1. Asset Assessments Webinar Health Care Eligibility and Access January 2012 Note: This session is being recorded. 1

2. Session Overview Part 1: Multiple Topics –Continuous Period of Institutionalization –Asset Assessment Effective Date –Verifying Assets Part 2:Determining Asset Eligibility Using an Asset Assessment 2

3. Submitting Questions Please, no case-specific questions. –Check HCPM. –Submit question to HealthQuest. Submit general session questions using private chat feature. 3

4. Submitting Questions Today Click on the “Private” tab. Double click on “Leaders and Assistants.” Type your question in the box at the bottom. Click on the arrow to send the question. 4

5. Question Responses and Polling 5 Please be patient. –Individual answers provided as time allows. –Other answers provided at end of each Part of the webinar. Polling Questions. –Select from answers provided.

6. Continuous Period of Institutionalization 6

7. 30 Consecutive Days Continuous Period of Institutionalization –30 consecutive days of LTCF or EW/AC services. MA-LTC Eligibility –Can apply regardless of length of time LTC services received. –30 consecutive days in reference to determining LTC spouse. 7

8. Hospitalization and the Continuous Period Medical hospital = LTCF –Skilled nursing facility care received. Hospitalization included in continuous period of institutionalization: –Skilled nursing facility care received for 30+ days. –Immediately discharged to LTCF or receipt of services through EW/AC. 8

9. Leon Example Requests MA-LTC through EW today. –November 10 - admitted to hospital. –December 20 - discharged home. –November 15 – December 20 received skilled nursing facility services. Continuous period of institutionalization established November 15 – December 20. 9

10. Hospitalization and the Continuous Period Medical hospital = LTCF –Skilled nursing care received. Hospitalization included in continuous period of institutionalization: –Skilled nursing care received for 30+ days. –Immediately discharged to LTCF or receipt of services through EW/AC. 10

11. Carlos Example December 30 – admitted to LTCF directly from hospital. December 19 – admitted to hospital. February 22 – anticipated discharge. Continuous period of institutionalization established December 19 – February 22. 11

12. Continuous Period Summary Term changed in January 2011. Medical hospitalization may or may not be a part of the period. 12

13. Asset Assessment Effective Date 13

14. Continuous Period for EW and AC LTCC completed within 60 days. Waiver services paid or qualify to be paid by EW or AC. Services are, were or will be delivered by a licensed provider and received or anticipated to be received for at least 30 days. 14

15. Pablo Example Requested MA-LTC on January 8. –April 28, 2010 – LTCC. –April 30 – June 30, 2010 – privately paid for services received from licensed provider. –Case manager confirms services would have been paid by EW if Pablo had been eligible. Continuous period of institutionalization established April 28 – June 30. 15

16. EW and AC Effective Date If initial continuous period of institutionalization established at MA- LTC request: Asset Assessment Effective Date = LTCC date 16

17. Additional LTCC Do not change asset assessment effective date if new LTCC needed after 60 days, and MA-LTC is still pending, and Client is cooperating. 17

18. Vern Example Requested EW on September 15. –No previous continuous period of institutionalization. –September 13 – LTCC. Asset assessment effective date is September 13 based on anticipated continuous period of institutionalization. 18

19. Vern Example Continued November 12 (60 days after first LTCC): –MA-LTC still pending. –Vern cooperating with verifications. –November 13 – new LTCC completed. Asset assessment effective date continues to be September 13 based on first LTCC. 19

20. Anticipated Continuous Period 20 You must verify an anticipated continuous period was met when: –Client reapplies for MA-LTC, and –An asset assessment is again required.

21. Sarah Example 21 Requested EW on July 24, 2011. –No previous continuous period of institutionalization. –July 23 – LTCC. Asset assessment effective date is July 23 based on anticipated continuous period of institutionalization.

22. Sarah Example Continued 22 MA-LTC eligibility approved July 24. –Requests EW be closed because does not want to pay LTC waiver obligation. –August 31 - EW closed, no services received. Reapplied for MA-LTC January 3. –Determine new asset assessment effective date.

23. Questions? 23

24. Verification of Assets 24

25. Verifying Assets Verify assets owned on: –Asset assessment effective date. –First day of month for which client requests eligibility to begin. –Change in assets between eligibility begin month and month in which MA-LTC asset eligibility is determined. 25

26. Tristan Example 26 Requests EW on May 1. –Retro coverage requested back to March. –No previous continuous period of institutionalization. –April 29 – LTCC. –MA-LTC Approved May 28. Verify assets for April 29 and March 1.

27. Part 1 Summary 27 Hospital stays and the continuous period of institutionalization. Asset assessment effective date. –Do not change if additional LTCC needed. –Anticipated continuous period verified at reapplication for MA-LTC. Verifying assets.

28. Question Check-In 28

29. Part 2 Processing MA-LTC Asset Eligibility Using an Asset Assessment 29

30. When to Apply Process Determine asset eligibility for MA-LTC months after calculating the actual community spouse asset allowance. 30

31. Step 1 Determine the month for which MA-LTC asset eligibility is being determined. 31

32. Step 1 – EW Requests Month for which eligibility is being approved based on: –Months requesting coverage. –When services are expected to begin. –Actual month approving coverage. –Meets all MA-LTC eligibility requirements. 32

33. Elizabeth Example 33 Requests EW on September 1. –Requests retro coverage back to June. –August 27 – LTCC, services to begin upon MA-LTC approval. –October 1- MA-LTC approved. Determine MA-LTC asset eligibility as of October 1 using the community spouse asset allowance.

34. MA-LTC Asset Verifications 34 Use value of assets verified for the first day of the first month for which eligibility was requested. If a change is reported, verify assets for first day of month determining MA-LTC asset eligibility.

35. Bruce Example Requests EW on February 3. –Requests retro coverage back to November. –November 1 – verified asset values. –March 8 - MA-LTC eligibility approved. –No changes to assets reported. Use asset values verified for November 1 to determine MA-LTC asset eligibility for March. 35

36. Step 1 – LTCF Request Month for which client meets all of the following: –Resides in LTCF. –Requests coverage. –Meets all MA-LTC eligibility requirements. 36

37. Step 1 - Ida and Hardy 37 Ida requests MA-LTC on January 8. –Requests retro coverage back to November. –January 1 – Admitted to LTCF. –July 1, 2008 – Asset assessment effective date. –Actual community spouse asset allowance $91,450. –Meets all MA-LTC eligibility requirements. Determine MA-LTC asset eligibility for January.

38. Ida and Hardy Continued 38 Ida requests MA-LTC on January 8. –Requests retro coverage back to November. –January 1 – Admitted to LTCF. –July 1, 2008 – Asset assessment effective date. –Meets all MA-LTC eligibility requirements. Determine MA-LTC asset eligibility for January using asset values verified for November 1.

39. Step 2 Calculate the couple’s total non-excluded assets. –Do not consider availability. –Count assets converted to income stream after effective date, if owned on effective date. –Exclude vehicle with highest equity value. 39

40. Step 2 – Annuity Conversion If: –Annuity in accumulation phase on asset assessment effective date. –Annuitized after effective date. Then: –Count the annuitized value as a non-excluded asset. 40

41. Step 2 – Annuity Purchase 41 If: –Annuity not owned on asset assessment effective date. –Purchased and annuitized after effective date. Then: –Count available amount as a non-excluded asset.

42. Step 2 – Ida and Hardy 42 Verified non-excluded assets owned on November 1: –Joint checking account ($800). –Ida IRA ($35,000). –Hardy trust ($30,000). –Hardy life insurance ($3,000). –Jointly owned land ($50,000). Total non-excluded assets = $118,800.

43. Step 3 Asset Limit + Actual Community Spouse Asset Allowance 43

44. Step 3 – Ida and Hardy 44 $3,000 + $91,450 = $94,450

45. Step 4 45 Compare Step 3 amount to Step 2 amount: Step 3 ≥ Step 2: MA-LTC asset-eligible. Step 3 < Step 2: Continue to Step 5.

46. Step 4 – Ida and Hardy Step 3: $94,450. Step 2: $118,800. $94,450 < $118,800 Continue to Step 5. 46

47. Step 5 Consult with couple to determine assets attributed to community spouse asset allowance. –Check box on DHS-3340A. –Attributed assets ≤ community spouse asset allowance. –Do not advise how to attribute. Refer to financial advisor or lawyer. 47

48. Step 5 – Ida and Hardy What happens if: Checking account not attributed? –Counted asset for Ida. Annuity not attributed? – Not counted because unavailable. 48

49. Step 6 Determine LTC spouse’s total counted assets. Evaluate following basic MA asset policy: –Non-excluded, non-attributed assets owned by either spouse. –Excluded assets owned by LTC spouse. Asset-eligible: Continue to Step 9. Not asset-eligible: Continue to Step 7. 49

50. Step 6 – Ida and Hardy Assets not attributed: –Ida’s IRA – $0 counted because unavailable. –Ida’s IBA – Designated to BFE. –Jointly-owned house – Excluded. Ida is asset-eligible. Continue to Step 9. 50

51. Step 7 Determine if the community spouse requires additional income to meet monthly maintenance needs. 51

52. Step 8 Determine if additional income- producing assets may be attributed. See HCPM 19.45.15 52

53. Step 9 – MA-LTC Eligible Co mplete and send DHS-3340C. Lists: –Assets attributed to the community spouse asset allowance. –Assets that are not counted. –Any remaining assets. Provides instructions to transfer attributed assets. 53

54. Step 9 – MA-LTC Ineligible Redetermine eligibility for basic MA. EW clients: –No longer use asset assessment (community spouse asset allowance) to determine asset- eligibility. –Evaluate assets following basic MA asset policy. 54

55. Step 9 – Ida and Hardy Complete and send DHS-3340C with: –Assets attributed to the community spouse asset allowance. –Assets that are not counted. –Any remaining assets. Provides instructions to transfer attributed assets. 55

56. Transferring Assets 56

57. Transferring Assets – Before Approval Must transfer to LTC spouse prior to MA- LTC approval if an asset is both: –Owned, in whole or in part, by the community spouse. –Not attributed to community spouse asset allowance. 57

58. Transferring Assets – Ida Before Example Jointly-owned checking account not attributed. –Must be transferred before Ida’s MA-LTC eligibility is approved. –Count as an asset for Ida. 58

59. Transferring Assets – After Approval Can transfer after approval, but before next annual renewal, if the asset is both: –Owned by the LTC spouse. –Attributed to the community spouse asset allowance. Note: Income earned on the asset is income to LTC spouse until transferred. 59

60. Transferring Assets – Ida After Example Attributed joint checking account and jointly-owned land. –Must transfer both into Hardy’s ownership by next annual renewal. –Count interest or rent as income to Ida until transferred. 60

61. Final Questions… 61

62. Thanks for attending today’s webinar! 62