Vermont Health Access Choices for Long-Term Care Medicaid: Best Practices and Updates
Updated in February 2023, these slides outline best practices for assisting LTC Medicaid applicants in Vermont. Topics covered include care choices, eligibility, application process, resources, income criteria, acronyms, and partnership details between DVHA and DAIL. Please note that the slides are subject to change and will be maintained on DVHA's Internet site.
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Department Of Vermont Health Access Choices For Care Long-term Care Medicaid BEST PRACTICES FOR ASSISTING LTC MEDICAID APPLICANTS UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 1
Agenda Agenda Overview of Choices for Care Eligibility groups Long-Term Care settings Applying for Long-Term Care Medicaid Application forms Application process Verification Long-Term Care Resource and Income Criteria Resource limits Countable and excluded resources Income Patient Share UPDATED: February 2023 IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: 2
Acronyms Acronyms AFC Adult Family Care home CFC Choices for Care DAIL Disability, Aging and Independent Living DVHA Department of Vermont Health Access ERC Enhanced Residential Care HBW Home Based Waiver LTC Long Term Care Medicaid LTCCC DAIL Long Term Care Clinical Coordinator LTCS DVHA Long Term Care Specialist MCA Medicaid for Children and Adults NF Nursing Facility UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 3
OVERVIEW OVERVIEW OF OF CHOICES FOR CARE CHOICES FOR CARE UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 4
DVHA and DAIL DVHA and DAIL CFC LTC Medicaid Partnership CFC LTC Medicaid Partnership The application for Choices for Care Long-Term Care Medicaid is a joint application between the Department of VT Health Access (DVHA) and the Department of Disability, Aging and Independent Living (DAIL) DVHA LTCS DVHA LTCS Processes LTC Medicaid financial eligibility DAIL LTCCC DAIL LTCCC Completes clinical assessment NOTE: NOTE: An individual must meet all financial and clinical criteria to qualify for CFC LTC Medicaid along with residing in an LTC setting. UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 5
CFC Eligibility CFC Eligibility Applicants receive a clinical assessment from the DAIL Long- Term Care Clinical Coordinator (LTCCC) to determine their functional ability. Applicants are classified as highest or needs. highest or high high Highest Needs Highest Needs: Entitled to services and are enrolled as soon as they meet financial and clinical criteria. High Needs High Needs: Enrolled when they meet clinical and financial criteria and and when DAIL determines that funds are available. Clinically eligible for highest or high financial eligibility process continues. Not clinically eligible for highest or high financial eligibility process ends, and application is denied. UPDATED: February 2023 these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware that 6
CFC Eligibility CFC Eligibility (continued) Must qualify medically for High or Highest need. Must qualify financially. An individual must meet all financial and clinical criteria to qualify for CFC LTC Medicaid and must reside in a LTC setting. CFC LTC eligibility is reviewed annually. CFC LTC eligibility is reviewed annually. UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 7
What is Long What is Long- -Term Care? Term Care? It is Skilled Nursing/Custodial care provided in: Nursing facility Home Based waiver setting Adult Family Care Home Enhanced Residential Care Hospital Swing Bed Hospice UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 8
APPLYING APPLYING FOR FOR LTC MEDICAID LTC MEDICAID UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 9
Application Form Application Form Applicants must complete the Application for Choices For Care Long-Term Care Medicaid 202LTC to start the financial and clinical evaluation. UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 10
LTC Medicaid Application and Required Forms LTC Medicaid Application and Required Forms Choices for Care Long-Term Care Medicaid Application 202LTC revised 02/18 Information Release form 201B Long-Term Care Recovery from Estates form 204REC Burial Fund Intention Statement 216BF Authorization for Verification of Resources (for the spouse not applying for Medicaid) 202NAS UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 11
Completing the LTC Medicaid Application Complete and accurate information is required for the applicant and their spouse/civil union partner, even if only one is applying for coverage. The application must be signed by the client or authorized representative. If signed by an authorized representative, documentation is required. List all resources such as bank accounts, life insurance policies, retirement accounts, real property, etc. List all sources of income. List all transfers completed in the previous 60-63 months. UPDATED: February 2023 these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware that 12
Who may be eligible for Who may be eligible for Long Long- -Term Care Medicaid? Term Care Medicaid? To be eligible for CFC, you must: Be at least 65 years of age or 18 years of age or older with a physical disability. or Active MCA. Meet citizenship and identity requirements. Be a Vermont resident. Meet clinical criteria including LTC provider and start date. Meet financial criteria for LTC Medicaid. Meet permissible transfer rules. UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 13
Application Process Application Process When DVHA receives an LTC Medicaid application: The LTCCC nurse receives a copy right away. The client/representative is called within four days to schedule or complete the interview. If unable to reach by phone, an Appointment Notice for an interview is mailed. If there is no contact at appointment time, a second Appointment Notice is mailed. If still no contact at second appointment, the LTC Medicaid application is denied. UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 14
Interview DVHA LTCS must conduct an interview with the individual or his/her authorized representative. The case manager cannot complete the interview unless authorized by the applicant or authorized representative. Options for the interview include: Phone interview, or Face-to-face office interview, if requested UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 15
Look Look- -Back Period Back Period The look-back period is 60-63 months prior to the application or retroactive date. Application received April 1, 2022 Look-back period is April 1, 2017 March 31, 2022 Reviewing for transfer of income or resources for less than Fair Market Value (FMV). If a disallowed transfer occurs, there may be a penalty applied. UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 16
Verification needed for an Verification needed for an Initial LTC Application Initial LTC Application Do not wait to apply Do not send originals Send as much information as the client can Need information for the client, client s spouse or civil union partner Two 10-day requests for information (plus two days for mailing) During the current Public Health Emergency, we are allowing 14 days to provide verification. Contact the LTCS if: Extension of time is needed to submit verification. Client is having trouble getting verification. DVHA may be able to assist. UPDATED: February 2023 IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: 17
RESOURCES UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 18
Countable Resource Limits Countable Resource Limits $2,000 $2,000 Plus one month s net income - Applicant $148,620 $148,620 Community Spouse of applicant ($150,620 total for a couple as of 1/1/23) $5,000 $5,000 Plus one month s net income - Single HBW homeowner living in their home No resource limit for MCA UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 19
Resources Resources Resources include but are not limited to: Cash on hand Bank/credit union accounts, checking, savings, etc. Stocks, bonds, mutual funds Annuities Trust Funds Life Insurance policies / Burial accounts Real Property Vehicles UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 20
Vehicles Vehicles Cars, trucks, boats, snowmobile, ATV, tractor, camper, etc. All cars are excluded except antiques All other vehicles are a countable resource unless they are used for necessary transportation For example: LTC applicant and spouse own a car and a truck The car is excluded as a resource The truck is a countable resource UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 21
Real Property Real Property Ownership interest, including life estates, in any real property must be evaluated Primary residence Camps Rental property Wood lots, open land, etc. Timeshares Jointly owned property Business Property UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 22
Primary Residence Primary Residence The equity in the primary residence is excluded if: Individual resides in the home, or Individual is institutionalized, and Individual intends to return home, or Individual s spouse or dependent resides in the home, or Individual has a medical condition that prevented him/her from living in the home before institutionalization To be excluded the primary residence cannot a revocable trust, unless they reserve the power to sell, lease, or mortgage property cannot be placed in UPDATED: February 2023 be aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please 23
Life Insurance Life Insurance Whole life policies Policies with cash value Whole life policies are evaluated by the Department Term life policies Policies with no cash value Term policies are excluded UPDATED: February 2023 be aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please 24
Burial Funds Burial Funds A maximum of $10,000 per person Any separately identifiable fund clearly designated for burial expenses Cannot be commingled with other resources or income Couples may maintain a joint account for burial funds For more information see the Burial Fund Intention Statement form 216BF UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 25
Retirement Funds Retirement Funds Retirement funds include but are not limited to: Pension plans IRAs, Keoghs, 401Ks, mutual funds Annuities UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 26
Retirement Funds Retirement Funds (continued) Retirement funds are excluded if the individual: Must terminate employment to draw funds, or Can t withdraw a lump sum, or Is ineligible for periodic payments, or Has reached retirement age and is drawing enough to meet their life expectancy (per SSA s actuarial tables) NOTE NOTE: : The required minimum distribution (RMD) payment does not meet this requirement. If the individual is eligible for lump sum or periodic payments, the individual must choose the periodic payments. NOTE: NOTE: Please seek legal advice from an attorney familiar with Vermont LTC Medicaid or VT Legal Aid. UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 27
Resource Spenddown Resource Spenddown If resources are above the maximum, they must be spent for the benefit of the applicant. The resources may not be gifted, transferred or given away. If applying for retroactive coverage, one or more of the following actions may be taken to reduce excess resources: Set up a burial fund of up to $10,000 Spend money on unpaid medical expenses If income is below Protected Income Level (PIL), resources may be spent on housing, food, clothing, etc. UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 28
INCOME INCOME UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 29
Types of Income Types of Income Earned Income Income from employment, such as: Salary Wages Commissions Bonuses Severance pay Self-employment UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 30
Earned Income Deductions Earned Income Deductions Deductions from earned income: $65.00 $65.00 and one-half of the remainder For example: $500.00 - $65.00 = $435.00 2 = $217.50 ($217.50 of the $500.00 is countable income) . NOTE: NOTE: Other deductions and exclusions may be available. Deductions allowed to determine financial eligibility are not allowed deductions to calculate the patient share. UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 31
Unearned Income Unearned Income Unearned income is any payment other than earned income received from any source. Unearned income includes but is not limited to: Social Security, Railroad and Veteran s Benefits Pensions Annuities Promissory/Mortgage Notes Interest/Dividends Payments from trusts Alimony Regular contributions IRA payments UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 32
Unearned Income Deductions Unearned Income Deductions Unearned income deductions: $20.00 $20.00 Court-ordered child support payments NOTE: NOTE: Other deductions and exclusions may be available. Deductions allowed to determine financial eligibility are not allowed deductions to calculate the patient share. UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 33
Patient Share Patient Share Once an individual is granted LTC Medicaid, a patient share is calculated. Gross income Gross income - - allowable deductions = patient share allowable deductions = patient share Patient share is paid to the individual s highest paid provider Current patient share pays for previous month s care (i.e., income received in June pays for May s care) No patient share if active MCA. Deductions allowed to determine financial eligibility are not allowed deductions to calculate the patient share. NOTE: NOTE: The amount of an individual s patient share may change. The individual and provider will be notified of the new patient share amount. UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 34
Patient Share Deductions Patient Share Deductions To determine an individual s patient share, DVHA deducts the following from the individual s gross $72.66 $72.66 Personal Needs Allowance (NF residents only) $1,358.00 $1,358.00 Community Maintenance Allowance (HBW/ERC/AFC residents only) $724.53 $724.53 Home Upkeep Deduction (NF and ERC residents) if medical provider certifies person is expected to return home within six months of admission date and all other criteria are met gross monthly income: UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 35
Patient Share Deductions Patient Share Deductions (continued) Other deductions include: Allocations to community spouse or dependent family members Reasonable medical expenses incurred, if applicable NOTE: NOTE: Reasonable medical expenses do term care services received during penalty periods. do not not include long- NOTE: NOTE: Unpaid patient shares cannot current patient share. cannot be used to reduce a UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 36
Change Report Requirements Change Report Requirements All changes must be reported within 10 days Changes include but are not limited to but are not limited to: Income for individual and spouse Resource (if they exceed the $2,000 limit) Inheritance or insurance payments Sale of property Ownership such as adding/removing names to bank accounts, property or other accounts Spouse s shelter expenses Insurance premiums and/or coverage UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 37
How to Submit Documents How to Submit Documents AHS Uploader www.ahsuploader.vermont.gov Mail to: ADPC 280 State Drive Waterbury, VT 05671-1500 Drop off at the local Economic Services office Secure Fax 802-241-0514 UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 38
What Causes Delays in Processing What Causes Delays in Processing ARIS background checks delays Medicaid start date Placement Client does not reside in a LTC setting NF/ERC refusal without Medicaid coverage DVHA staff shortage and high caseloads Unsigned application Application signed by someone other than the client or authorized representative Incomplete submission of requested documentation Undeclared resources or transfers Company s response time to request for information (life insurance, annuity, etc.) UPDATED: February 2023 aware that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be 39
Questions Questions UPDATED: February 2023 that these slides will become obsolete. Current updated slides will be maintained at DVHA's Internet Site: IMPORTANT NOTICE: These slides are subject to change based upon HBEE rules and established business policies. Please be aware 40
