Long Reher Hanson Positive Strategies for Aging and Living with Disabilities ELDER LAW and MEDICAL ASSISTANCE PROGRAMS Presented by: Laurie Hanson Long, Reher & Hanson, P.A

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Course Overview n Estate Planning for People with Disabilities n Long-term Care n Payment Sources for Long-Term Care and Eligibility Criteria: u Medicare u Veterans Home u Medical Assistance n Medical Assistance Programs and coverage 2

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Estate/Financial Planning for Persons Living with Disabilities n If an individual must maintain or obtain eligibility for public benefits to meet basic needs, estate planning must strive to: u Enhance the individual’s quality of life and allow the individual to live as independently as possible for as long as possible. u Ensure that assets are protected and used only to supplement and not to supplant government benefits. u Ensure continued eligibility for all needs- based programs. 3

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Planning Entails Coordination of Professionals: n Elder Law Attorney: u Legal documents F Health care directives F Power of attorneys F Trusts F Wills u Public benefits eligibility/planning n Financial advisor n Accountant n Care manager 4

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Long-Term Care Services For people who need assistance with activities of daily living, such as bathing, dressing, eating, transferring: n Personal care assistants, private duty nursing n Nursing home coverage n Home health care n Modifications to home or car n Respite n Case management, etc. 5

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Long-term care settings n Home health care n Adult day services n Assisted living n Board and care homes n Skilled nursing facilities n Hospice 6

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Private pay/private insurance Medicare and supplemental insurance Long-term care insurance Veteran’s benefits/Veteran’s home Long-Term Care Payment Sources – Other than MA 7

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities What is Medicare? n Federal health insurance program for Social Security and Railroad Retirement recipients who: u have reached age 65 u have been disabled for two years, OR u are suffering from chronic kidney disease or ALS.

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Medicare includes: n Part A: Acute care (hospital), skilled nursing home, hospice care, and home health care benefits n Part B: Physicians’ services, durable medical goods, etc. n Medicare+Choice: Broadens options for providers and services n Part D: Prescription drugs

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Long-term care coverage under Medicare n 3 nights hospitalization and admitted to NH within 30 days of discharge n Maximum coverage: 100 days per spell of illness n First 20 days covered in full n After first 20 days, co-payment of $128 in 2008 n Home health care

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Medicare Supplemental Insurance policies n Must cover certain coinsurance payments under Medicare. n Will not cover skilled or custodial care in nursing homes after the first 100 days. n Will not cover skilled care in nursing homes if Medicare itself is not paying. If Medicare doesn’t pay, neither does the Medigap policy.

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Veterans Benefits n Aid and Attendance for veterans or widows of veterans receiving skilled care n Prescriptive drugs n Adult day care n Disability pension n Death and survivorship benefits n VA contract nursing homes > 70% disability n Check with your County Veterans Service Officer to see if you qualify

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Minnesota Veterans Homes n Established to provide health care services to Minnesota veterans; spouses and surviving spouses 55 and older. n Types of care: u Board and care (domiciliary) u Nursing care n Located at Hastings (domiciliary only) Silver Bay, Fergus Falls, Luverne, and Minneapolis.

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Veterans Home: Eligibility n 181 consecutive days of active duty n Honorably discharged n Wife or widow of veteran 55 years old or older n Resident of Minnesota n No unpaid bills for prior residence in Minnesota VH.

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Medicaid n Cooperative program between State and Federal Government n Centers for Medicare and Medicaid Services ( n Social Security Administration ( n Minnesota Department of Human Services ( n Local County Agency is where applications are filed (most counties have a web site) 15

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Medical Assistance n Called “MA” n Minnesota’s Medicaid program n Minn. Stat. 256B et. seq. n Minnesota Department of Human Services Health Care Programs Manual ( u Click on “Publications” on the top bar, then “Manuals” and then on “Health Care Programs Manual”) 16

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities MA ELIGIBILITY GENERAL REQUIREMENTS n Minnesota resident n Categorical Eligibility u Elderly: 65 and older u Blind u Disabled n Financial Eligibility u Assets and income

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities MA Programs n Basic Medical Assistance (MA) n MA in the community n MA for the nursing home residents n Home and community-based MA “waiver” programs for people who would need to reside in an institutionalized setting to receive these services. 18

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities MA Covered Services n Hospitalization, physician services, laboratory and x-ray services; n Some dental and eye care, medical supplies and treatments; n Transportation, prescription drugs (some), hospice, day treatment programs, special education programs; n Occupational, physical, and speech therapies; n Hearing aids; n Mental health services for adults and children; n See Minn. Stat. 256B.0625 for complete list. AND n Long-Term Care services 19

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Waiver Programs under MA n Called “home and community-based services” (HCBS) n Waiver” means: extended services (like NH services) can be provided in the community n HCBS provided at home, apartment, assisted living facility, adult foster homes n Programs available depend on age: u Programs for persons under 65: deeming waiver u Programs for persons 65 and older: spousal impoverishment rules

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Basic eligibility requirements for waiver services n Have disabled basis of eligibility for MA: SMRT or Social Security Administration n Screening to determine need for nursing home level of care n Finding by LTCC team that, if not for provision of waiver services, person would have to be in NH/hospital n Financial eligibility n Choose to receive services in the community n Costs in community < cost in facility n County service plan ensuring health and safety

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Basic services under waivers n Adult day care n Respite care n Homemaker services n Adaptations to home or vehicle n Transportation n Extended home health services n Extended PCA services n Case management n Assisted living n Independent living skills n Family counseling and training n Adult foster care n Residential care services n Equipment and supplies not covered by MA, Medicare, or client n Companion services n Home-delivered meals n Chore services

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Home and community-based care programs in MN For persons 65 years old and older: n Elderly Waiver Program (EW) n Special Income Standard Elderly Waiver program (SIS EW) n Alternative Care program (AC)

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Elderly Waiver program The EW program is an MA program: n Applicant/recipient must be eligible for MA. n Spousal impoverishment rules are applied for married couples. n MA transfer rules are applied. n Monthly spenddown is applied to EW services first, then to MA services.

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities SIS EW program The SIS EW program is for persons of low income: n Applicant/recipient must be eligible for MA. u Income is under specific cap, currently $1,911. n Spousal impoverishment rules are applied for married couples. n MA transfer rules are applied. n Monthly spenddown is applied to EW services, not to MA services.

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Alternative Care program The AC program is not MA, but a State program funded with State dollars: n Higher income and asset limits than EW. n Spousal impoverishment rules are applied for married couples. n MA transfer rules are applied. n Monthly premium required, based on income and assets and cost of AC services. n AC clients may be eligible for Medicare Savings Programs. n People eligible for MA are not eligible for AC, but may receive AC services for 10 days while MA application is processed.

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities Waiver programs in MN for persons under age 65: n Deeming waiver: only recipient’s assets and income considered n Developmental Disability (DD) n Community Alternative Care (CAC) n Community Alternatives for Disabled Individuals (CADI) n Traumatic Brain Injury (TBI)

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities MA-EPD for persons under age 65: n MA for Employed Persons with Disabilities n MA-EPD allows people with disabilities to qualify for MA under higher income and asset limits than standard MA. The goal of the program is to encourage people with disabilities to work and enjoy the benefits of being employed.

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities MA-EPD: Eligibility standards n Certified disabled: SMRT or SSA n years of age (ends at 65) n Be employed and have required taxes withheld or paid from earned income n Have monthly earnings > $65 n Not be eligible for MA under other, more beneficial categories n Meet asset limit and pay premium n Persons can be on MA-EPD and waiver: no spenddown for waiver program

Long Reher Hanson Positive Strategies for Aging and Living with Disabilities MA-EPD: Assets and income n Asset limit: up to $20,000, not including retirement accounts n Premium is based on income: no maximum income limit n Also must pay 1/2% of unearned income n May also have co-pays for services such as prescription drugs, eye glasses, etc.