elder law and medical assistance programs

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.952-929-0622

www.mnelderlaw.com


Course Overview Estate Planning for People with Disabilities Long-term Care Payment Sources for Long-Term Care and Eligibility

Criteria: Medicare Veterans Home Medical Assistance

Medical Assistance Programs and coverage

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Estate/Financial Planning for Persons Living with Disabilities

If an individual must maintain or obtain eligibility for public benefits to meet basic needs, estate planning must strive to: Enhance the individual’s quality of life

and allow the individual to live as independently as possible for as long as possible.

Ensure that assets are protected and used only to supplement and not to supplant government benefits.

Ensure continued eligibility for all needs-based programs.

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Planning Entails Coordination of Professionals:

Elder Law Attorney: Legal documents

Health care directives Power of attorneys Trusts Wills

Public benefits eligibility/planning Financial advisor Accountant Care manager

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Long-Term Care ServicesFor people who need assistance with activities of daily

living, such as bathing, dressing, eating, transferring:

Personal care assistants, private duty nursing

Nursing home coverage

Home health care

Modifications to home or car

Respite

Case management, etc.

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Long-term care settings

Home health care Adult day services Assisted living Board and care homes Skilled nursing facilities Hospice

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• 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

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What is Medicare? Federal health insurance program for Social

Security and Railroad Retirement recipients who:

have reached age 65

have been disabled for two years, OR

are suffering from chronic kidney disease or

ALS.


Medicare includes:

Part A: Acute care (hospital), skilled nursing home, hospice care, and home health care benefits

Part B: Physicians’ services, durable medical goods, etc.

Medicare+Choice: Broadens options for providers and services

Part D: Prescription drugs


Long-term care coverage under Medicare

3 nights hospitalization and admitted to NH

within 30 days of discharge

Maximum coverage: 100 days per spell of

illness

First 20 days covered in full

After first 20 days, co-payment of $128 in

2008

Home health care


Medicare Supplemental Insurance policies

Must cover certain coinsurance payments under Medicare.

Will not cover skilled or custodial care in nursing homes after the first 100 days.

Will not cover skilled care in nursing homes

if Medicare itself is not paying. If Medicare

doesn’t pay, neither does the Medigap

policy.


Veterans Benefits Aid and Attendance for veterans or widows

of veterans receiving skilled care Prescriptive drugs

Adult day care Disability pension Death and survivorship benefits VA contract nursing homes > 70% disability Check with your County Veterans Service

Officer to see if you qualify


Minnesota Veterans Homes http://www.mvh.state.mn.us

Established to provide health care services

to Minnesota veterans; spouses and

surviving spouses 55 and older. Types of care:

Board and care (domiciliary) Nursing care

Located at Hastings (domiciliary only) Silver Bay, Fergus Falls, Luverne, and Minneapolis.


Veterans Home: Eligibility

181 consecutive days of active duty

Honorably discharged

Wife or widow of veteran 55 years old or

older

Resident of Minnesota No unpaid bills for prior residence in

Minnesota VH.


Medicaid Cooperative program between State and

Federal Government Centers for Medicare and Medicaid Services

(www.cms.gov) Social Security Administration (

www.ssa.gov) Minnesota Department of Human Services (

www.dhs.state.mn.us) Local County Agency is where applications

are filed (most counties have a web site)

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Medical Assistance

Called “MA” Minnesota’s Medicaid program Minn. Stat. 256B et. seq. Minnesota Department of Human Services

Health Care Programs Manual (www.dhs.state.mn.us) Click on “Publications” on the top bar, then

“Manuals” and then on “Health Care Programs Manual”)

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MA ELIGIBILITY GENERAL REQUIREMENTS

Minnesota resident Categorical Eligibility

Elderly: 65 and older Blind Disabled

Financial Eligibility Assets and income


MA Programs

Basic Medical Assistance (MA) MA in the community MA for the nursing home residents Home and community-based MA “waiver”

programs for people who would need to reside in an institutionalized setting to receive these services.

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MA Covered Services Hospitalization, physician services, laboratory and x-ray

services; Some dental and eye care, medical supplies and

treatments; Transportation, prescription drugs (some), hospice, day

treatment programs, special education programs; Occupational, physical, and speech therapies; Hearing aids; Mental health services for adults and children; See Minn. Stat. 256B.0625 for complete list. AND Long-Term Care services

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Waiver Programs under MA Called “home and community-based services”

(HCBS)

Waiver” means: extended services (like NH services) can be provided in the community

HCBS provided at home, apartment, assisted living facility, adult foster homes

Programs available depend on age:

Programs for persons under 65: deeming waiver

Programs for persons 65 and older: spousal impoverishment rules


Basic eligibility requirements for waiver services Have disabled basis of eligibility for MA: SMRT or

Social Security Administration Screening to determine need for nursing home level of

care Finding by LTCC team that, if not for provision of waiver

services, person would have to be in NH/hospital Financial eligibility Choose to receive services in the community Costs in community < cost in facility County service plan ensuring health and safety


Basic services under waivers Adult day care Respite care Homemaker services Adaptations to home or

vehicle Transportation Extended home health

services Extended PCA services Case management Assisted living

Independent living skills Family counseling and

training Adult foster care Residential care services Equipment and supplies

not covered by MA, Medicare, or client

Companion services Home-delivered meals Chore services


Home and community-based care programs in MN

For persons 65 years old and older:

Elderly Waiver Program (EW)

Special Income Standard Elderly Waiver program (SIS EW)

Alternative Care program (AC)


Elderly Waiver program

The EW program is an MA program:

Applicant/recipient must be eligible for MA. Spousal impoverishment rules are applied for

married couples. MA transfer rules are applied. Monthly spenddown is applied to EW services

first, then to MA services.


SIS EW program

The SIS EW program is for persons of low income:

Applicant/recipient must be eligible for MA. Income is under specific cap, currently $1,911.

Spousal impoverishment rules are applied for married couples.

MA transfer rules are applied. Monthly spenddown is applied to EW services, not to

MA services.


Alternative Care program

The AC program is not MA, but a State program funded with State dollars:

Higher income and asset limits than EW.

Spousal impoverishment rules are applied for married couples.

MA transfer rules are applied.

Monthly premium required, based on income and assets and cost of AC services.

AC clients may be eligible for Medicare Savings Programs.

People eligible for MA are not eligible for AC, but may receive AC services for 10 days while MA application is processed.


Waiver programs in MN for persons under age 65:

Deeming waiver: only recipient’s assets and income considered

Developmental Disability (DD)

Community Alternative Care (CAC)

Community Alternatives for Disabled

Individuals (CADI)

Traumatic Brain Injury (TBI)


MA-EPD for persons under age 65:

MA for Employed Persons with Disabilities

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.


MA-EPD: Eligibility standards Certified disabled: SMRT or SSA 16-64 years of age (ends at 65) Be employed and have required taxes

withheld or paid from earned income Have monthly earnings > $65 Not be eligible for MA under other, more

beneficial categories Meet asset limit and pay premium Persons can be on MA-EPD and waiver:

no spenddown for waiver program


MA-EPD: Assets and income

Asset limit: up to $20,000, not including retirement accounts

Premium is based on income: no maximum income limit

Also must pay 1/2% of unearned income May also have co-pays for services such as

prescription drugs, eye glasses, etc.

elder law and medical assistance programs

Documents

hospice care

custodial care

personal care assistants

acute care hospital

activities of daily

skilled nursing home

eligibility criteria

continued eligibility