them under Section 8 (b) of the Seneca Nation Settlement Act of 1990
55 Pa. Code §§ 178.61(b) 55 Pa. Code §§ 178.61(c) 55Pa. Code § 178.61(l)
Payments to volunteers
The CAO will not count payments from VISTA, Service Learning Programs and Special Volunteer Programs. These payments to volunteers are made under Section 404(g) of the Domestic Volunteer Services Act of 1973.
Payments under the Alaska Native Claims Settlement Act
The CAO will not count tax exempt portions of payments received under Section 21(a) of the Alaska Native Claims Settlement Act.
Radiation exposure compensation trust fund payments
The CAO will not count the one-time lump sum payment to a person exposed to doses of radiation and determined to have contracted certain diseases after the exposure. The Federal Department of Justice makes payment to the individual or the individual’s survivors.
Ricky Ray Hemophilia relief payments
The CAO will not count relief payments from the Ricky Ray Hemophilia Relief Fund Act of 1998, P.L. 105-369, which provides for a single payment of $100,000 to certain persons with a blood-clotting disorder who may have contacted an HIV infection from a blood transfusion.
Payment is also for certain current and former spouses of these persons who also contacted an HIV infection, for certain children of these individuals who also contacted an HIV infection, and for certain surviving spouses, children and parents of the above described individuals. These payments are excluded, regardless of when received:
Payments from Ricky Ray Hemophilia Fund.
Payments made from a fund established due to a class settlement in the case of Susan Walker v. Bayer Corporation, al., 96-C-5024 (N.D.Ill).
Payments made in lieu of the class settlement. 20 CFR § 416.1236(a)(14)
Student financial assistance for attendance
The CAO will not count student financial assistance for attendance costs an individual receives from a program funded in whole or in part under Title IV of the Higher Education Act of 1965, as amended, or under Bureau of Indian Affairs Student assistance programs. The assistance must be made available for tuition and fees normally required of a student carrying the same academic workload, as determined by the institution. The costs also include:
Rental or purchase of any equipment, materials, or supplies required of all students in the same course of study
An allowance for books, supplies, transportation and miscellaneous personal expenses
The student must be attending the institution on at least a half-time basis, under Section 14(27) of P.L. 100-50, the Higher Education Technical Amendments Act of 1987 (20 U.S.C. 108uu) or under Bureau of Indian Affairs student assistance programs.
Support or Maintenance Assistance (SMA) benefits
The CAO will not count in-kind support or maintenance assistance (SMA) benefits given:
In-kind by a private, nonprofit organization
As cash or in-kind assistance by a home heating oil or gas supplier
By an entity providing home energy whose revenues are primarily derived on a rate-of-return basis and regulated by the Pennsylvania Utility Commission
Uniform relocation assistance and real property acquisitions
The CAO will not count money received under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.
USDA Surplus food donation
The CAO will not count the value of surplus commodities donated by the United States Department of Agriculture.
VA benefit to Korea service veterans’ children with spina bifida
The CAO will not count benefit payments to children of Korea service veterans who are diagnosed with spina bifida receive a benefit from the Department of Veterans Affairs (VA)These children receive one of three levels of a benefit from the VA based on the disability.
VA benefit to women Vietnam veterans’ children with certain birth defects
The CAO will not count benefit payments to children of women Vietnam veterans born with certain birth defects may be eligible for monthly VA benefits. Qualification for this VA benefit depends on whether the birth defect is associated with the service of the child’s mother in Vietnam and whether this birth defect result in permanent physical or mental disability.
Vietnam veterans children with spina bifida
The CAO will not count payment to children of Vietnam Veterans who are diagnosed with Spina Bifida.
Issued March 12, 2012