2. 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 Attorneys SM St. Louis Park, Minnesota 952-929-0622 www.mnelderlaw.com

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

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

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

6. Long, Reher & Hanson, P.A. October, 2007 SOCIAL SECURITY Retirement Survivor Disability Insurance Railroad Retirement Benefits Medicare p. 1 of outline SUPPLEMENTAL SECURITY INCOME (SSI-needs based) Medicaid Medical Assistance MAEPD and all Waivers

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

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

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

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

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

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

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

14. Long, Reher & Hanson, P.A. October, 2007 Which Program? What if Steven was unable to work? He is 30 years old, quadriplegic and on a ventilator.

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

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

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

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

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

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

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

22. Long, Reher & Hanson, P.A. October, 2007 MEDICARE SAVINGS PROGRAMS Qualified Medicare Beneficiary Service Limited Beneficiary Qualified Individual. Pages 3-4 of outline

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

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

25. Long, Reher & Hanson, P.A. October, 2007 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: $737 Page 10 of outline

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

27. Long, Reher & Hanson, P.A. October, 2007 Dual Eligibles Minnesota Senior Health Options Minnesota Disability Health Options

28. 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 PAYMENT SOURCES FOR HEALTH CARE FOR THE ELDERLY AND DISABLED. Laurie Hanson Long, Reher & Hanson P.A. Minnesota Elder Law Attorneys SM St. Louis Park, Minnesota 952-929-0622 www.mnelderlaw.com