CELA flashcards
CELA · Build recall with a focused review session.
33 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Countable resource limit
- For Medicaid long-term care, a single applicant generally may retain no more than $2,000 in countable resources; a married couple uses the CSRA range set annually.
- Community spouse resource allowance
- The share of a couple's combined countable resources the community spouse may keep, bounded by an annually indexed floor and ceiling; amounts above the ceiling pass to the institutionalized spouse.
- Monthly maintenance needs allowance
- The minimum monthly income the community spouse may retain; if the couple's income falls short, a fair hearing or court order can divert the institutionalized spouse's income.
- Five-year look-back
- The period during which states review asset transfers made for less than fair market value before a Medicaid long-term care application; disqualifying transfers create a penalty period.
- Penalty period calculation
- The uncompensated transfer value is divided by the state's average private-pay nursing facility daily rate; the quotient is the number of days of ineligibility.
- Penalty start date
- The penalty begins the later of the first day of the month of institutionalization or the month of the transfer; partial months round down and the remainder is disregarded.
- Home equity limit
- Home equity above the annually indexed statutory maximum counts as a countable resource unless a spouse, dependent, or certain caregiver resides there.
- Medicaid estate recovery
- States may recover Medicaid costs from a deceased recipient's probate estate; recovery is deferred during a surviving spouse's life and while certain heirs occupy the home.
- Durable power of attorney
- A written authorization that survives the principal's incapacity; gifting authority must be expressly stated before an agent may make uncompensated transfers.
- Testamentary capacity
- The testator must understand the nature of the act, the property owned, the natural objects of bounty, and the disposition being made when the will is executed.
- Undue influence
- A will or transfer is voidable when another person substitutes their intent for the testator's through a confidential relationship, susceptibility, and suspicious circumstances.
- Representative payee
- A person or entity appointed to receive Social Security or SSI benefits on behalf of a beneficiary and apply them solely to the beneficiary's needs.
- Spousal impoverishment rules
- Provisions letting the community spouse retain a set share of resources and income so the institutionalized spouse can qualify for Medicaid without leaving the spouse destitute.
- Hardship waiver
- A state process that may reduce or waive a Medicaid transfer penalty when denial would deprive the applicant of food, clothing, shelter, or medical care.
- Caregiver child exception
- A transfer of the home to a child who lived there and provided care for at least two years before institutionalization may be exempt from penalty.
- Sibling joint ownership exception
- A home transfer to a sibling with an equity interest who lived there at least one year before institutionalization is exempt from the transfer penalty.
- First-party special needs trust
- A trust holding the beneficiary's own assets, established before age 65 by the beneficiary, parent, grandparent, guardian, or court, and containing a Medicaid payback clause.
- Third-party special needs trust
- A trust funded with assets never owned by the beneficiary, typically by parents or grandparents; no age limit, no payback, and remainder passes to chosen beneficiaries.
- Medicaid payback clause
- A required provision in first-party and pooled trusts directing the trustee, on the beneficiary's death, to reimburse the state for Medicaid benefits paid before other distributions.
- Pooled trust
- A trust managed by a nonprofit association holding accounts for multiple beneficiaries; first-party accounts require payback, and a separate sub-account is kept for each person.
- ABLE account
- A tax-advantaged account for a person with a qualifying disability, allowing annual contributions up to the gift tax exclusion and tax-free withdrawals for qualified disability expenses.
- ABLE contribution limit
- For 2024, total annual contributions to an ABLE account are capped at $18,000, plus a limited additional contribution from the beneficiary's own earned income.
- ABLE SSI resource exclusion
- ABLE account balances up to $100,000 are disregarded for SSI resource limits; amounts above that reduce eligibility but do not affect Medicaid eligibility.
- Qualified disability expenses
- Expenses related to the beneficiary's blindness or disability, including education, housing, transportation, health, assistive technology, and financial management, that support improved independence.
- Sole benefit rule
- An SNT must exist for the sole benefit of the beneficiary; trust language must bar distributions to others and prohibit the beneficiary from compelling distributions.
- SSI resource limit
- An individual may hold no more than $2,000 in countable resources to receive SSI; a married couple may hold $3,000; an excluded SNT does not count.
- In-kind support and maintenance
- Food or shelter provided by others reduces SSI; the presumed maximum value reduction equals one-third of the federal benefit rate plus $20.
- SNT cash distribution
- Cash paid directly to a beneficiary is countable income in the month received and a countable resource in the following month, which can jeopardize SSI eligibility.
- SNT shelter distribution
- Trust payments for rent, mortgage, or utilities may be treated as in-kind support and maintenance, reducing SSI by the presumed maximum value unless an exception applies.
- Trustee discretion standard
- The trustee holds sole and absolute discretion over distributions; the beneficiary must have no enforceable right to compel payments, or the trust may be counted as a resource.
- Special needs trust remainder
- After Medicaid payback in a first-party trust, remaining assets pass to named remainder beneficiaries; a third-party trust has no payback and passes entirely as directed.
- Supplemental needs trust purpose
- A trust that supplements rather than supplants public benefits, funding goods and services not provided by Medicaid, SSI, or other programs.
- Trustee successor selection
- The trust document should name successor trustees and a mechanism for appointment so administration continues without court intervention if the original trustee resigns or dies.