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

judie.hughes@state.mn.us

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