Page 3

Aged, Blind and Disabled Manual Policy Manual Number: 125.025 Section: Institutional Medicaid Chapter: Long-Term Care Partnership

March 18, 2019 Division of TennCare 3 4. When an LTCP Policy Holder Should Apply for TennCare Medicaid a. If the LTCP policy holder exhausts the benefits of his LTCP policy; or b. When the LTCP policyholder, a spouse, a family member or friend feels that the policyholder can no longer afford to pay for the cost of care. 5. Does an LTCP policy guarantee access to TennCare Medicaid? No, owning an LTCP policy does not guarantee access to TennCare Medicaid even if the policy holder exhausts his benefits. Individuals must still meet all other eligibility requirements. The LTCP allows policy holders to have a portion of their assets disregarded (i.e., not counted) during the eligibility determination process and subsequently protected from estate recovery. A copy of the LTCP Statement of Benefits Paid must be mailed or faxed to: The Bureau of TennCare Third Party Liability/Estate Recovery Unit 310 Great Circle Road, 4E Nashville, TN 37243 Fax number: 615-253-5588 6. Examples a. Example 1: LTCP Benefits have been Exhausted When an Institutionalized Individual Applies for TennCare Medicaid Patricia McVey is a resident of Happy Homes nursing facility. Her qualified $90,000 LTCP policy has been paying for her care. When Ms. McVey applies for TennCare Medicaid, she verifies that the benefits of her LTCP policy have been exhausted and were used towards her cost of care. Ms. McVey has the following countable resources: a $6,000 savings account; a $7,500 checking account; and $80,000 in a Certificate of Deposit. TennCare verifies her countable resources equal $93,500 ($6,000 + $7,500 + $80,000). Her TennCare Medicaid resource limit is $2,000. Because Ms. McVey has fully exhausted her LTCP policy benefit, $90,000 of her countable resources will be protected. The protected resources do not count toward her $2,000 TennCare Medicaid resource limit. Ms. McVey has $80,000 in a Certificate of Deposit, $6,000 in her savings account and $4,000 in her checking account that are protected. This leaves her with $3,500 in resources that are to be considered when determining her eligibility for TennCare Medicaid. The resource limit is $2,000 and since she does not have a prepaid burial plan, she can designate $1,500 for burial. She is now TennCare Medicaid eligible.