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Medical Assistance and Long-term Care

Stuart E. Schmitz and Jeffrey Schmidt
Schmitz & Schmidt, PA.
400 Robert Street North, #1840
St. Paul, Minnesota 55101
651-291-2405

Long Term Care Payment Sources

• Medicare
• Health Insurance
• Long Term Care Insurance
• Veterans Benefits
• Private Payment
• Medical Assistance

Medical Assistance (Title 42 United States Code, section 1396a, and Minnesota Statutes, Chapter 256B)

• State/Federal program to fund health care costs of poor, disabled and elderly ("Medicaid" in many states)
• Eligibility
...• Three requirements (Residency/Categorical/Financial)
...• Asset Limit = $3,000.00
...• "Available" Assets
...• “Unavailable” Assets
...• "Exempt" Assets
...• Homestead
• Income Contribution Toward Care = All Except $79.00 Per Month Personal Needs Allowance

Asset Protection of "Community Spouse" -- The Community Spouse Resource Allowance (CSRA)

• Assets assessed as of first date of a continuous period of institutionalization of 30 days or more
...• First continuous period of institutionalization
...• Asset Assessment form and verifications
• Assets are allocated (but not necessary transferred) between the spouses as shown in Figures A, B and C

Figure A

Institutionalized Spouse	Assets at Institutionalization $100,000	Community Spouse
$50,000	"Spend Down"	$50,000
($47,000)	Assets remaining at application date	0
$3,000	$53,000	$50,000

Figure B

Institutionalized Spouse	Assets at Institutionalization $250,000	Community Spouse (maximum share)
$145,600	"Spend Down"	$104,400
($142,600)	Assets remaining at application date	0
$3,000	$102,540	$104,400

Figure C

Institutionalized Spouse	Assets at Institutionalization $40,000	Community Spouse (mimimum share)
$10,611	"Spend Down"	$29,389
($7,611)	Assets remaining at application date	0
$3,000	$32,389	$29,389

Income Protection of “Community Spouse”

• Community spouse keeps all of his or her own income
• Community spouse assured monthly income of $1,751 (the Minimum Monthly Maintenance Needs Allowance or MMMNA)
• The MMMNA is raised by the amount that “shelter expenses” exceed $526 each month, up to a cap of $2,619
• Community spouse may be allowed to retain an allocation of the institutionalized spouse’s income as described in Figure D below
• Community spouse may be allowed to retain more assets (over an above the CSRA) if the combined income is too small to meet the MMMNA

Figure D

Minimum monthly maintenance needs allowance	$1,751
Shelter Expenses = Mortgage, Insurance, Taxes, Utility Standard of $305	$655
"Excess" Shelter Expenses = Amount over $526	$129
Community Spouse Monthly Maintenance Needs Allowance	$1,770
Community Monthly Spouse Income	$1,000
Income Allocation from Institutionalize Spouse	$770
Community Spouse Income	$1,770

Transfers of Assets

• A “Period of Ineligibility” is imposed with transfers for less than fair market value
• All transfers must be disclosed at the time of Medical Assistance application
• Look-back = 60 months immediately before the month of application
• Period of Ineligibility begins with the month after an application where the individual is proved to be otherwise eligible
• Determining the period of ineligibility for transfers:

Amount Transferred	Statewide average payment rate for skilled nursing facility care ($4,198 as of July 2005)	Period of Ineligibility
$10,000	$4,772	2.09 months beginning in the month after transfer
$50,000	$4,772	10.47months beginning in the month after transfer
$100,000	$4,772	20.95 months beginning in the month after transfer
$200,000	$4,772	62.86 months beginning in the month after transfer. (Could be limited to 60 months with the "look back" rule.)

Liens and Estate Recovery
• Liens Against Non-Homestead Real Estate – Satisfied Only When Sold
• Claim Against Estate of Second Spouse to Die to Reimburse Benefits Paid

Home and Community-Based Long-Term Care Programs
• Elderly Waiver – Medical Assistance eligibility
• Alternative Care – State funded, retain more assets
• Group Residential Housing – Assisted Living Facility Assistance

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