Manual Requests for Asset Verification through the Asset Verification System (AVS), OPS180103 (Published January 30, 2018)
Policy Changes Due to the Achieving a Better Life Experience (ABLE) Act, OPS170701 (Published July 10, 2017)
The CAO must look at the resources of the applicant or recipient and his or her spouse who is included in the Healthy Horizons, SLMB, or QI family.
The CAO must apply the SSI-related rules of Chapter 340, Resources. For a lump sum, the CAO must apply the rules of Chapter 357, Lump Sum.
If the applicant or recipient has excess resources but uses the excess amount to pay a medical expense, the CAO will treat the excess amount as if it never existed.
The applicant or recipient is not eligible for Healthy Horizons on the date when total countable resources are more than the resource limit in 319, Appendix A. The applicant or recipient remains ineligible until the date his or her total resources are at the limit or less.
The CAO must not consider resources of a Healthy Horizons applicant or recipient who:
Has a natural or adopted child or stepchild under age 21 living in the household.
Is pregnant or has a pregnant wife living in the household.
Is exercising care and control of a child under age 21.
Is a child under age 21 or has a spouse under age 21.
NOTE: These resource exclusions do not apply to Pure SLMBs and QIs. (See Section 319.1.)
The CAO must take the following steps to determine resource eligibility:
1. Determine the total countable resources of the applicant or recipient and his or her spouse according to the SSI-related rules in Chapter 340, Resources.
2. Compare the total countable resources with the Healthy Horizons categorically needy limit in 319, Appendix A.
If the resources are equal to or less than the limit, the applicant or recipient meets the resource requirements for Healthy Horizons categorically needy benefits. Determine whether he or she is eligible based on income.
If the resources are more than the limit, deny Healthy Horizons categorically needy benefits, and determine whether the individual is eligible for Healthy Horizons cost-sharing benefits.
3. Compare the total countable resources with the Healthy Horizons cost-sharing limit in 319, Appendix A.
If the resources are equal to or less than the limit, the applicant or recipient meets the resource requirements for Healthy Horizons cost-sharing benefits. Determine whether he or she is eligible based on income.
If the resources are more than the limit, deny Healthy Horizons cost-sharing benefits.
4. Compare the total countable resources to the SLMB and QI limits in 319, Appendix B and Appendix C.
If the resources are equal to or less than the limit, the applicant or recipient meets the resource requirements for SLMB or QI benefits. Determine whether he or she is eligible based on income.
If the resources are more than the limit, deny SLMB or QI benefits.
Updated August 21, 2018, Replacing February 14, 2012