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MA, MAEPD, VA, VH, GAMC, GRH, CADI, CAC, TBI, MR/RC, DD, EW, AC, MCHA, QMB, SLMB, QI-1,TEFRA, MINNCARE, MEDICARE PARTS A

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.

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MA, MAEPD, VA, VH, GAMC, GRH, CADI, CAC, TBI, MR/RC, DD, EW, AC, MCHA, QMB, SLMB, QI-1,TEFRA, MINNCARE, MEDICARE PARTS A

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  1. 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 AttorneysSM St. Louis Park, Minnesota 952-929-0622 www.mnelderlaw.com Long, Reher & Hanson, P.A. October, 2007

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

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

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

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

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

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

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

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

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

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

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

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

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

  15. Which Program? Sally is 57 years of age. She is admitted to the hospital for one week due to an intentional overdose and depression. Shehas some part-time work but no real source of income and $8,000 in assets. Last month she earned $425.00. Long, Reher & Hanson, P.A. October, 2007

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

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

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

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

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

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

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

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

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

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

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

  27. 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 AttorneysSM St. Louis Park, Minnesota 952-929-0622 www.mnelderlaw.com Long, Reher & Hanson, P.A. October, 2007

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