1 LTC Services Melody Sanders, Health Care Training Judie Hughes, Health Care Training MFWCAA (Fall 2009)

2 Agenda Introduction. Have You Ever? New LTC Courses! MA-LTC Eligibility Determination. TPL – Medicare. Break Asset Assessments. Income and Calculations.

3 Have You Ever… Had an request for MA-LTC with more than 5 transfers? Had an MA-LTC receive a lump sum income? Had a client with LTC coverage?

4 Have You Ever… Had a client with a high Medicare premium? Stumped your supervisor? Attended the MFWCAA conference?

5 Sequencing of LTC Courses 10 online courses. (40 hours) 1 classroom course. (4 days) 5 training cases.

6 LTC Online Courses Annuities 101 / Advanced Assets Intro to MA-LTC MA-LTC Basics MA-LTC Requirements Asset Assessment Annuities and MA-LTC MA-LTC Transfers LTCP Income and MA-LTC LTC Training Caseload Summary

7 LTC Handouts and Cases REMEMBER! Bring online handouts and case materials to the MA-LTC Systems course!

8 LTC Resources HCPM Manual Letters Bulletins MAXIS POLI/TEMP MMIS User Manual Health Care Training Courses HealthQuest

9 Who is covered by MA-LTC? LTCF residents. HCBS waiver program recipients.

10 Basic MA vs. MA-LTC Meet basic MA eligibility requirements first! SSN Citizenship/Identity Immigration Status Residency Basis of Eligibility Then apply MA-LTC eligibility requirements.

11 “Otherwise Eligible” All basic MA and MA-LTC eligibility requirements are met, but for a transfer penalty. Verifications provided. Asset-eligible. Home Equity Limit met. DHS named PRB, when required.

12 First Month of MA-LTC Request Applying basic MA rules for MA-LTC. Applying MA-LTC requirements. Requesting appropriate verifications.

13 Request Month Determination Date request for MA-LTC received. DHS-3531 (Application) DHS-3543 (Request) HCAPP or CAF with DHS-4803

14 Request Month Determination Date of LTCC (HCBS clients). DHS Anticipate services within 30 days from LTCC or date of request, whichever is later.

15 Request Month Determination Date of LTCF admission and anticipated date of discharge. DHS-1503 Must reside for at least 30 consecutive days.

16 Request Month Determination Retroactive months requested. No limit for MA enrollees residing in LTCF. MA begin date or date of admission, whichever is later. Eligibility for waiver services cannot begin earlier than LTCC date (month).

17 LTCF Example 1 Rodney requests MA and MA-LTC. Request date April months retro requested. Admitted to LTCF on February 10. Action: February is month of request for MA-LTC. January is month of request for basic MA.

18 LTCF Example 2 Chester MA enrollee for 2 years. Request date April 15 using DHS No retro requested. Admitted to LTCF previous December. Action: December is month of request for MA-LTC.

19 Waiver Example Elroy requesting MA and MA-LTC. Request date April 3. 3 months retro requested. LTCC completed March 30. DHS-5181 indicates services anticipated to begin 30 days from LTCC date. Action: March is month of request for MA-LTC.

20 OHC/TPL DHS-5590 – LTC/Waiver Case Checklist Row for Third Party Liability information available.

21 Types of TPL Car Insurance Workman’s Compensation Homeowner’s Insurance Medicare Employer Health Care Coverage

22 Medicare Part A – Hospitalization Part B – Medical Part C – Medicare Advantage Part D – Prescription Drug

23 Medicare Part A - Hospitalization Benefits: Inpatient Hospitalization Inpatient Care in a Skilled Nursing facility Hospice Limited Home Health Care Monthly Premium Deductibles ( $1,068) Coinsurance / Copayments

24 Medicare Part B - Medical Benefits Medically-necessary services for diagnosis or treatment of medical condition. Preventive services Monthly Premium ($96.40/month + or -) Deductible ($135/year) Coinsurance (20% of services)

25 Medicare Part C - Advantage Part A Part B Part D (sometimes)

26 Medicare Part D – Prescription Drug Provided through an insurance or other private companies approved by Medicare. Medicare Prescription Drug Plans Medicare Advantage Plans.

27 Medicare Part D - Benefits Formulary determines drugs covered. Prior authorization for certain prescriptions Quantity limits. Step Therapy.

28 Medicare Part D - Costs Premium (varies based on plan chosen) Copayment (based on drugs/plan) Deductible (up to $295) Extra help or Low-Income Subsidy No coverage between $2,700 - $4,350. Coverage and copayments begin at $4,351.

29 Medicare and MA-LTC Costs client is responsible for may be used as: Deduction on LTC income calculation. Health care expense to meet medical spenddown.

30 Asset Assessment Method of establishing value of assets attributed to the LTC spouse. Attributed assets used to determine asset-eligibility for MA and MA-LTC.

31 Required Asset Assessment LTCF residents with a community spouse. EW clients with a community spouse.

32 Community Spouse Asset Allowance Amount of the couple’s counted assets the community spouse may retain at the time the LTC spouse requests MA-LTC. Estimated (upon requested asset assessment) Actual (upon request for MA-LTC – required asset assessment)

33 MA-LTC Request To determine assets attributable to LTC spouse use: Actual CSAA. Verified assets owned by couple in first month of request for MA-LTC.

34 Step 1 Evaluate assets owned in first month of request based on asset assessment rules. Use evaluation to determine total countable assets owned by the couple.

35 Step 2 Actual CSAA: ≥ Total Countable Assets All counted asset attributable to CS. Only excluded assets owned by LTC spouse attributable to LTC spouse. < Total Countable Assets Go to Step 3.

36 Steps 3a and 3b a. Total counted asset owned by CS based on evaluation in Step 1. b. CS total counted assets is: > Actual CSAA, CS must contribute to cost of care. = Actual CSAA, go to Step 4. < Actual CSAA, go to Step 3c.

37 Steps 3c and 3d c. Actual CSAA - CS counted asset total (3a) = additional attributable counted asset needed. d. Attribute LTC spouse’s counted assets to CS up to actual CSAA. Remaining LTC spouse assets attributable to LTC spouse. Go to Step 4.

38 Step 4 Evaluate asset attributable to LTC spouse using basic MA eligibility rules.

39 Step 5 Answer questions.

40 Income Basics Verification of income mandatory. Type of income calculation determined by: Household composition. Basis of eligibility. MA-LTC request date. The living arrangement. Transfer penalty.

41 Monthly Reporting Bulletin No monthly reporting for medical spenddowns. Continued monthly reporting for certain clients using an LTC income calculation.

42 Frank Example Resides in LTCF. Receives $1, RSDI/month. Pays Medicare Part B ($96.40). Receives land payments 2x/year. March ($8,000) November ($8,000) Land in life estate (unavailable). Liability insurance of $465 paid in November. Property taxes $1,090 x 2/year.

43 Receipt of Lump Sum Case note facts regarding the amount and frequency of payments. Set DAIL/WRIT for when a lump sum payment is due. Calculate obligation using anticipated income. Recalculate when income actually received and review asset-eligibility.

44 Combination LTC/Medical Spenddown 1. Obligation changes from LTC spenddown to a combination LTC/Medical spenddown. 2. Do not close eligibility unless client requests closure. (Even if medical spenddown portion not met.) 3. Review of assets in the month following the month in which the combination spenddown occurred.

45 Frank Example Resides in LTCF. Receives $1, RSDI/month. Pays Medicare Part B ($96.40/month). Receives land payments 2x/year. March ($8,000) November ($8,000) Land in life estate (unavailable). Liability insurance of $465 paid in November. Property taxes $1,090 x 2/year.

46 Rental Income Deductions Interest and escrow portions of a mortgage payment. Real estate insurance. Repairs (minor corrections to an existing structure)- example for Frank’s repairs to a tile – but not putting in new tile. Property taxes Lawn care. Snow removal. Advertising for tenants. Utilities. Property management fees paid to a third party. Do not carry excess expenses over to other tax years or use excess expenses to offset other income.

47 Sally Example Owns a home ($15,000 equity) and will not return. Resides in LTCF. RSDI recipient - $834/month. Granddaughter moves into home – pays $50/month rent.

48 Considerations Assets. Homestead exclusion after six months. Care of enrollee exclusion. Up for sale. Income-producing asset. $6000, 6%. Expenses. Up keep expenses. Available income.

49 Income-Producing Property Exclude up to $6,000 in equity value. Limited to combined equity of all property meeting 6% rule. Each property must meet 6% rule. Continue to exclude up to 24 months if earnings on property drop below 6%.

50 Allowable Rental Expenses Interest and escrow of mortgage payment. Homeowner’s insurance. Repairs as needed. Property taxes.

51 Sally’s Allowable Expenses $455 home owner’s insurance $560 property taxes. $1,015 total expense $50 rent X 12 months = $600

52 Thank you Thank you for sharing your experiences! Questions?