Medicaid Policy
Medicaid Policy
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Link to a list of policies approved for sale in Utah
Link to a list of States that participate in the Long Term Care Partnership program
Definition
Long Term Care Insurance Partnership (LTCIP) policies are insurance policies that will pay for some or all of the individual’s long term care medical needs while also allowing a form of asset and estate recovery protection for Medicaid purposes. These LTCIP policies must be approved for sale in Utah by the Utah Insurance Department. Other States that have been approved to issue LTCIP policies are considered partnership states. Individuals may have a plan that they purchased in another partnership state.
Utah became a LTC insurance partnership state on October 1, 2014.
General Eligibility Requirements
Individuals must meet the criteria to be determined eligible for Nursing Home or a Home and Community based Waiver in Utah (LTC).
Residency in a Partnership State.
The insured person is a resident of the State of Utah and the policy issue date was not earlier than October 1, 2014; or
The insured person was a resident of a Partnership State when LTCIP coverage first became effective under the policy.
Who can qualify:
The following individuals are allowed these protections.
Aged, blind or disabled individuals who are approved for Nursing Home or a HCB Waiver and whose countable income does not exceed 300% of the SSI payment rate.
The following individuals are not allowed these protections.
SSI recipients
Individuals who meet eligibility criteria for one of the SSI Protected groups
Individuals who would be eligible in the community for the 100% FPL group of aged or disabled individuals
Individuals who meet the eligibility criteria of the MWI program for the working disabled
Individuals whose countable income is above 300% of the SSI payment rate.
Treatment of Payments from a LTCIP.
LTCIP payments are generally not counted as income.
See 415-1 (Medical Insurance Payments) to determine if the payment would count as income.
Resource Disregard
To determine eligibility of an applicant, the eligibility agency allows a resource disregard equal to the amount of payments made by the policy on behalf of the individual.
The amount of the disregard is the total amount of financial benefits paid to or for the benefit of the individual up to the first moment of the month of the Medicaid application month in Utah.
The disregard applies to countable assets the individual owns or that are deemed available to the individual for the purpose of determining eligibility.
This disregard applies only to payments made for the benefit of the individual. Benefits paid to or on behalf of the spouse of the individual do not apply when determining the resource disregard for the individual.
Example - The individual has purchased a LTCIP policy and goes into a nursing home. The policy begins making payments on behalf of the individual to the facility to cover the nursing home costs. The policy pays a total of $14,000.00 on behalf of the individual in months before the application month. The individual will receive a resource disregard of $14,000.00.
Example – The spouse of a individual received LTCIP payments totaling $17,000.00 in months before the application month. This amount is not added to the resource disregard for the individual.
The resources disregard can be applied to any type of countable resources including real property.
The amount of resources disregarded for Medicaid eligibility purposes will also be excluded from the estate recovery process.
The amount of assets excluded based on this rule are not exempt from transfer of asset policy. Any transfer of assets made will be subject to the rules found in section 575.
If the LTC Insurance Partnership policy continues to make payments during or after the month of application, these additional payments are not added to the resource disregard. These payments are a TPL source.
This resource disregard will not apply to the assessment of assets. Complete the assessment of assets to determine the countable resources of the individual. Apply the disregard to the portion of assessed resources attributed to the individual.
Example - The individual is married and in a nursing home. The individual has received a total of $27,000.00 in benefits from the LTC Insurance Partnership policy at the first moment of the month of application. The assessment of assets determines that the couple has a total of $57,000.00 in assets held at application. The individual’s portion of the assessed assets is $28,500.00. After applying the LTC Insurance Partnership policy resource disregard of $27,000.00 the individual has $1,500.00 in remaining countable resources as his share to determine eligibility. This individual would be asset eligible for Medicaid.
Example - An individual applies for nursing home Medicaid and has a community spouse. Some time back, the individual’s spouse purchased a LTC Insurance Partnership policy and later was in a nursing home. The policy made payments on behalf of the spouse to the facility to cover the nursing home costs. The policy paid a total of $25,000.00 on behalf of the spouse. The spouse returned home before the individual entered a nursing home and applied for Medicaid. The assessment of assets determines that the couple has a total of $57,000.00 in assets at application. The individual’s portion of the assessed assets is $28,500.00. The individual will not receive a resource disregard because the LTC insurance payments were for the spouse. The individual is not resource eligible.