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LTC Survival Tips
Judie Hughes, DHS Health Care Training
MFWCAA Conference – October 2008
Topics
LTC Concept ShiftRecent Policy UpdatesRecent Form ChangesInitiating a Transfer PenaltyMonthly ReportingAnnuities and LTCP Refresher
LTC Conceptual Shift
MA Payment of LTC Services
LTCF Long-Term Care Facility
CAC Community Alternative Care
CADI Community Alternatives for Disabled Individuals
DD Developmental Disabilities
EW Elderly Waiver
TBI Traumatic Brain Injury
Requesting MA-LTC
Application vs. Request
LTC Concept Shift
Review MA eligibility criteria
Basis of eligibility SSN Citizenship/ Identity Residency Income / Assets TPL
Review MA-LTC eligibility criteria
Screening Asset Assessment Home Equity Limit LTCP Annuity (PRB) Income Calculation
Requirement Differences
Disability Waivers
LTCC or DD Community Income
Calculation
LTCF/EW
LTCC or PAS Asset Assessment Community Income
Calculation (EW w/o a community spouse)
LTC Income Calculation (SIS-EW and LTCF)
Requirement Similarities
Home Equity Limit Annuity - Naming DHS the PRB LTCP Transfer Rules
MA-LTC Conceptual Shift
Recent Policy Updates
Recent Policy Updates
Eligibility Begin Date Home Maintenance Needs Allowance Community/Family Spouse Allocation LTCF Interaction with Medicare Part A Waiver Obligation Adjustments
Eligibility Begin Date
Process application prior to a move to Minnesota if:
Person is disabled or age 65 or over Cannot live outside of an institution
Notify facility of potential eligibility and approve when placed.
HCPM 07.20.25
Example
Noah lives in ICF-MR in OhioSister lives in MNRequesting MA-LTC in MN
Action:Process request up to approvalNotify MN ICF-MR of eligibilityApprove when move confirmed.
Home Maintenance Needs Allowance
Reside in an LTCF Expected discharge within 3 months for
MA-LTC eligibility Expense to maintain a residence Did not reside with spouse, child < 21 or
certain tax dependents at time of entry
Bulletin #08-21-09
HCPM 23.15.10 / 23.20
Example
Lewis entered LTCF on 9/1/07 Applied MA-LTC 10/1/08 Expected discharge 12/1/08
Old Policy: Could not use
New Policy: Can use!
Spouse and Family Allocations
Adjustments made when client reports changes to spouse’s or family members’ income or expenses
Family Allocation allowed even if not made available
HCPM 23.15.10
LTCF Interaction with Medicare Part AMedicare Part A Covers
SNF care after 3+ days of hospitalization
Post-hospital services in a qualified SNF for up to 100 days beginning with day 20
HCPM 23.20
Waiver Obligation Adjustments
Adjust retroactively!
Request a voluntary repayment using the
Notice of Overpayment (DHS-4939).
HCPM 23.20
Recent Policy Updates
Recent Form Changes
Monthly Form Changes Document
LTCF Screening Date
What do you do if the LTCC date is not recorded on the DHS-1503?
Initiating a Transfer Penalty
Transfer Initiation Tidbits
Disability Waivers Community Income Calculation Must meet medical spenddown
LTCF LTC Income Calculation LTC spenddown entered as medical
spenddown in MMIS
Transfer Initiation Tidbits
Elderly Waiver Community Income Calculation Must meet medical spenddown to be
eligible. Cost of waiver services actually
receiving used to meet medical spenddown.
Do not have to actually be approved eligible for EW to initiate the transfer
penalty!
Initiating a Transfer Penalty
Monthly Reporting
Income Calculation
LTC LTCF resident SIS-EW EW with a community spouse
Community EW without a community spouse Disability Waivers
HC ELIG - BHSM10/06/08 11:59:13 MAXIS FMTIAAM1 Version: 01 Of 01 Health Care Eligibility Results Process Dt: 10/06/08UNAPPROVED Basic HC Summary And Approval (BHSM) Appl Dt: 09/01/08 App Dt: Program: MA Ref Nbr: 01 TESTING, ADA A PMI Nbr: 2720 Current Program Status........ PENDING Responsible County........ 91 Eligibility Result.................... ELIGIBLE Servicing Location........... 91 Source Of Information...... STAT HRF Reporting................. MONTHLY 12 Month Renewal Date......... 08 01 09 6 Month Income Renewal Date... 02 01 09 Elig Type......................... EX Major Program................ MA TMA/TYMA Begin Date........... __ __ TMA/TYMA Type............. __ * * * * * * * * * * * * * * * * Worker Message * * * * * * * * * * * * * * * ***************************APPROVAL OF RESULTS REQUIRED Function: ELIG Case Nbr: 154763 Month: 11 08 Command: ____ __ __Sv: 91 PW: PWJMH59 SW: Name: TESTING, ADA A User: PWJMH59
Monthly Reporters
Monthly Reporting
= Manual Monthly Spenddown
LTC Income Calculation
HRF sent when earned income
> $80/month
Based on Special Personal Allowance from Earned Income Deduction•Certified disabled•Employed under IPR•Reside in LTCF
Special Personal Allowance Deductions
Allow the following deductions: First $80 of earned income FICA Transportation costs Employment expenses State and federal taxes if not exempt
Allowance Criteria Not Met
FIAT BHSM when income is
≤ $80 each month and it cannot be reasonably anticipated
LTC Income Calculation
HRF sent when earned income is > $80 per month
FIAT to monthly reporter when income is ≤ $80 per month and Special Personal Allowance is not available
Community Income Calculation
FIAT when MAXIS: Determines earned income is non-
varying – FIAT “HRF reporting” field to monthly as needed
Determines a manual monthly spenddown - FIAT automated monthly spenddown and “HRF reporting” field to monthly as needed
Monthly Reporters
Annuities
LTCF and All Waivers
Bulletin #08-21-04
Designating DHS the PRB
Requesting MA-LTC Meets all MA and MA-LTC eligibility
criteria Client and/or client spouse is the owner
of the annuity
Death benefit can be designated to other than surviving spouse
An annuity transaction occurred
Steps for Designation
Send DHS-5036 or DHS-5036A to client. Set DAIL/WRIT for 10 days. Approved MA-LTC
Send signed DHS-5036 or DHS-5036A with the DHS-5037 to the annuity issuer. Set DAIL/WRIT 30 days
Annuities as Transfers
Client eligible for MA and MA-LTC Client and/or spouse has ownership
interest Client and/or spouse funded the annuity Annuity has been annuitized Not assignable or revocable
Transfer Evaluation Methods
Method 1 Client is a payee Annuity transaction occurred
Method 2 Annuitized during lookback period or
while enrollee Method 1 conditions not met
Transfer Evaluation Methods
Method 1 Commercial Equal payments not deferred or balloon Actuarially sound
Method 2 Commercial Equal monthly payments – not deferred or
balloon Actuarially sound
Annuities
LTC Partnership
651-431-7446 or 1-888-234-5189
Bulletin #08-21-08
LTCP Example
Catherine and Raymond are married Raymond lives in their home – no
services Catherine:
Requests MA-LTC on 9/8/08 Resides in an LTCF Has LTC Insurance Meets all MA and MA-LTC criteria except
assets
Example – Asset Assessment
$297,000 ÷ 2 = $148,500 half of total assets
$148,000 > $104,400 maximum asset allowance
$297,000 - $104,400 = $192,600 attributed to Catherine
Attributed assets are: $150,000 cabin property $42,600 savings account
Example – A.
DHS-5426A and
copy of policy returned.
Action: Submit HealthQuest
Example – B.
HealthQuest response:Qualified LTCPBenefits partially paid as of 9/24/08$190,000 paid (PAL)
Action: Send DHS-5426 and DHS-5426C. Set 30 day DAIL/WRIT.
Example – C.
Catherine designates:Property ($150,000)Savings Account ($42,600)
Action: Send DHS-5426C back for update. Set 10 day DAIL/WRIT.
Example – D.
Catherine designates:Property ($150,000) – fully protectedSavings Account ($42,600) - partial
Action: Enter case note. Update STAT and TPL. Approve MA-LTC. Set 60-days
before renewal DAIL/WRIT.
Example – Renewal
DAIL/WRIT received 7/1/09Catherine renewal 9/1/08
Action: Send insurance provider a signed copy of DHS-5426A and a –DHS-5426E. Set 10 day DAIL/WRIT.
Example – E.
5426E returned:Benefits exhausted$70,000 in additional benefits paid
Action:PAL = $260,000 ($190,000 + $70,000)Send DHS-5426D with DHS-5426Set 30 day DAIL/WRIT
Example – F.
5426D returned:Cabin property transferred
($209,000)Savings Account $43,000
Action:LTCP renewal process complete.$8,000 unprotected amount.
LTCP
Final Thoughts
