Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Welcome to the Medicaid Policy Panel
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Welcome to the Medicaid Policy Panel Adult Medicaid Quiz (or…What you hoped you would never need to know about Adult Medicaid)
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel As you know, the recently completed Medicaid case review revealed several areas where we could improve. During the course of this meeting, we will be addressing these areas, but first, we want to find out what we may (or may not) know about policy in these areas.
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel The following questions are taken from our Adult Medicaid Basic Training pre/post tests, as well as questions that relate to the Medicaid review itself.
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Don’t sweat this test! It’s designed to give you some points to ponder and to give us some talking points. It will also challenge what you may believe regarding this policy and review findings.
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Let others take the test as well! When you get back home, you can access the PowerPoint version of this test. You can use it as a training tool for your staff. The test is located under the Learning Sessions area of the Adult Medicaid web site located at
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #1 Place in order (from most error-prone to least), the following causes of errors during the recent Medicaid review Income Eligibility Pass-Through Eligibility Resources (Burial issues) On-going ineligibles
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And the Answer Is Place in order (from most error-prone to least), the following causes of errors during the recent Medicaid review Resources (Burial issues) On-going ineligibles Pass-Through Eligibility Income Eligibility
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #2 Which of the following are technical eligibility factors that must be met in order to meet requirements for Long Term Care? Check all that apply: A. Resides in a nursing facility listed on KAMES Inquiry B. Aged, Blind or Disabled C. Enrolled in Part B of Medicare D. A resident of Kentucky E. Sign the MA 36 F. A US citizen or qualified Alien G. Verification of shelter expenses H. Enumeration I. Third Party Liability J. Knows someone in high places
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And, the Answer Is Which of the following are technical eligibility factors that must be met in order to meet requirements for Long Term Care? Check all that apply: B. Aged, Blind or Disabled D. A resident of Kentucky F. A US citizen or qualified Alien H. Enumeration I. Third Party Liability
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #3 Which of the following are “Excluded Resources” for AMA? Check all that apply: A. Term and burial Insurance B. Homestead property during the first six months of continuous institutionalization C. Homestead property after the first six months of continuous institutionalization, when the spouse resides at the property D. Nursing home savings account E. One vehicle, if used for employment, to obtain medical treatment, or is equipped for the disabled F. Two vehicles, one used for medical transportation, and one used for employment G. All resources of an SSI individual H. Gravesites, crypts, caskets, and headstones I. $1,500 burial exclusion for each member of the assistance group
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And, the Answer Is Which of the following are “Excluded Resources” for AMA? Check all that apply: A. Term and burial Insurance B. Homestead property during the first six months of continuous institutionalization C. Homestead property after the first six months of continuous institutionalization, when the spouse resides at the property E. One vehicle, if used for employment, to obtain medical treatment, or is equipped for the disabled G. All resources of an SSI individual H. Gravesites, crypts, caskets, and headstones I. $1,500 burial exclusion for each member of the assistance group
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #4 Wendy Frost has made application for HCBS. She has a fully funded irrevocable funeral contract in the amount of $5,500. The itemized contract shows that $4,700 of the $5,500 contract is for excludable burial items. She also has two life insurance policies. Policy A has a FV of $5,000 and CSV of $1,235. Policy B has a FV of $4,000 and a CSV of $921. A signed MA-36 is in the case record. What is the amount that should be added to her other resources to be compared to the Resource Scale? A. $2,156 C. $2956 B. $0 D. $2,056
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And the Answer is Since Wendy already had a fully funded funeral contract, she is not allowed to designate her life insurance policies as burial reserves. Therefore, the CSV of all the policies has to be considered as a regular resource. A. $2,156
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #5 Which of the following are technically eligible for the Pass Through Category? A. Individual lost SSI, but received at least one SSI check and one RSDI check in the same month correctly B. Individual received SSI due to disability as a child and lost SSI due to entitlement to or increase in RSDI DAC receipt C. Individuals who were disabled as a child and later recovered D. Individuals, ages 60-64, who lost SSI or SSP as a result of entitlement to RSDI early widow's or widower's benefits, and who are not yet entitled to Medicare Part A E. Individuals who received SSI and a private pension in the same month F. Individuals who received SSI or SSP and who lost SSI or SSP as a result of entitlement to RSDI disabled widow's or widower's or disabled surviving divorced spouse's benefits, and are not yet entitled to Medicare Part A.
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And the Answer Is Which of the following are technically eligible for the Pass Through Category? A. Individual lost SSI, but received at least one SSI check and one RSDI check in the same month correctly B. Individual received SSI due to disability as a child and lost SSI due to entitlement to or increase in RSDI DAC receipt D. Individuals, ages 60-64, who lost SSI or SSP as a result of entitlement to RSDI early widow's or widower's benefits, and who are not yet entitled to Medicare Part A F. Individuals who received SSI or SSP and who lost SSI or SSP as a result of entitlement to RSDI disabled widow's or widower's or disabled surviving divorced spouse's benefits, and are not yet entitled to Medicare Part A.
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #6 Which type of case would best suit the following? A.Lost their SSI due to a COLA increase in their RSDI B.Has Medicare A & B with countable income of $700 and no medical bills C.Has Medicare A & B, lives alone in home, countable income of $1345, has medical bill from prior month of $3000 D.Has Medicare A & B, lives alone in home, gross income of $600, pays a neighbor to cook meals and sort medicines daily
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And the Answer Is Which type of case would best suit the following? A. Lost their SSI due to a COLA increase in their RSDI Pass-through (F,G,H) B. Has Medicare A & B with countable income of $700 and no medical bills QMB (Z Case) C. Has Medicare A & B, lives alone in home, countable income of $1345, has medical bill from prior month of $3000 Spend Down (J,K,M) D. Has Medicare A & B, lives alone in home, gross income of $600, pays a neighbor to cook meals and sort medicines daily SSP (FP, GP, HP)
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #7 State Supplementation Samantha is single and lives in a Family Care Home. Her only income is $632 monthly from RSDI based upon her disability. If eligible for State Supp. What would the amount of her grant be? A.$149 B.$179 C.$163 D.$159
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And, the Answer Is State Supplementation Samantha is single and lives in a Family Care Home. Her only income is $632 monthly from RSDI based upon her disability. If eligible for State Supp. What would the amount of her grant be? C. $163 $795 Family Care home (includes $40 PNA) -632 monthly income $163 Monthly SSP Grant
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #8 Determine the amount of excess burial reserves: Mary Jones is a resident of an approved nursing facility. She has 3 life insurance policies and no funeral contract for burial. She has signed a MA-36 to designate all three policies for burial. Policy A – FV = $2500 CSV = $900 Policy B – FV = $1500 CSV = $236 Policy C – FV = $1500 CSV = $726 What is the amount of the excess burial reserve? A. $362B. $4000 C. $0D. $1500
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And the Answer Is Determine the amount of excess burial reserves: Mary Jones is a resident of an approved nursing facility. She has 3 life insurance policies and no funeral contract for burial. She has signed a MA-36 to designate all three policies for burial. Policy A – FV = $2500 CSV = $900 Policy B – FV = $1500 CSV = $236 Policy C – FV = $1500 CSV = $726 What is the amount of the excess burial reserve? A. $362 Policy A – FV = $2500 CSV = $900 Policy B – FV = $1500 CSV = $236 Policy C – FV = $1500 CSV = $726 Total $ Excess 362
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #9 Determine the total amount of resources: Susan Jones has been admitted to a Medicaid approved nursing facility. Her representative has provided verification of the following for Ms. Jones: Checking Account of $429 Savings Account of $682; Nursing Facility Account of $110 Prearranged funeral contract of $6,000 that is funded by a life insurance policy of $6,000 that has an irrevocable assignment of ownership to the funeral home. Excludable burial space items included in the funeral contract total $4,000. A. $7221B. $1221 C. $0D. $3221
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And the Answer Is Determine the total amount of resources: Susan Jones has been admitted to a Medicaid approved nursing facility. Her representative has provided verification of the following for Ms. Jones: Checking Account of $429 Savings Account of $682; Nursing Facility Account of $110 Prearranged funeral contract of $6,000 that is funded by a life insurance policy of $6,000 that has an irrevocable assignment of ownership to the funeral home. Excludable burial space items included in the funeral contract total $4,000. B. $1221 Since there is an irrevocable assignment of Ownership (rather than the Funeral Home being the “Beneficiary”) of the life insurance policy that funds the prearranged funeral contract, none of that insurance policy will be considered as a resource. The total of the other assets: $429 + $682 + $110 = $1,221
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #10 Determine Patient Liability: Bob Mac is 70 years old, lives alone and has been certified eligible for HCBS level of care. He has the following income: $728 from RSDI; $428 from a private pension; and $43 in monthly interest. He pays $93.50 for SMI premiums and $86.30 per month for health insurance. How much will he have to pay toward his own care (Patient Liability)? A. $992B. $794 C. $333D. $952
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And the Answer Is Determine Patient Liability: Bob Mac is 70 years old, lives alone and has been certified eligible for HCBS level of care. He has the following income: $728 from RSDI; $428 from a private pension; and $43 in monthly interest. He pays $78.20 for SMI premiums and $86.30 per month for health insurance. How much will he have to pay toward his own care (Patient Liability)? C. $333 Mr. Mac’s gross income: $728 (RSDI) + $428 (pension) = $1,156. (Interest income is excluded.) His deductions are: $93.50 (SMI) + $86.30 (health insurance) + $643 (Personal Needs Allowance) = $ $1,156 - $ = $333.20, which rounds up to $333.
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #11 Pass Through: If a Pass Through applicant lost his/her SSI eligibility for any reason other than a COLA, what must happen in order to meet the Pass Through technical eligibility requirement? A. He/she must reapply for SSI B. He/she must go through two COLA’s C. He/she must verify the reason the SSI was discontinued D. He/she must go through at least one COLA E. He/she cannot be eligible for the Pass Through Program
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And the Answer Is Pass Through: If a Pass Through applicant lost his/her SSI eligibility for any reason other than a COLA, what must happen in order to meet the Pass Through technical eligibility requirement? D. He/she must go through at least one COLA
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Question #12 Estate Recovery: Estate Recovery applies to individuals over 55 who receive MA for: (Check all that apply) A. Nursing Facility, excluding institutionalized Hospice B. Spenddown C. ICF/MR/DD D. Supports for Community Living E. Non-Institutionalized Hospice F. Home and Community Based Services
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel And the Answer Is Estate Recovery: Estate Recovery applies to individuals over 55 who receive MA for: (Check all that apply) A. Nursing Facility, excluding institutionalized Hospice C. ICF/MR/DD D. Supports for Community Living F. Home and Community Based Services
Introduction to Policy 101- An AMA Primer Medicaid Policy Panel Test Scoring All 12 Correct – Too Much Time on Your Hands 8-11 Correct – Above Average (Please stay!!!) 4-7 Correct – About average Good job! 0-3 Correct – Don’t feel too bad… THIS STUFF IS HARD!!!!!!