Page 46

Chapter: 1600 Assets Program: MSSI, SFP 42

countable resources are reduced by $60,000 and the remaining $1,000 is considered countable in the eligibility determination.

The resource disregard is protected from estate recovery. Complete and send a Third Party Recovery Transmittal (CF-ES 2356) to notify the Agency for Health Care Administration’s Third Party Liability vendor of the amount to be disregarded for estate recovery purposes. If the individual will continue to receive the LTC insurance benefits, determine if the payments will be considered income to the individual or a third party source. If the recipient directly receives the insurance payments, follow instructions in manual passage 1840.1007 to determine if the payments are considered income to the individual. If the insurance benefits are paid to the nursing home, exclude the payments under 1840.0118 as a third party source that the provider must bill prior to billing Medicaid.

Verification Requirements:

Not all long-term care insurance policies are a qualified LTC Insurance Partnership Policy. Eligibility staff must request documentation at the time of application to verify the:

1. policy is a qualified LTC Insurance Partnership Policy, and 2. total amount of long term care benefits paid out to or for the applicant.

The insurance company may use the approved Office of Insurance Regulation Form (OIR-B2- 1781) or a similar form developed by the insurance company. 1640.0595 Continuing Care Entrance Fee (MSSI) The following policy applies to individuals applying for ICP, institutionalized MEDS-AD, institutionalized Hospice, Home and Community Based Services Programs or PACE on or after November 1, 2007. Do not apply the policy to recipients who were eligible for Medicaid prior to November 1, 2007 and have no break in eligibility.

An entrance fee paid by an individual upon admission into a continuing care retirement community (CCRC) or life care community is considered an asset when all of the following conditions are met:

1. The individual has the ability to use the entrance fee when their income and assets are insufficient to pay for their care. 2. The entrance fee (or any remaining portion) is refundable when the individual dies or terminates the contract with the CCRC or life care community. 3. The entrance fee does not confer an ownership interest in the CCRC or life care community. Examples of ownership interest include circumstances where all or part of the entrance fee is used to purchase an apartment, condominium or cooperative unit within the CCRC.

When all three of the above conditions are met, count the maximum refund that could be available to the individual as an available asset regardless of whether the refund is actually received.

Request and review the CCRC or life care community contract. Forward the contract to the Circuit Legal Counsel, if necessary. If it is determined the potential for a refund exists, accept the CCRC’s statement as to the amount of the refund.