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us/statute/42/1396p/f — Disqualification for long-term care assistance for individuals with substantial home equity · Axiom

Disqualification for long-term care assistance for individuals with substantial home equity

9 rules0 of 4 subsections

Official source

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(1)

(1)#

(A) Notwithstanding any other provision of this subchapter, subject to subparagraphs (B) and (C) of this paragraph and paragraph (2), in determining eligibility of an individual for medical assistance with respect to nursing facility services or other long-term care services, the individual shall not be eligible for such assistance if the individual’s equity interest in the individual’s home exceeds $500,000.

(B) A State may elect, without regard to the requirements of section 1396a(a)(1) of this title (relating to statewideness) and section 1396a(a)(10)(B) of this title (relating to comparability), to apply subparagraph (A) by substituting for “$500,000”, an amount that exceeds such amount, but does not exceed $750,000.

(C) The dollar amounts specified in this paragraph shall be increased, beginning with 2011, from year to year based on the percentage increase in the consumer price index for all urban consumers (all items; United States city average), rounded to the nearest $1,000.

(2)#

Paragraph (1) shall not apply with respect to an individual if—

(A) the spouse of such individual, or

(B) such individual’s child who is under age 21, or (with respect to States eligible to participate in the State program established under subchapter XVI) is blind or permanently and totally disabled, or (with respect to States which are not eligible to participate in such program) is blind or disabled as defined in section 1382c of this title ,

is lawfully residing in the individual’s home.

(3)#

Nothing in this subsection shall be construed as preventing an individual from using a reverse mortgage or home equity loan to reduce the individual’s total equity interest in the home.

(4)#

The Secretary shall establish a process whereby paragraph (1) is waived in the case of a demonstrated hardship.

in view

Whole section

Encodings · 9

statutory_home_equity_limit42 USC § 1396p (f) · parameter

42 U.S.C. 1396p(f)(1)(A)

name: statutory_home_equity_limit
kind: parameter
dtype: Money
unit: USD
period: Year
source: 42 U.S.C. 1396p(f)(1)(A)
metadata:
  proof:
    atoms:
      - path: versions[0].formula
        kind: amount
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: exceeds $500,000
versions:
  - effective_from: '2011-01-01'
    formula: '500000'

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maximum_state_substituted_home_equity_limit42 USC § 1396p (f) · parameter

42 U.S.C. 1396p(f)(1)(B)

name: maximum_state_substituted_home_equity_limit
kind: parameter
dtype: Money
unit: USD
period: Year
source: 42 U.S.C. 1396p(f)(1)(B)
metadata:
  proof:
    atoms:
      - path: versions[0].formula
        kind: amount
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: does not exceed $750,000
versions:
  - effective_from: '2011-01-01'
    formula: '750000'

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home_equity_limit_rounding_multiple42 USC § 1396p (f) · parameter

42 U.S.C. 1396p(f)(1)(C)

name: home_equity_limit_rounding_multiple
kind: parameter
dtype: Money
unit: USD
period: Year
source: 42 U.S.C. 1396p(f)(1)(C)
metadata:
  proof:
    atoms:
      - path: versions[0].formula
        kind: amount
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: rounded to the nearest $1,000
versions:
  - effective_from: '2011-01-01'
    formula: '1000'

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adjusted_statutory_home_equity_limit42 USC § 1396p (f) · derived

42 U.S.C. 1396p(f)(1)(C)

name: adjusted_statutory_home_equity_limit
kind: derived
entity: Person
dtype: Money
unit: USD
period: Year
source: 42 U.S.C. 1396p(f)(1)(C)
metadata:
  proof:
    atoms:
      - path: versions[0].formula
        kind: formula
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: >-
            increased, beginning with 2011, from year to year based on the
            percentage increase in the consumer price index
      - path: versions[0].formula
        kind: amount
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: rounded to the nearest $1,000
versions:
  - effective_from: '2011-01-01'
    formula: >-
      floor(((statutory_home_equity_limit * (1 +
      cumulative_cpi_u_increase_rate_since_statutory_base_year)) /
      home_equity_limit_rounding_multiple) + 0.5) *
      home_equity_limit_rounding_multiple

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adjusted_maximum_state_substituted_home_equity_limit42 USC § 1396p (f) · derived

42 U.S.C. 1396p(f)(1)(C)

name: adjusted_maximum_state_substituted_home_equity_limit
kind: derived
entity: Person
dtype: Money
unit: USD
period: Year
source: 42 U.S.C. 1396p(f)(1)(C)
metadata:
  proof:
    atoms:
      - path: versions[0].formula
        kind: formula
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: The dollar amounts specified in this paragraph shall be increased
      - path: versions[0].formula
        kind: amount
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: rounded to the nearest $1,000
versions:
  - effective_from: '2011-01-01'
    formula: >-
      floor(((maximum_state_substituted_home_equity_limit * (1 +
      cumulative_cpi_u_increase_rate_since_statutory_base_year)) /
      home_equity_limit_rounding_multiple) + 0.5) *
      home_equity_limit_rounding_multiple

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applicable_home_equity_limit42 USC § 1396p (f) · derived

42 U.S.C. 1396p(f)(1)(A)-(C)

name: applicable_home_equity_limit
kind: derived
entity: Person
dtype: Money
unit: USD
period: Year
source: 42 U.S.C. 1396p(f)(1)(A)-(C)
metadata:
  proof:
    atoms:
      - path: versions[0].formula
        kind: formula
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: >-
            A State may elect ... by substituting for "$500,000", an amount that
            exceeds such amount, but does not exceed $750,000
versions:
  - effective_from: '2011-01-01'
    formula: >-
      if state_elects_higher_home_equity_limit:
      min(max(state_substituted_home_equity_limit_amount,
      adjusted_statutory_home_equity_limit),
      adjusted_maximum_state_substituted_home_equity_limit) else:
      adjusted_statutory_home_equity_limit

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paragraph_1_home_equity_bar_waived_for_hardship42 USC § 1396p (f) · derived

42 U.S.C. 1396p(f)(4)

name: paragraph_1_home_equity_bar_waived_for_hardship
kind: derived
entity: Person
dtype: Judgment
period: Month
source: 42 U.S.C. 1396p(f)(4)
metadata:
  proof:
    atoms:
      - path: versions[0].formula
        kind: exception
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: paragraph (1) is waived in the case of a demonstrated hardship
versions:
  - effective_from: '2011-01-01'
    formula: demonstrated_hardship_waiver_granted

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paragraph_1_home_equity_bar_exception_applies42 USC § 1396p (f) · derived

42 U.S.C. 1396p(f)(2)

name: paragraph_1_home_equity_bar_exception_applies
kind: derived
entity: Person
dtype: Judgment
period: Month
source: 42 U.S.C. 1396p(f)(2)
metadata:
  proof:
    atoms:
      - path: versions[0].formula
        kind: exception
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: >-
            Paragraph (1) shall not apply ... if ... spouse ... or ... child ...
            is lawfully residing in the individual's home
versions:
  - effective_from: '2011-01-01'
    formula: >-
      spouse_lawfully_resides_in_individual_home

      or child_under_age_21_lawfully_resides_in_individual_home

      or child_blind_lawfully_resides_in_individual_home

      or
      child_permanently_and_totally_disabled_lawfully_resides_in_individual_home

      or
      child_disabled_as_defined_in_section_1382c_lawfully_resides_in_individual_home

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is_medicaid_long_term_care_home_equity_eligible42 USC § 1396p (f) · derived

42 U.S.C. 1396p(f)(1)-(4)

name: is_medicaid_long_term_care_home_equity_eligible
kind: derived
entity: Person
dtype: Judgment
period: Month
source: 42 U.S.C. 1396p(f)(1)-(4)
metadata:
  proof:
    atoms:
      - path: versions[0].formula
        kind: predicate
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: >-
            the individual shall not be eligible ... if the individual's equity
            interest ... exceeds $500,000
      - path: versions[0].formula
        kind: exception
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: Paragraph (1) shall not apply
      - path: versions[0].formula
        kind: exception
        source:
          corpus_citation_path: us/statute/42/1396p/f
          excerpt: paragraph (1) is waived in the case of a demonstrated hardship
versions:
  - effective_from: '2011-01-01'
    formula: |-
      individual_home_equity_interest <= applicable_home_equity_limit
      or paragraph_1_home_equity_bar_exception_applies
      or paragraph_1_home_equity_bar_waived_for_hardship

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▸rulespec code

Shown source

statutes/42/1396p/f.yaml

Displaying the canonical repository encoding.

Rules

statutory_home_equity_limit

Parameter

source: 42 U.S.C. 1396p(f)(1)(A)

- name: statutory_home_equity_limit
  kind: parameter
  dtype: Money
  unit: USD
  period: Year
  source: 42 U.S.C. 1396p(f)(1)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: amount
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: exceeds $500,000
  versions:
    - effective_from: '2011-01-01'
      formula: '500000'

maximum_state_substituted_home_equity_limit

Parameter

source: 42 U.S.C. 1396p(f)(1)(B)

- name: maximum_state_substituted_home_equity_limit
  kind: parameter
  dtype: Money
  unit: USD
  period: Year
  source: 42 U.S.C. 1396p(f)(1)(B)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: amount
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: does not exceed $750,000
  versions:
    - effective_from: '2011-01-01'
      formula: '750000'

home_equity_limit_rounding_multiple

Parameter

source: 42 U.S.C. 1396p(f)(1)(C)

- name: home_equity_limit_rounding_multiple
  kind: parameter
  dtype: Money
  unit: USD
  period: Year
  source: 42 U.S.C. 1396p(f)(1)(C)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: amount
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: rounded to the nearest $1,000
  versions:
    - effective_from: '2011-01-01'
      formula: '1000'

adjusted_statutory_home_equity_limit

Derived

source: 42 U.S.C. 1396p(f)(1)(C)

- name: adjusted_statutory_home_equity_limit
  kind: derived
  entity: Person
  dtype: Money
  unit: USD
  period: Year
  source: 42 U.S.C. 1396p(f)(1)(C)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: >-
              increased, beginning with 2011, from year to year based on the percentage increase in
              the consumer price index
        - path: versions[0].formula
          kind: amount
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: rounded to the nearest $1,000
  versions:
    - effective_from: '2011-01-01'
      formula: >-
        floor(((statutory_home_equity_limit * (1 +
        cumulative_cpi_u_increase_rate_since_statutory_base_year)) /
        home_equity_limit_rounding_multiple) + 0.5) * home_equity_limit_rounding_multiple

adjusted_maximum_state_substituted_home_equity_limit

Derived

source: 42 U.S.C. 1396p(f)(1)(C)

- name: adjusted_maximum_state_substituted_home_equity_limit
  kind: derived
  entity: Person
  dtype: Money
  unit: USD
  period: Year
  source: 42 U.S.C. 1396p(f)(1)(C)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: The dollar amounts specified in this paragraph shall be increased
        - path: versions[0].formula
          kind: amount
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: rounded to the nearest $1,000
  versions:
    - effective_from: '2011-01-01'
      formula: >-
        floor(((maximum_state_substituted_home_equity_limit * (1 +
        cumulative_cpi_u_increase_rate_since_statutory_base_year)) /
        home_equity_limit_rounding_multiple) + 0.5) * home_equity_limit_rounding_multiple

applicable_home_equity_limit

Derived

source: 42 U.S.C. 1396p(f)(1)(A)-(C)

- name: applicable_home_equity_limit
  kind: derived
  entity: Person
  dtype: Money
  unit: USD
  period: Year
  source: 42 U.S.C. 1396p(f)(1)(A)-(C)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: >-
              A State may elect ... by substituting for "$500,000", an amount that exceeds such
              amount, but does not exceed $750,000
  versions:
    - effective_from: '2011-01-01'
      formula: >-
        if state_elects_higher_home_equity_limit:
        min(max(state_substituted_home_equity_limit_amount, adjusted_statutory_home_equity_limit),
        adjusted_maximum_state_substituted_home_equity_limit) else:
        adjusted_statutory_home_equity_limit

paragraph_1_home_equity_bar_waived_for_hardship

Derived

source: 42 U.S.C. 1396p(f)(4)

- name: paragraph_1_home_equity_bar_waived_for_hardship
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396p(f)(4)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: exception
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: paragraph (1) is waived in the case of a demonstrated hardship
  versions:
    - effective_from: '2011-01-01'
      formula: demonstrated_hardship_waiver_granted

paragraph_1_home_equity_bar_exception_applies

Derived

source: 42 U.S.C. 1396p(f)(2)

- name: paragraph_1_home_equity_bar_exception_applies
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396p(f)(2)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: exception
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: >-
              Paragraph (1) shall not apply ... if ... spouse ... or ... child ... is lawfully
              residing in the individual's home
  versions:
    - effective_from: '2011-01-01'
      formula: |-
        spouse_lawfully_resides_in_individual_home
        or child_under_age_21_lawfully_resides_in_individual_home
        or child_blind_lawfully_resides_in_individual_home
        or child_permanently_and_totally_disabled_lawfully_resides_in_individual_home
        or child_disabled_as_defined_in_section_1382c_lawfully_resides_in_individual_home

is_medicaid_long_term_care_home_equity_eligible

Derived

source: 42 U.S.C. 1396p(f)(1)-(4)

- name: is_medicaid_long_term_care_home_equity_eligible
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396p(f)(1)-(4)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: predicate
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: >-
              the individual shall not be eligible ... if the individual's equity interest ...
              exceeds $500,000
        - path: versions[0].formula
          kind: exception
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: Paragraph (1) shall not apply
        - path: versions[0].formula
          kind: exception
          source:
            corpus_citation_path: us/statute/42/1396p/f
            excerpt: paragraph (1) is waived in the case of a demonstrated hardship
  versions:
    - effective_from: '2011-01-01'
      formula: |-
        individual_home_equity_interest <= applicable_home_equity_limit
        or paragraph_1_home_equity_bar_exception_applies
        or paragraph_1_home_equity_bar_waived_for_hardship

▸citations (3)

References

This rule cites 3 other rules.

42 USC § 1396a (a)(1)inferredUS Federal › Statutes › Title 42 › § 1396a › (a)(1)
42 USC § 1396a (a)(10)(B)inferredUS Federal › Statutes › Title 42 › § 1396a › (a)(10)(B)
42 USC § 1382cinferredUS Federal › Statutes › Title 42 › § 1382c