Page 453

35.1.3 Verification Verify the following items as described. 35.1.3.1 Verification of the Qualified LTCIP Policy A "qualified LTCIP policy” must meet all relevant requirements of federal and state law. Qualified LTCIP policies are certified by the Wisconsin Office of the Commissioner of Insurance (OCI). OCI certification of the policy must be verified by assuring that the policy is in the “Long-Term Care Insurance Partnership Program (LTCIP)” section of the Long-Term Care page on the OCI website. 35.1.3.2 Reciprocity Standards Participation in Wisconsin’s LTCIP program is allowed for individuals who purchased qualified policies in any state that is subject to the LTCIP reciprocity standards as documented in that state’s Medicaid State Plan. Such states are referred to as "Participating States." Information regarding reciprocity states can be found at: http://www.aaltci.org/long-term-care-insurance/learning-center/long-term-care-insurance- partnership-plans.php#approved If the policy was issued by a Participating Reciprocity State: 1. Apply the policies specified at 35.1.2 LTCIP ASSET DISREGARD. 2. Apply the policies specified in this subsection, 35.1.3 VERIFICATION. If the policy was not issued by a Participating State, the individual is not eligible to participate in Wisconsin’s LTCIP program. The LTCIP asset disregards and estate recovery offsets do not apply to such individuals. 35.1.3.3 Verification of Benefits Paid In addition, the amount paid out by a qualified LTCIP policy must be verified before it can be disregarded for Medicaid eligibility or estate recovery purposes. The qualified LTCIP policy carrier must document the amount paid for benefits on or after January 1, 2009 using the appropriate OCI approved form (OCI 26-114) and provide verification of the payout amount upon request. Only benefits paid on or after January 1, 2009 may be disregarded when determining eligibility for Medicaid programs. 35.1.4 Examples Example 1: Ruth is a resident of a medical care facility. She has no spouse. Her qualified $90,000 LTCIP policy has been paying for her care. When Ruth applies for WI Medicaid payment of long-term care services, she verifies that her qualified LTCIP policy has paid out $80,000 in policy benefits since January 1, 2009. Ruth owns the following non-exempt assets: • $5,000 savings account • $6,000 checking account • $70,000 equity value in non-homestead property The worker determines that Ruth's total non-exempt assets equal $81,000 ($5,000 + $6,000 + $70,000). Her WI Medicaid asset limit is $2,000; however, because $80,000 has been paid out by Ruth’s qualified WI LTCIP policy, an additional $80,000 in non-exempt assets is disregarded. Ruth passes the asset test for WI Medicaid because we disregard $80,000 of her assets. The remaining non-exempt assets are less than $2,000. If Ruth were to pass away at this point, $80,000 of her assets would be protected from estate recovery.