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LTC Services

Melody Sanders, Health Care TrainingJudie Hughes, Health Care Training

MFWCAA (Fall 2009)

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Agenda

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

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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?

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Have You Ever…

Had a client with a high Medicare premium?

Stumped your supervisor?

Attended the MFWCAA

conference?

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Sequencing of LTC Courses

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

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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

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LTC Handouts and Cases

REMEMBER!

Bring online handouts and case materials to the MA-LTC Systems course!

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LTC Resources

HCPMManual LettersBulletinsMAXIS POLI/TEMPMMIS User ManualHealth Care Training

CoursesHealthQuest

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Who is covered by MA-LTC?

LTCF residents.

HCBS waiver program recipients.

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Basic MA vs. MA-LTC

Meet basic MA eligibility requirements first!SSNCitizenship/Identity Immigration StatusResidencyBasis of Eligibility

Then apply MA-LTC eligibility requirements.

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“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.

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First Month of MA-LTC Request

Applying basic MA rules for MA-LTC.

Applying MA-LTC requirements.

Requesting appropriate verifications.

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Request Month Determination

Date request for MA-LTC received.

DHS-3531 (Application)DHS-3543 (Request)HCAPP or CAF with DHS-4803

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Request Month Determination

Date of LTCC (HCBS clients).

DHS-5181.Anticipate services within 30 days from

LTCC or date of request, whichever is later.

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Request Month Determination

Date of LTCF admission and anticipated date of discharge.

DHS-1503Must reside for at least 30 consecutive

days.

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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).

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LTCF Example 1

Rodney requests MA and MA-LTC. Request date April 15. 3 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.

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LTCF Example 2

Chester MA enrollee for 2 years. Request date April 15 using DHS-3543. No retro requested. Admitted to LTCF previous December.

Action:

December is month of request for MA-LTC.

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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.

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OHC/TPL

DHS-5590 – LTC/Waiver Case Checklist

Row for Third Party Liability information available.

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Types of TPL

Car Insurance Workman’s Compensation Homeowner’s Insurance Medicare Employer Health Care Coverage

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Medicare

Part A – HospitalizationPart B – MedicalPart C – Medicare AdvantagePart D – Prescription Drug

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Medicare Part A - Hospitalization

Benefits:

Inpatient Hospitalization Inpatient Care in a Skilled Nursing facilityHospiceLimited Home Health Care

Monthly Premium Deductibles (2009 - $1,068) Coinsurance / Copayments

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Medicare Part B - Medical

BenefitsMedically-necessary services for diagnosis

or treatment of medical condition.Preventive services

Monthly Premium ($96.40/month + or -)Deductible ($135/year)Coinsurance (20% of services)

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Medicare Part C - Advantage

Part APart BPart D (sometimes)

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Medicare Part D – Prescription Drug

Provided through an insurance or other private companies approved by Medicare.

Medicare Prescription Drug Plans Medicare Advantage Plans.

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Medicare Part D - Benefits

Formulary determines drugs covered. Prior authorization for certain

prescriptionsQuantity limits.Step Therapy.

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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.

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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.

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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.

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Required Asset Assessment

LTCF residents with a community spouse.

EW clients with a community spouse.

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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)

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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.

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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.

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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 AssetsGo to Step 3.

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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.

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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.

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Step 4

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

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Step 5

Answer questions.

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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.

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Monthly Reporting

Bulletin 09-21-12No monthly reporting for medical

spenddowns.Continued monthly reporting for certain

clients using an LTC income calculation.

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Frank Example

Resides in LTCF. Receives $1,086.40 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.

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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.

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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.

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Frank Example

Resides in LTCF. Receives $1,086.40 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.

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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.

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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.

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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.

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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%.

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Allowable Rental Expenses

Interest and escrow of mortgage payment.

Homeowner’s insurance.Repairs as needed.Property taxes.

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Sally’s Allowable Expenses

$455 home owner’s insurance$560 property taxes.

$1,015 total expense

$50 rent X 12 months = $600

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Thank you

Thank you for sharing your experiences!

Questions?