Asset Assessments Webinar

Health Care Eligibility and Access

January 2012

Note: This session is being recorded.

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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

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Submitting Questions

Please, no case-specific questions.– Check HCPM.– Submit question to HealthQuest.

Submit general session questions using private chat feature.

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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.

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Question Responses and Polling

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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.

Continuous Period of Institutionalization

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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.

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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

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.

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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.

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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.

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Continuous Period Summary

Term changed in January 2011.

Medical hospitalization may or may not be a part of the period.

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Asset Assessment Effective Date

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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.

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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.

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EW and AC Effective Date

If initial continuous period of institutionalization established at MA-LTC request:

Asset Assessment Effective Date =

LTCC date

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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.

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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.

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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.

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Anticipated Continuous Period

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You must verify an anticipated continuous period was met when:

– Client reapplies for MA-LTC, and – An asset assessment is again required.

Sarah Example

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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.

Sarah Example Continued

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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.

Questions?

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Verification of Assets

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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.

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Tristan Example

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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.

Part 1 Summary

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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.

Question Check-In

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Part 2

Processing MA-LTC Asset Eligibility Using an Asset

Assessment

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When to Apply Process

Determine asset eligibility for MA-LTC months after calculating the actual community spouse asset allowance.

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Step 1

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

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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.

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Elizabeth Example

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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.

MA-LTC Asset Verifications

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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.

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.

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Step 1 – LTCF Request

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

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Step 1 - Ida and Hardy

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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.

Ida and Hardy Continued

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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.

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.

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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.

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Step 2 – Annuity Purchase

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If:– Annuity not owned on asset assessment

effective date.– Purchased and annuitized after effective date.

Then:– Count available amount as a non-excluded

asset.

Step 2 – Ida and Hardy

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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.

Step 3

Asset Limit +

Actual Community Spouse Asset Allowance

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Step 3 – Ida and Hardy

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$3,000 + $91,450 = $94,450

Step 4

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Compare Step 3 amount to Step 2 amount:

Step 3 ≥ Step 2: MA-LTC asset-eligible.

Step 3 < Step 2: Continue to Step 5.

Step 4 – Ida and Hardy

Step 3: $94,450. Step 2: $118,800.

$94,450 < $118,800

Continue to Step 5.

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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.

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Step 5 – Ida and Hardy

What happens if: Checking account not attributed?

– Counted asset for Ida.

Annuity not attributed?– Not counted because unavailable.

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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.

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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.

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Step 7

Determine if the community spouse

requires additional income

to meet monthly maintenance needs.

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Step 8

Determine if additional income-producing assets may be attributed.

See HCPM 19.45.15

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Step 9 – MA-LTC Eligible

Complete 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.

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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.

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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.

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Transferring Assets

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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.

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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.

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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.

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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.

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Final Questions…

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Thanks for attending today’s webinar!

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