elder law and medical assistance programs
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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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Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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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Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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 Reher Hanson Positive Strategies for Aging and Living with Disabilities
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 Reher Hanson Positive Strategies for Aging and Living with Disabilities
Long-term care settings
Home health care Adult day services Assisted living Board and care homes Skilled nursing facilities Hospice
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Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
• 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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Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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.
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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 Reher Hanson Positive Strategies for Aging and Living with Disabilities
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
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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.
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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.
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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.
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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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Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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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Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
MA ELIGIBILITY GENERAL REQUIREMENTS
Minnesota resident Categorical Eligibility
Elderly: 65 and older Blind Disabled
Financial Eligibility Assets and income
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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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Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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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Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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)
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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.
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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.
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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.
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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)
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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.
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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
Long Reher Hanson Positive Strategies for Aging and Living with Disabilities
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.