long, reher & hanson, p.a. october, 2007 ma, maepd, va, vh, gamc, grh, cadi, cac, tbi, mr/rc,...

Long, Reher & Hanson, P.A. October, 2007

MA, MAEPD, VA, VH, GAMC, GRH, CADI, CAC, TBI, MR/RC, DD, EW, AC, MCHA, QMB, SLMB,

QI-1,TEFRA, MINNCARE,MEDICARE PARTS A,B,C,D…

MSHO & MDHO

OVERVIEW OF LONG-TERM CARE PAYMENTS SOURCES FOR THE ELDERLY AND PERSONS

WITH DISABILITIES Laurie Hanson

Long, Reher & Hanson P.A.Minnesota Elder Law AttorneysSM

St. Louis Park, Minnesota952-929-0622

www.mnelderlaw.com


YOUR CLIENT’S HEALTH CARE NEEDS

• Basic health insurance

• Benefits to pay for long-term care at home

• Benefits to pay for care in an assisted living facility

• Benefits to pay for care in a nursing home

• Benefits to pay for hospice care


Who is your client?

• Age

• Found Disabled by the Social Security Administration or the State Medical Review Team – or not.

• Source of income

• Assets

• Veteran


Which Program?

Stan is single and worked for the railroad for 45 years. He is 76 and just suffered a stroke. He is in the hospital and needs long-term care. His income is $2,000 per month. He has a Medicare supplemental insurance policy ($111.50 per month).


SOCIAL SECURITY• Retirement• Survivor• Disability• Insurance

Railroad Retirement BenefitsMedicare

p. 1 of outline

SUPPLEMENTAL SECURITY INCOME

(SSI-needs based)Medicaid

• Medical Assistance• MAEPD and all Waivers


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– are suffering from chronic kidney disease OR– have ALS (Lou Gehrig’s disease).


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 drug plans


Medical Assistance

• An Entitlement Program: If you qualify for benefits, you receive benefits which include:

• Hospitalization, physician services, some dental and eye care

• Mental health services for adults and children

• Skilled nursing home, therapies, home health care, medical supplies and treatments, etc.


MA ELIGIBILITY GENERAL REQUIREMENTS

• Minnesota resident

• Categorical Basis of Eligibility– 65 and older Blind or Disabled

– Pregnant woman

– Under 21

– Parent or caretaker of dependent child

• Financially Eligible


Basic financial eligibility for single person

• Available assets:

No more than $3,000.

• Income:

$851 OR spenddown to $639 or

Income exceeds the cost of care

Sam will be eligible only if income exceeds cost of care and he has only $3,000


Which Program?

Steven is 30 years old and is quadriplegic. He is a computer programmer and wants to work full time. He needs seven hours of home health care each day.


Medical Assistance for Employed Persons with Disabilities (MAEPD)

• Individuals between the ages of 17 and 65 who are certified disabled and earn more than $65.00 each month

• Premium fee on sliding basis up to 7.5% of income

• Higher asset limits• May receive MA long-term care benefits

p. 3 of outline


Which Program?

What if Steven was unable to work? He is 30 years old, quadriplegic and on a ventilator.


Straight MA or one of Two Waivers

For people under the age of 65

• Community Alternative Care (CAC) (p.5)

• Community Alternatives for Disabled

Individuals (CADI) (p. 5)

• If he had a brain injury: The TBI program

(p.7)


Which Program?

Sally is 57 years of age. She is admitted to the hospital for one week due to an intentional overdose and depression. She has some part-time work but no real source of income and $8,000 in assets. Last month she earned $425.00.


General Assistance Medical Care

• Adults who are not eligible for Medical Assistance (if she were 19 – eligible for MA).

• Assets are less than $1,000 (or $10,000 for hospital only)

• Household income may not exceed 75% of FPG ($639) – 175% for Hospital-only ($1,489)

p. 7 of outline


Which Program?

Sally is 57 years of age. She has been released from the hospital and is back to work. She earns about $450.00 per month. She has $500 in her checking account – she needs ongoing health insurance for prescriptions.

• What if she had $8,000 or earns more than $639?• What if she inherits $100,000?


MinnesotaCare

• Income less than 175% of FPG ($1,489 per month)

• Assets less than$10,000• Had no other insurance for the past four

months• Unable to get health insurance through

employer• Pays a premium

Page 8 of outline


MCHA• Minnesota’s safety net for those hard-to-

insure individuals.• Covers pre-existing conditions.• Cannot turn down an individual• Must be rejected for other coverage• Higher premiums• Medica is administering the plan.

p. 9 of outline


WHICH PROGRAM?

Henry is 67 on Medicare and his income is $860 per month. He is very upset about his part B premium cost rising and cannot meet his deductible and co pays.


MEDICARE SAVINGS PROGRAMS

• Qualified Medicare Beneficiary• Service Limited Beneficiary• Qualified Individual.

Pages 3-4 of outline


WHICH PROGRAM?

John is 67 and his income is $1,200 per month. He is residing in an assisted living facility. The cost for the room and board is $859 and the cost for the health care services is $1,500.


Elderly Waiver

• Eligible for SISEW • Pay a waiver obligation above standard of $839

for assisted living services• Does not have enough money to pay for the room

and board.• Can use the remedial care cost as part of waiver

obligation. Minn. Stat. § 256B.056, subd. 5.

• Page 4 of outline


Group Residential Housing

State-funded income supplement program that pays for room-and board costs for low-income people living in a licensed or registered facility with which the county human service agency has a negotiated rate.

Current rate: $737Page 10 of outline


VETERANS

Sam, Sally, John, Henry, and Steven are Veterans! What have we missed!

Both State and Federal Programs are available (See pages 1-2 and 11)


Dual Eligibles

• Minnesota Senior Health Options

• Minnesota Disability Health Options


MA, MAEPD, VA, VH, GAMC, GRH, CADI, CAC, TBI, MR/RC, DD, EW, AC, MCHA, QMB, SLMB,

QI-1,TEFRA, MINNCARE,MEDICARE PARTS A,B,C,D…

MSHO MDHO

PAYMENT SOURCES FOR HEALTH CARE FOR THE ELDERLY AND DISABLED .

Laurie HansonLong, Reher & Hanson P.A.

Minnesota Elder Law AttorneysSM

St. Louis Park, Minnesota952-929-0622

www.mnelderlaw.com

long, reher & hanson, p.a. october, 2007 ma, maepd, va, vh, gamc, grh, cadi, cac, tbi, mr/rc,...

Documents

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hospice care slide

home health care benefits

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nursing home benefits

acute care hospital

cost of care sam