Liens, adjustments and recoveries, and transfers of assets

No lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the State plan, except— in the case of the real property of an individual— No lien may be imposed under paragraph (1)(B) on such individual’s home if— No adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan may be made, except that the State shall seek adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan in the case of the following individuals: In the case of an individual who was 55 years of age or older when the individual received such medical assistance, the State shall seek adjustment or recovery from the individual’s estate, but only for medical assistance consisting of— Clause (i) shall not apply in the case of an individual who received medical assistance under a State plan of a State which had a State plan amendment approved as of May 14, 1993, and which satisfies clause (iv), or which has a State plan amendment that provides for a qualified State long-term care insurance partnership (as defined in clause (iii)) which provided for the disregard of any assets or resources— For purposes of this paragraph, the term “qualified State long-term care insurance partnership” means an approved State plan amendment under this subchapter that provides for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a long-term care insurance policy if the following requirements are met: If the policy is sold to an individual who— Any adjustment or recovery under paragraph (1) may be made only after the death of the individual’s surviving spouse, if any, and only at a time— in the case of a lien on an individual’s home under subsection (a)(1)(B), when— For purposes of this subsection, the term “estate”, with respect to a deceased individual— For purposes of clause (iii)(III), the model regulations and the requirements of the model Act specified in this paragraph are: In the case of the model regulation, the following requirements: In the case of the model Act, the following: For purposes of this paragraph and paragraph (1)(C)— The date specified in this clause, with respect to— The services described in this subparagraph with respect to an institutionalized individual are the following: With respect to an institutionalized individual, the number of months of ineligibility under this subparagraph for an individual shall be equal to— With respect to a noninstitutionalized individual, the number of months of ineligibility under this subparagraph for an individual shall not be greater than a number equal to— The number of months of ineligibility otherwise determined under clause (i) or (ii) with respect to the disposal of an asset shall be reduced— For purposes of this paragraph, the purchase of an annuity shall be treated as the disposal of an asset for less than fair market value unless— For purposes of this paragraph with respect to a transfer of assets, the term “assets” includes an annuity purchased by or on behalf of an annuitant who has applied for medical assistance with respect to nursing facility services or other long-term care services under this subchapter unless— the annuity is— purchased with proceeds from— the annuity— Notwithstanding the preceding provisions of this paragraph, in the case of an individual (or individual’s spouse) who makes multiple fractional transfers of assets in more than 1 month for less than fair market value on or after the applicable look-back date specified in subparagraph (B), a State may determine the period of ineligibility applicable to such individual under this paragraph by— For purposes of this paragraph with respect to a transfer of assets, the term “assets” includes funds used to purchase a promissory note, loan, or mortgage unless such note, loan, or mortgage— An individual shall not be ineligible for medical assistance by reason of paragraph (1) to the extent that— the assets transferred were a home and title to the home was transferred to— the assets— For purposes of this subsection, an individual shall be considered to have established a trust if assets of the individual were used to form all or part of the corpus of the trust and if any of the following individuals established such trust other than by will: Subject to paragraph (4), this subsection shall apply without regard to— In the case of a revocable trust— In the case of an irrevocable trust— if there are any circumstances under which payment from the trust could be made to or for the benefit of the individual, the portion of the corpus from which, or the income on the corpus from which, payment to the individual could be made shall be considered resources available to the individual, and payments from that portion of the corpus or income— This subsection shall not apply to any of the following trusts: A trust established in a State for the benefit of an individual if— A trust containing the assets of an individual who is disabled (as defined in section 1382c(a)(3) of this title) that meets the following conditions: Paragraph (1) shall not apply with respect to an individual if— For purposes of determining an individual’s eligibility for, or amount of, benefits under a State plan under this subchapter, the rules specified in paragraph (2) shall apply to individuals residing in continuing care retirement communities or life care communities that collect an entrance fee on admission from such individuals. For purposes of this subsection, an individual’s entrance fee in a continuing care retirement community or life care community shall be considered a resource available to the individual to the extent that— In this section, the following definitions shall apply: The term “assets”, with respect to an individual, includes all income and resources of the individual and of the individual’s spouse, including any income or resources which the individual or such individual’s spouse is entitled to but does not receive because of action—