8.100.5	Aged, Blind, and Disabled Medical Assistance General Eligibility
8.100.5.A.	Application Requirements
1.	When an individual applies for Medical Assistance on the basis of disability or blindness, the eligibility sites shall take the application and determine whether the individual is eligible for Long Term Care or any of the categories of assistance described in section 8.100.6 under Qualified Disabled and Working Individuals. If the applicant does not qualify for Medical Assistance on one of those bases, he/she shall be referred to the local Social Security office to apply for SSI.
a.	Applicants who apply for Long-Term Care Medical Assistance on the basis of disability or blindness, or who apply for the Medicaid Buy-In Program for Working Adults with Disabilities without a current disability determination, shall complete a Medical Assistance disability determination application in addition to the required Medical Assistance application. The disability determination application is not required for individuals that have already been determined disabled by the Social Security Administration.
b.	The Medical Assistance disability determination application shall be collected by a designated eligibility site representative and shall be forwarded to the state disability determination contractor upon completion. The state disability determination contractor shall conduct a client disability determination and shall forward the determination to the designated eligibility site representative.
c.	For the Medicaid Buy-In Program for Working Adults with Disabilities, if an individual does not meet the Social Security Administration definition of disability, the state disability determination contractor can review the individual’s circumstances to determine if the individual meets limited disability.
2.	Persons requesting Aged, Blind, and Disabled Medical Assistance need only to complete the Colorado Medical Assistance application.
8.100.5.B.	Verification Requirements
1.	The particular circumstances of an applicant will dictate the appropriate documentation needed for a complete application. The following items shall be verified for individuals applying for Medical Assistance:
a.	A Social Security Number shall be provided for each individual on the application for whom Medical Assistance is being requested, or proof shall be submitted that an application for a Social Security Number has been made. Members of religious groups whose faith will not permit them to obtain Social Security Numbers shall be exempt from providing a Social Security Number.
b.	Verification of citizenship and identity as outlined in the section 8.100.3 under Citizenship and Identity Eligibility Requirements.
c.	Earned income may be self-declared by an individual and verified by the Income and Eligibility Verification System (IEVS). Individuals who provide self-declaration of earned income must also provide a Social Security Number for wage verification purposes. If a discrepancy occurs between self-declared income and IEVS wage data reports, IEVS wage data will be used to determine eligibility. An individual may dispute IEVS wage data by submitting all wage verification for all months in which there is a wage discrepancy.
If the applicant is self employed, ledgers are sufficient for verification of earnings, if a ledger is not available, receipts are acceptable. The ledger included in the Medical Assistance application is sufficient verification of earnings, unless questionable. If an individual cannot provide verification through self-declaration, income shall be verified by wage stubs, written documentation from the employer stating the employees' gross income or a telephone call to an employer. Applicants may request that communication with their employers be made in writing.
As of CBMS implementation, estimated earned income shall be used to determine eligibility if the applicant/client provides less than a full calendar month of wage stubs for the application month. A single recent wage stub shall be sufficient if the applicant's income is expected to be the same amount for the month of application. Written documentation from the employer stating the employees' gross income or a telephone call to an employer, if the applicant authorizes the telephone call shall also be acceptable verification of earned income. Verification of earned income received during the month prior to the month of application shall be acceptable if the application month verification is not yet available. Actual earned income shall be used to determine eligibility if the client provides verification for the full calendar month.
d.	Verification of all unearned income shall be provided if the unearned income was received in the month for which eligibility is being determined or during the previous month. If available, information that exists in another case record or verification system shall be used to verify unearned income.
e.	Verification of all resources shall be provided if the resources were available to the applicant in the month for which eligibility is being determined.
f.	Immigrant registration cards or papers, if applicable, to determine if the client is eligible for full Medical Assistance benefits. If an applicant does not provide this, he/she shall only be eligible for emergency Medical Assistance if they meet all other eligibility requirements.
g.	Pregnancy verification, if applicable, and if the pregnancy is not observable. The verification shall be documented according to 8.100.4.G.9.a.
h.	Additional verification-If the requested verification is submitted by the applicant, no other additional verification shall be required unless the submitted verification is found to be questionable on the basis of fact.
i.	The determination that information is questionable shall be documented in the applicant's case file and CBMS case comments.
8.100.5.C.	Effective Date Of Eligibility
1.	Medical Assistance shall be approved effective as of the date of application for Medical Assistance, or as of the date the person becomes eligible for Medical Assistance, whichever is later. Individuals held in correctional facilities or who are held in community corrections programs that are determined eligible for Medical Assistance shall be approved effective as of the individual’s date of release.
2.	Clients applying for Medical Assistance under the Aged, Blind and Disabled category shall be reviewed for retroactive eligibility as described at 8.100.3.E. When reviewing for retroactive eligibility for an individual who is SSI eligible or applied and became SSI eligible in each of the retroactive months, the applicant must:
a.	Be aged at least 65 years, or;
b.	Meet the Social Security Administration definition of disability by;
i.	approved as eligible to receive either SSI or SSDI, on or prior to the date of a medical service, or
ii.	having a disability onset date determined on or prior to the date of a medical service,
c.	and meet the financial requirements as described at 8.100.5.E.
8.100.5.D.	Medical Assistance Estate Recovery Program
1.	The eligibility site shall provide written information from the Department to the following people explaining the provisions of the Medical Assistance Estate Recovery Program and how those provisions may pertain to the applicant/client:
a.	Applicants age 55 and older who are institutionalized.
b.	Applicants/clients who will turn age 55 before their next eligibility re-determination who are institutionalized.
c.	Clients age 55 and older, and approved for admittance to an institution
8.100.5.E.	Availability Of Resources and Income
1.	Income, which includes earned and unearned income, shall be calculated on a monthly basis regardless of whether it is received annually, semi-annually, quarterly or weekly.
2.	For married couples, the income and resources of both spouses are counted in determining eligibility for either or both spouses. Refer to section 8.100.7 for exceptions.
3.	Resources and income shall be considered available both when actually available and when the applicant or client has a legal interest in a sum (including cash or equity value of a resource) and has the legal ability to make such sum available for support and maintenance.
4.	If the applicant or client demonstrates with written documentation that appropriate steps are being taken to secure the resources, Medical Assistance shall not be delayed or terminated. Verification of efforts to secure the resources must be provided at regular intervals as requested by the eligibility site.
5.	Resources will be considered available and Medical Assistance shall be denied or terminated if the applicant or client refuses or fails to make a reasonable effort to secure a potential resources or income.
6.	Timely and adequate notice must be given regarding a proposed action to deny, reduce or terminate assistance due to failure to make reasonable efforts to secure resources or income. If upon receipt of the prior notice, the individual acts to secure the potential resource, the proposed action to deny, reduce, or terminate assistance must be withdrawn, and assistance must be approved or continued until the resource or income is, in fact, available.
7.	If the resources or income has been transferred to a trust, the trust shall be submitted for review to the Department to determine the effect of the trust on eligibility in accordance with section 8.100.7.E.
8.100.5.F.	Income Requirements
1.	This section reviews how income is looked at for the ABD Medical Programs and determining premiums for the Medicaid Buy-In Program for Working Adults with Disabilities. For more general income information and income types refer to the General Medical Assistance General Eligibility Requirements section 8.100.3.
2.	Earned income is countable as income in the month received and a countable resource the following month. Earned Income includes the following:
a.	Wages, which include salaries, commissions, bonuses, severance pay, and any other special payments received because of employment.
b.	Net earnings from self-employment
c.	Payments for services performed in a sheltered workshop
d.	Royalties and honoraria
3.	Unearned income is countable as income in the month received and a countable resource the following month. Unearned income includes, but is not limited to, the following:
a.	Death benefits, reduced by the cost of last illness and burial
b.	Prizes and rewards
c.	Gifts and inheritances
d.	Interest payments on promissory notes established on or after March 1, 2007.
e.	Interest or dividend payments received from any resources
f.	lump sum payments from SSA/SSI, workman’s compensation, insurance settlements
g.	Dividends, royalties or other payments from mineral rights or other resources listed for sale within the resource limits
h.	Income from annuities that meet requirements for exclusion as a resource
8.100.5.G.	Deeming Of Income And Resources For The OAP Program
All aliens who apply for OAP on or after April 16, 1988, for three years after the date of admission into the United States, shall have the income and resources of their sponsors other than relatives deemed for their care. Refer to the Medical Assistance General Eligibility Requirements section 8.100.3.K for specific information on deeming of income and resources.
8.100.5.H.	Income Disregards
1.	The following income disregards are only applicable to SSI related, OAP, and Medicare Savings Programs (MSP), and the Medicaid Buy-In Program for Working Adults with Disabilities. Only the unearned income disregard is applicable to AwDC. These disregards are not applicable to the HCBS waivers or the LTC programs.
2.	The gross amount of earned and unearned income is countable toward eligibility with the following exclusions:
a.	the first $20 of total available unearned income (except for SSI income) must be disregarded;
b.	an additional $65 plus 1/2 of the remainder of earned income must be disregarded;
c.	income of spouses living together is considered mutually available and must be compared to the current SSI benefit level for a couple; net income of a non recipient spouse must be reduced by an amount up to one half the individual SSI benefit level for unmet needs of each non recipient child in the family. This does not apply to the Medicaid Buy-In Program for Working Adults with Disabilities.
d.	income of single persons must be compared to the current SSI benefit level for an individual (a one third reduction applies to a person living in the household of another);
e.	unemancipated children are not subject to a one-third reduction, an amount of parental income equal to the individual or couple SSI benefit level must be allowed for the needs of the parent or parents, up to one half the individual SSI benefit level must be allowed for the unmet needs of each non recipient child in the family, and the remainder must be considered as income available to the applicant or recipient child. For the purposes of this rule, "unemancipated child" means (1) a child under age 18 who is living in the same household with a parent or spouse of a parent, or (2) a child under age 21 who is living in the same household with a parent or spouse of a parent, if the child is regularly attending a school, college, or university, or is receiving technical training designed to prepare the child for gainful employment;
f.	one third of child support for the applicant/recipient child from an absent parent must be disregarded;
g.	the first $400 of gross monthly earnings, not to exceed $1620 in a calendar year, shall be exempt from consideration as earned income of a disabled or blind child who is a student regularly attending school.
h.	any other applicable exemptions in 20 CFR 416.1112. 20 CFR 416.1112 is incorporated herein by reference. No amendments or later editions are incorporated. Copies are available for inspection from the following person at the following address: Custodian of Records, Colorado Department of Health Care Policy and Financing, 1570 Grant Street, Denver, CO 80203. Any material that has been incorporated by reference in this rule may be examined at any state publications repository library.
8.100.5.I.	Determining Ownership of Income
1.	If payment is made solely to one individual, the income shall be considered available income to that individual.
2.	If payment is made to more than one individual, the income shall be considered available to each individual in proportion to their interests.
3.	In case of a married couple in which there is no document establishing specific ownership interests, one-half of the income shall be considered available to each spouse.
4.	Income from the Community Spouse's Resource Allowance, as defined in the spousal protection rules in this volume, is income to the community spouse.
8.100.5.J.	Income-Producing Property
1.	Net rental income from an exempt home or a life estate interest in an exempt home is countable after the following allowable deductions:
a.	Property taxes and insurance
b.	Necessary reasonable routine maintenance expenses
c.	Reasonable management fee for a professional property manager.
d.	Non-business property that is necessary to produce goods or services essential to self support is excluded up to $6000 for applicants who are not applying for long-term care in a Long Term Care institution.
e.	Property used in a trade or business which is essential to self-support is excluded up to a limit of $6000 if it produces 6% return of the excluded value. This exclusion does not apply to applicants for Long Term Care in a Long Term Care institution.
8.100.5.K.	Department of Veterans Affairs (VA) Payments
1.	Payments for aid and attendance (A&A) and unreimbursed medical expenses (UME) shall not be considered as income and should not be paid as patient payment for the following:
a.	Veteran in a medical facility that is not a state veteran's medical facility.
b.	Veteran or spouse of a veteran in a state veteran's medical facility who has a spouse or child at home.
2.	Payments for aid and attendance (A&A) and unreimbursed medical expenses (UME) to a veteran or spouse of a veteran in a state veteran's medical facility with no spouse or child at home shall be treated as follows:
a.	Payments shall not be considered as income.
b.	Payments shall be used as patient payment to the medical facility.
8.100.5.L.	Reverse Mortgages
1.	In accordance with C.R.S. 11-38-110, reverse mortgages payments made to a borrower shall not be treated as income for eligibility purposes.
2.	Funds remaining the following month after the payment is made will be countable as a resource.
3.	Any payments from a reverse mortgage that are transferred to another individual without fair consideration shall be analyzed in accordance with the rules on transfers without fair consideration in the Long Term Care section and may result in a penalty period of ineligibility.
8.100.5.M.	Resource Requirements
1.	Consideration of resources: Resources are defined as cash or other assets or any real or personal property that an individual or spouse owns. The resource limit for an individual is $2,000. The resource limits for the QMB, SLMB, and QI programs are $8,180 for a single individual and $13,020 for a married individual living with a spouse and no other dependents. For a married couple, the resource limit is $3,000. If one spouse is institutionalized, refer to Spousal Protection-Treatment of Income and Resources for Institutionalized Spouses. Resources are not counted for the Medicaid Buy-In Program for Working Adults with Disabilities or AwDC.
2.	The following resources are exempt in determining eligibility:
a.	The principal place of residence, which is owned by the applicant or applicant's spouse, including the home in which the individual resides, the land on which the home is located and related out-buildings.
b.	If an individual or spouse moves out of his or her home without the intent to return, the home becomes a countable resource because it is no longer the individual's principal place of residence.
c.	If an individual leaves his or her home to live in an institution, the home will still be considered the principal place of residence, irrespective of the individual's intent to return as long as the individual's spouse or dependent relative continues to live there. Dependent relative is defined as one who is claimed as a dependent for federal income tax purposes.
d.	The individual's equity in the former home becomes a countable resource effective with the first day of the month following the month it is no longer his or her principal place of residence.
e.	The home will still be considered the individual's principal place of residence and retain the exemption if all of the following conditions apply:
i)	The individual is institutionalized.
ii)	The individual intends to return home whether or not in fact he or she does return home.
iii)	The intent to return home is documented in writing.
iv)	The intent to return home applies to the home the individual or spouse was living in prior to being institutionalized or a replacement house as long as a spouse or dependent relative continues to live there. Dependent relative is defined as one who is claimed as a dependent for federal income tax purposes.
v)	The intent to return home also applies if the client is living in an assisted living/alternative care facility (ALF/ACF) and receives HCBS while in that facility or transfers into a Long Term Care institution to receive services. As a result of the client having no ownership interest in the ALF/ACF this will not be considered their principal place of residence.
vi)	For an institutionalized individual in a Long Term Care institution, receiving HCBS or enrolled in the PACE program, the exemption for the principal place of residence does not apply to a residence which has been transferred to a trust or other entity, such as a partnership or corporation. If the residence is transferred back into the name of the individual's name, the exemption will be regained.
See 8.100.5.M.2.g for more information.
f.	The principal place of residence, which is subject to estate recovery, becomes a countable resource upon the execution and recording of a beneficiary deed. The exemption can be regained if a revocation of the beneficiary deed is executed and recorded.
For applications filed on or after January 1, 2006, an individual’s home if:
i)	The individual’s equity interest in the home is $500,000 or less, or
ii)	The individual’s equity interest in the home exceeds $500,000 and the individual’s spouse, dependent child under the age of 21, or blind or disabled child resides in the home.
g.	Excess real property will not be included in countable resources as long as reasonable efforts to sell it have been unsuccessful. Reasonable efforts to sell means:
i)	The property is listed with a real estate agent at current market value.
ii)	If owner listed, the property must be for sale at current market value, advertised and shown to the public.
iii)	Any reasonable offer must be accepted and the owner has the burden of demonstrating that an offer was not reasonable.
iv)	If an offer is received that is at least two-thirds of the current market value, the individual must present evidence to establish that the offer was unreasonable.
v)	The client must continue reasonable efforts to sell and must submit verification of these efforts to the eligibility site on a quarterly basis. Reasonable effort is at eligibility site discretion.
h.	One automobile is totally excluded regardless of its value if it is used for transportation for the individual or a member of the individual's household. An automobile includes, in addition to passenger cars, other vehicles used to provide necessary transportation.
i.	Household goods are not counted as a resource to an individual (and spouse, if any) if they are:
i)	Items of personal property, found in or near the home, that are used on a regular basis; or
ii)	Items needed by the household for maintenance, use and occupancy of the premises as a home.
iii)	Such items include but are not limited to: furniture, appliances, electronic equipment such as personal computers and television sets, carpets, cooking and eating utensils, and dishes.
j.	Personal effects are not counted as a resource to an individual (and spouse, if any) if they are:
i)	Items of personal property ordinarily worn or carried by the individual; or
ii)	Articles otherwise having an intimate relation to the individual.
iii)	Such items include but are not limited to: personal jewelry including wedding and engagement rings, personal care items, prosthetic devices, and educational or recreational items such as books or musical instruments.
iv)	Items of cultural or religious significance to the individual and items required because of an individual’s impairment are also not counted as a resource.
k.	The cash surrender value of all life insurance policies owned by an individual and spouse, if any, is a countable resource. However, if the total face value of all life insurance policies does not exceed $1500 on any person, the cash surrender value of those policies will be excluded.
l.	Term life insurance having no cash surrender value, and burial insurance, the proceeds of which can be used only for burial expenses, are not countable toward the resource limit.
m.	The total value of burial spaces for the applicant/recipient, his/her spouse and any other members of his/her immediate family is exempt as a resource. If any interest is earned on the value of an agreement for the purchase of a burial space, such interest is also exempt.
n.	An applicant or recipient may own burial funds through an irrevocable trust or other irrevocable arrangement which are available for burial and are held in an irrevocable burial contract, an irrevocable burial trust, or in an irrevocable trust which is specifically identified as available for burial expenses without such funds affecting the person's eligibility for assistance.
o.	An applicant or recipient may also own up to $1,500 in burial funds through a revocable account, trust, or other arrangement for burial expenses, without such funds affecting the person's eligibility for assistance. This exclusion only applies if the funds set aside for burial expenses are kept separate from all other resources not intended for burial of the individual or spouse's burial expenses. Interest on the burial funds is also excluded if left to accumulate in the burial fund. For a married couple, a separate $1500 exemption applies to each spouse.
The $1500 exemption is reduced by:
i)	the amount of any irrevocable burial funds such as are described in the preceding subparagraph, and
ii)	the face value of any life insurance policy whose cash surrender value is exempt.
3.	Countable resources include the following:
a.	Cash;
b.	Funds held by a financial institution in a checking or savings account, certificate of deposit or money market account;
c.	Current market value of stocks, bonds, and mutual funds;
d.	All funds in a joint account are presumed to be a resource of the applicant or client. If there is more than one applicant or client account holder, it is presumed that the funds in the account belong to those individuals in equal shares. To rebut this presumption, evidence must be furnished that proves that some or all of the funds in a jointly held account do not belong to him or her. To rebut the sole ownership presumption, the following procedure must be followed:
i)	Submit statements from all of the account holders regarding who owns the funds, why there is a joint account, who has made deposits and withdrawals, and how withdrawals have been spent.
ii)	Submit account records showing deposits, withdrawals and interest in the months for which ownership of funds is at issue.
iii)	Correct the account title and submit revised account records showing that the applicant or client is no longer an account holder or separate the funds to show they are solely owned by the individual according to timelines defined by the Department. Please review the Department User Reference Guide for timeframes.
e.	Any real property that is subject to a recorded beneficiary deed and on which an estate recovery claim can be made.
f.	For applications filed on or after January 1, 2006, an individual’s home if the individual’s equity interest in the home exceeds $500,000 and the individual’s spouse, dependent child under the age of 21, or blind or disabled child does not reside in the home.
g.	Real property not exempt as the principal place of residence and not exempt as income producing property with a value of $6000 or less, as described in this section.
h.	When the applicant alleges that the sale of real property would cause undue hardship to the co-owner due to loss of housing, all of the following information must be obtained:
i)	The applicant or client's signed statement to that effect.
ii)	Verification of joint ownership.
iii)	A statement from the co-owner verifying the following:
1)	The property is used as his principal place of residence.
2)	The co-owner would have to move if the property were sold.
3)	The co-owner would be unable to buy the applicant or client's interest in the property.
i.	There is no other readily available residence because there is no other affordable housing available or no other housing with the necessary modifications for the co-owner if he is a person with disabilities.
j.	Personal property such as a mobile home or trailer or the like, that is not exempt as a principal place of residence or that is not income producing.
k.	Personal effects acquired or held for their value or as an investment. Such items can include but are not limited to: gems, jewelry that is not worn or held for family significance, or collectibles.
l.	The equity value of all automobiles that are in addition to one exempt vehicle.
m.	The cash surrender value of life insurance policies if the face value exceeds $1500.
n.	Promissory notes established before April 1, 2006 are treated as follows:
i)	The fair market value of a promissory note, mortgage, installment contract or similar instrument is an available countable resource.
ii)	In order to determine the fair market value, the applicant shall obtain three estimates of fair market value from a private note broker, who is engaged in the business of purchasing such notes. In order to obtain the estimates and locate willing buyers, the note shall be advertised in a newspaper with state wide circulation under business or investment opportunities.
iii)	A note or similar instrument which transferred funds or assets for less than fair market value shall be considered as a transfer without fair consideration and a period of ineligibility shall be imposed.
o.	Promissory notes established on or after April 1, 2006 are treated as follows:
i)	The value of a promissory note, loan or mortgage is an available countable resource unless the note, loan or mortgage:
ii)	Has a repayment term that is actuarially sound based on the individual’s life expectancy as found in the tables in Long Term Care section for annuities purchased on or after February 8, 2006;
iii)	Provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and
1)	Prohibits the cancellation of the balance upon the death of the lender.
2)	The value of a promissory note, loan or mortgage which does not meet the criteria in outlined in 8.100.5.M.3.o.i)-iii) is the outstanding balance due as of the date of the individual’s application for HCBS, PACE or institutional services and is subject to the transfer without fair consideration provisions as outlined in section 8.100.7.
p.	Promissory notes established on or after March 1, 2007 are treated as follows:
i)	The value of a promissory note, loan or mortgage is the outstanding balance due as of the date of the individual’s application for HCBS, PACE or institutional services and is an available countable resource, and
ii)	A promissory note, loan or mortgage which does not meet the following criteria shall be a transfer without fair consideration and subject to the provisions outlined in the Long Term Care Medical Assistance section under Transfers Without Fair Consideration, 8.100.7.F.
1)	Has a repayment term that is actuarially sound based on the individual’s life expectancy as found in the tables in section 8.100.7.J for annuities purchased on or after February 8, 2006;
2)	Provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and
3)	Prohibits the cancellation of the balance upon the death of the lender.
4.	Treatment of Property Owned by Native Americans
a.	Effective July 1, 2009, notwithstanding any other requirement in 10 C.C.R. 2505-10, Section 8, the following property shall be considered exempt for the purpose of determining Medicaid resource eligibility for a Native American:
i)	Property, including real property and improvements, that is held in trust, subject to federal restrictions, or otherwise under the supervision of the Secretary of the Interior, located on a reservation, including any federally recognized Indian Tribe’s reservation, pueblo, or colony, including former reservations in Oklahoma, Alaska Native regions established by the Alaska Native Claims Settlement Act, and Indian allotments on or near a reservation as designated and approved by the Bureau of Indian Affairs of the Department of the Interior;
ii)	For any federally recognized Tribe not described in 8.100.5.M.4.a.i, property located within the most recent boundaries of a prior federal reservation;
iii)	Ownership interests in rents, leases, royalties, or usage rights related to natural resources (including extraction of natural resources or harvesting of timber, other plants and plant products, animals, fish, and shellfish) resulting from the exercise of federally protected rights; and
iv)	Ownership interests in or usage rights to items that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable tribal law or custom.