For Reference Only Last Updated 02/10/2016 Resource Eligibility Requirements Resources

For Reference Only Last Updated 02/10/2016 Financial Eligibility  Costs Page 71

For Reference Only Last Updated 02/10/2016 Brainstorming  Money motivations of all different parties Page 72

For Reference Only Last Updated 02/10/2016 Home Accounts Life insurance policies Annuities Estates

For Reference Only Last Updated 02/10/2016 Inheritance Home Accounts Annuities

For Reference Only Last Updated 02/10/2016 Inheritance Medicaid is not in the business of protecting inheritances!

For Reference Only Last Updated 02/10/2016 Estate Recovery  Estate Recovery allows Medicaid to recoup expenses from an estate prior to any inheritance disbursements.

For Reference Only Last Updated 02/10/2016 Estate Recovery Home Accounts Annuities To Medicaid

For Reference Only Last Updated 02/10/2016 Estate Recovery  Allows for less harsh rules upfront  Homes, vehicles etc.

For Reference Only Last Updated 02/10/2016 Home Accounts Life insurance policies Annuities Spousal Impoverishment Medicaid eligible

For Reference Only Last Updated 02/10/2016 Home Accounts Life insurance policies Annuities Spousal Protection Medicaid eligible

For Reference Only Last Updated 02/10/2016 Resources Objectives: After this module, participants will be able to:  Identify different resource limits for LTC  Identify, calculate and data enter a TWFC/POI  Spend down a mock case without a TWFC or private payment by using exempt resources  List references to aid in data entry Goal: To understand resource eligibility rules and processes as well as the laws and problems that guide them. Page 81

For Reference Only Last Updated 02/10/2016 Resource Overview  Estate Recovery  Spousal Protection  Taxpayer interest  Applicant rights Page 76

For Reference Only Last Updated 02/10/2016 Transfer Without Fair Consideration (TWFC)  5 year look back  Seeks to prevent giveaways to become eligible  Considers structure of newer assets  Resources could have paid for care Page 77

For Reference Only Last Updated 02/10/2016 Transfers w/o Fair Consideration

For Reference Only Last Updated 02/10/2016 TWFC Examples  Gifts, giveaways  Unequal exchanges  Resources used for someone else  Some types of resources, based on structure Page 78

For Reference Only Last Updated 02/10/2016 Not Transfers w/o Fair Consideration Home Accounts Life insurance policies Annuities

For Reference Only Last Updated 02/10/2016 Not a TWFC  Transfers between spouses  Purchases for self or spouse  Pre-payments*  Transfers between existing accounts/resources

For Reference Only Last Updated 02/10/2016 Period of Ineligibility (POI)  TWFC results in a POI  Medicaid will not pay for LTC services (NF or HCBS) during this period  Client is eligible to receive basic Medical Assistance based on the LTC limits! Page 79

For Reference Only Last Updated 02/10/2016 POI calculation  How long would this money have paid for care?  Uses state avg. private pay rate  Calculate to the day Page 80

For Reference Only Last Updated 02/10/2016 POI calculation example  $200,000  $200,000 / $7,563 = months  26 months and.44 months  30 X.44 = 13.2 days  Rounded up to 14 days  POI is 26 months and 14 days  2 years 2 months 14 days Page 80

For Reference Only Last Updated 02/10/2016 How to Generate the POI  Dispose of resource  Not fair consideration and  Amount RECEIVED for resource Page 81-87

For Reference Only Last Updated 02/10/2016 Run EDBC  Will show PASS for MA  Initiate Wrap-up  Medical Financial Eligibility Program List

For Reference Only Last Updated 02/10/2016 Wrap-up  Highlight the Individual  Select Medical Financial Detail

For Reference Only Last Updated 02/10/2016 Wrap-up Medical Financial Detail  Resource Test tab  Individual Details  TWFC-POI tab

For Reference Only Last Updated 02/10/2016 After Authorization  Sanction, Disquals, and POIs page will be populated  Med Span displays LTC-YX

For Reference Only Last Updated 02/10/2016 Investigating Resources  Request 3 months and start with what is declared  Enter additional information packet as received  All declared transfers must be verified Page 88

For Reference Only Last Updated 02/10/2016 Additional Sources  All sources available to you are valid  CBMS  DMV  County Assessor  Additional requests as needed Page 89

For Reference Only Last Updated 02/10/2016 Tracking Spent Assets  Transactions on the way to resource eligibility  Focus on large transactions  Trust your gut  Don’t sweat the small stuff  Burden of proof is on the applicant Page 90

For Reference Only Last Updated 02/10/2016 Resource limits  $2,000 individual limit  $3,000 couple limit if both are on LTC  $4,000 couple limit if both are on LTC and in the same room Page 92

For Reference Only Last Updated 02/10/2016 Disregard Income

For Reference Only Last Updated 02/10/2016 Community Spouse Resource Allowance (CSRA)  $119,220 PLUS the individual limit  Combined at initial application  Transfer to Spouse by RRR Page 93

For Reference Only Last Updated 02/10/2016 Community Spouse  Cannot be institutionalized  May be on Medicaid if the qualify  Designation given to apply Spousal protections Page 95

For Reference Only Last Updated 02/10/2016 Living Arrangements Unshared Nursing Facility Home w/ Community Spouse Home w/ Institutionalized Spouse Nursing Facility-with Community Spouse Nursing Facility-Both in NF

For Reference Only Last Updated 02/10/2016 Types of Resources  Liquid Assets  Vehicles  Real Property  Burials  Life Insurance  Annuities  Trusts  Promissory Notes  Life Estates Page 96

For Reference Only Last Updated 02/10/2016 Liquid Assets  Bank Accounts  Retirement Accounts  Cash  Items held as an investment  Etc.

For Reference Only Last Updated 02/10/2016 Liquid Asset-Data Entry

For Reference Only Last Updated 02/10/2016 Liquid Asset-Data Entry

For Reference Only Last Updated 02/10/2016 Encumbrances

For Reference Only Last Updated 02/10/2016 Vehicle  Exempt one per person if used for transportation  Regardless of value  Use FMV  Bluebooks are guideline Page 99

For Reference Only Last Updated 02/10/2016 Vehicle

For Reference Only Last Updated 02/10/2016 Vehicle 1. Select Vehicle Button 2. Select Add Resource

For Reference Only Last Updated 02/10/2016 Intent to Sell  Exemption for vehicles and property  Must be listed  Client must accept reasonable offers  Request updates/verification every 3 months Page 100

For Reference Only Last Updated 02/10/2016 Real Property  Primary Home  Secondary properties  Mineral rights  Other income producing property Page 101

For Reference Only Last Updated 02/10/2016 Primary Home  Exempt up to $552,000 in equity  Must be living in home or “Intend to Return”  Exempt if Spouse or dependent relative live in home (no limit)  FMV

For Reference Only Last Updated 02/10/2016 Secondary Property  Equity is countable  Intent to sell can be applied  Appraisals as guideline

For Reference Only Last Updated 02/10/2016 Mineral Rights  Land appraisal if land is owned  Mineral rights only appraisal if not  Often low due to extraction costs  Income producing property exemption Page 102

For Reference Only Last Updated 02/10/2016 Income Producing Property  Exempt up to $6000  Non-business property  Business property producing a 6% return on the excluded value  Income is countable income Page 102

For Reference Only Last Updated 02/10/2016 Real Property Data Entry

For Reference Only Last Updated 02/10/2016 Real Property Data Entry

For Reference Only Last Updated 02/10/2016 Burial Assets  Burial plots, and irrevocable policies are exempt  Additional $1500 set aside per person as revocable  Saves Medicaid burial costs later  HCPF must be remainder beneficiary Page 104

For Reference Only Last Updated 02/10/2016 Burial Asset

For Reference Only Last Updated 02/10/2016 Life insurance  Per Person (Applicant and Spouse Page 105

For Reference Only Last Updated 02/10/2016 Life Insurance  Face value: Death benefit  Cash Value: Investment component  Cash Surrender Value: Amount received to ‘cash out’ the policy

For Reference Only Last Updated 02/10/2016 Term Life Insurance  Premium payments keep death benefit active (face value)  No cash value  No cash surrender value

For Reference Only Last Updated 02/10/2016 Whole Life Insurance  Also called Universal or Variable  Premium goes to death benefit and an investment fund  The investment fund is the cash value  The cash surrender value is a separate amount

For Reference Only Last Updated 02/10/2016 Life Insurance

For Reference Only Last Updated 02/10/2016 Data Entry Practice Page

For Reference Only Last Updated 02/10/2016 Spend Down Activity You represent and Applicant and Spouse who have $4800 income, a car and a home Get under the resource limit without a TWFC and without paying for your own care

For Reference Only Last Updated 02/10/2016 Annuities  An annuity is a contract between an individual and a commercial company  The individual invests a lump sum  The company pays out a specified number of installment payments Page 120

For Reference Only Last Updated 02/10/2016 Eligibility Concerns Purchased for someone else, or Structure designed to avoid:  Estate Recovery  Initial eligibility limits  Patient payments

For Reference Only Last Updated 02/10/2016 Revocable Annuities  Can be cancelled  Full value is a countable resource  Payments are not income Page 121

For Reference Only Last Updated 02/10/2016 Irrevocable Assignable Annuity  Can have its owner changed  Can be sold  Principal plus interest is countable  Payments are not income

For Reference Only Last Updated 02/10/2016 Irrevocable Unassignable Annuity  Everything is locked in  Payments are income  The annuity is not a countable resource  Inside 5 year look-back needs further evaluation

For Reference Only Last Updated 02/10/2016 Within 5 years  HCPF as beneficiary  Purchased from licensed company  For individual or spouse  Actuarially sound  No deferral or balloon payments Page 122

For Reference Only Last Updated 02/10/2016 Exceptions  Retirement annuities  Codes listed in workbook

For Reference Only Last Updated 02/10/2016 Annuity Data Entry Page 124

For Reference Only Last Updated 02/10/2016 Annuity Data Entry

For Reference Only Last Updated 02/10/2016 Beneficiary Tab

For Reference Only Last Updated 02/10/2016 What is a Trust?  A trust is an arrangement in which a party is given property on the condition it is used to benefit someone else Page 126

For Reference Only Last Updated 02/10/2016 Trusts are a legal entity  Not an asset themselves Trust Assets can be placed in a trust Assets

For Reference Only Last Updated 02/10/2016 Trusts exist outside of the individual’s estate

For Reference Only Last Updated 02/10/2016 Trust Process  Gather Trust Documents  Submit all trust to HCPF  Trust Officer will identify the type of trust  You apply eligibility rules Page 128

For Reference Only Last Updated 02/10/ Types of Trusts Page

For Reference Only Last Updated 02/10/2016 Data Entry  Trust Screen walks through trust rules

For Reference Only Last Updated 02/10/2016 Resources Wrap-up Objectives: Can you?  Identify different resource limits for LTC  Identify, calculate and data enter a TWFC/POI  Spend down a mock case without a TWFC or private payment by using exempt resources  List references to aid in data entry Goal: To understand resource eligibility rules and processes as well as the laws and problems that guide them. Page 135