LTC Survival Tips Judie Hughes, DHS Health Care Training MFWCAA Conference – October 2008

Topics LTC Concept Shift Recent Policy Updates Recent Form Changes Initiating a Transfer Penalty Monthly Reporting Annuities 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

MA-LTC Conceptual Shift

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

Example Noah lives in ICF-MR in Ohio Sister lives in MN Requesting MA-LTC in MN Action: Process request up to approval Notify MN ICF-MR of eligibility Approve 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 # HCPM / 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

LTCF Interaction with Medicare Part A Medicare 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 - BHSM 10/06/08 11:59:13 MAXIS FMTIAAM1 Version: 01 Of 01 Health Care Eligibility Results Process Dt: 10/06/08 UNAPPROVED 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 Eligibility Result ELIGIBLE Servicing Location Source Of Information STAT HRF Reporting MONTHLY 12 Month Renewal Date Month Income Renewal Date Elig Type EX Major Program MA TMA/TYMA Begin Date __ __ TMA/TYMA Type __ * * * * * * * * * * * * * * * * Worker Message * * * * * * * * * * * * * * * *************************** APPROVAL OF RESULTS REQUIRED Function: ELIG Case Nbr: Month: 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 #

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 or Bulletin #

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 LTCP Benefits 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 protected Savings 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 7/1/09 Catherine 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-5426 Set 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