GEORGIA Medicaid and Long-Term Care Partnership 2-Hr Course

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1 GEORGIA Medicaid and Long-Term Care Partnership 2-Hr Course Presented by: Sandi Kruise Insurance Training A division of Sandi Kruise Inc

2 Georgia s Long-Term Care Partnership Program Overview The Long-Term Care Partnership Program (Partnership), administered by the Department of Community Health in collaboration with the Office of the Commissioner of Insurance and the Department of Human Resources, Division of Aging Services, provides an alternative to spending down or transferring assets by forming a partnership between Medicaid and private long-term care insurers. This public-private partnership creates an innovative program offering individuals quality, affordable long-term care insurance and a way to receive needed care without depleting all their assets. Only Partnership policies provide Medicaid asset protection. For every dollar that a Partnership policy pays out in benefits, a dollar of assets can be protected (disregarded) from the long-term care Medicaid asset limit. The protected assets will also be exempted from Estate Recovery in amount equal to the benefits paid by the Partnership policy. Once private insurance benefits are used, special Medicaid eligibility rules are applied if additional coverage is necessary. Partnership policies will be tax qualified plans under federal law and provide inflation protection benefits for purchasers. o Partnership policies provide compound annual inflation protection for individuals less than 61 years of age as of the date of purchase. This is one of the distinguishing features of a Partnership policy and also the inflation protection is a valuable benefit regardless of whether policy is a Partnership policy. o Partnership policies provide some level of inflation protection for individuals at least 61 years of age, but less than 75 years of age on date of purchase. o Partnership policies may provide inflation protection, but is not required, to individuals 76 years of age as of the date of purchase. Some Partnership policies cover home and community-based services. Individuals should consider looking into a policy that pays for these types of services. A Partnership policy is ideal for someone who will not be able to afford the high cost of long-term care, but who can afford the reasonable cost of long-term care insurance. The younger individuals are when purchasing a long-term care insurance policy, the less expensive it is. Individuals who have accumulated resources by saving or investing may be the best candidates for a Partnership policy. Before purchasing a Partnership policy, you may want to consult with a trusted advisor or long-term care insurance agent so you are able to pick a long-term product that is right for you. If you want to buy a Partnership policy, please contact your local agent or an insurance company that is approved to sell Partnership policies, or the Office of Commissioner of Insurance for a list of carriers approved to sell Partnership policies (404) or (toll-free)/website: Some employers may also offer long-term care insurance policies. The State of Georgia does not sell Partnership policies; they administer and monitor the Long-Term Partnership Program. Partnership policies are available from the participating insurance companies who are authorized by the Georgia Office of Insurance Commissioner to market and sell those policies. Agents who wish to sell Partnership policies must complete 8 hours of training initially and then 4 more hours every 2 years thereafter. Costs will vary and each company sets its own rates. A local insurance agent can provide specific information related to rates and premiums. Premiums can vary greatly across companies and within companies depending on what features are included in an individual policy. For more information on the Georgia Long-Term Care Partnership Program, please visit our website at: or call GeorgiaCares at (toll-free). 1

3 GEORGIA MEDICAID PROGRAMS FOR LONG-TERM CARE Overview Medicaid Long-Term Care programs enable eligible recipients to live in the setting that is most appropriate for their needs, including nursing facilities, their own or a caregiver s home. To be eligible for long-term care assistance, applicants must meet both income and resource limits, although these limits may be higher than the limits for other Medicaid programs. Other criteria considered are: functional status, age, citizenship and Georgia residency. Waiver recipients must qualify for the level of care provided in a nursing facility or other qualified institution. Georgia s Medicaid Long-Term Care Programs Community Care Services Program Community Care Services Program waiver provides both home and community-based services to elderly and/or functionally- impaired or disabled people. It includes care management, adult day health, alternative living services, personal care, home delivered meals, extended home health and emergency response systems. Independent Care Waiver Program (ICWP) ICWP offers services to a limited number of adult Medicaid members with physical disabilities, including persons with traumatic brain injuries (TBI). This program is for eligible Medicaid members between the ages of 21 and 64 who are severely physically disabled. ICWP services include personal support, home health, emergency response systems, specialized medical equipment and supplies, counseling and home modifications. Mental Retardation Waiver Program (MRWP) MRWP and Community Habilitation Support Services (CHSS) offer home or community-based service for people with mental retardation or a developmental disability. Five regional offices under the Department of Human Resources determine eligibility and coordinate service delivery for these programs. MRWP covers day rehabilitation and supported employment, residential training and supervision, specialized medical equipment and supplies, vehicle adaptations and home modifications. Nursing Facility Nursing Facility services include skilled nursing care, rehabilitation services, and health-related care in an institutional setting. Persons in nursing facilities need round-the-clock nursing oversight. These services also include Intermediate Care Facility/Mental Retardation and swing bed services. Service Options Using Resources in a Community Environment (SOURCE) SOURCE serves frail elderly and disabled Georgians who are eligible for Supplemental Security Income/Medicaid. This program is available in limited areas. An assessment process identifies individuals. In addition to core services of monitoring and assistance with functional tasks, SOURCE individuals can have Assisted Living Services, extended home health, personal care, home delivered 2

4 meals, adult day health care, emergency response services, and 24-hour medical access to a case manager and primary care physician. Home Health Services Home Health Services include skilled nursing, home health aide, and physical, speech and occupational therapy services. Services are provided in the member s home and require physician orders. Because they are meant to be short term in nature, there is an annual limit on the number of visits that can be reimbursed. Hospice Hospice includes palliative medical care and services for persons who are terminally ill and their families. Hospice offers nursing care, medical social services, counseling, medications, medical appliances and supplies, home health aide, and therapy services. Care may be provided in the member s home or in an in-patient facility, including nursing facilities. Community Mental Health Services Community Mental Health Services are provided to persons of all ages who are emotionally or mentally disturbed, alcohol or substance abusers. Services are provided in out-patient facilities, clinics, or shortterm in-patient facilities. Community Mental Health Services include diagnostic assessments; crisis intervention; psychiatric treatment; nursing assessment and care; individual, group, and family outpatient therapies; medication administration; day treatment; substance abuse 3

5 GEORGIA MEDICAID ELIGIBILITY OVERVIEW The Georgia Medicaid program is administered by the Department of Community Health, Division of Medical Assistance. The Medicaid program is funded by the federal and state governments. States administer the Medicaid program using federal regulations and guideline. Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. CATEGORIAL RELATIONSHIP Many groups of people are covered by Medicaid. Even within these groups, certain requirements must be met. Every individual must be included in one of the following Medicaid categories: Family: Must be a child under age 21. or a pregnant woman Age: 65 years of age or older; or Blind: Under age 65 and visually impaired; or Disabled: Under age 65 and physically or mentally impaired. BASIC ELIGIBILTY Every individual must meet all the following basic eligibility criteria: Must be a resident in Georgia. Must be a U.S. Citizen or a qualified alien. Must have income and resources below the prescribed limits. Must agree to assign to the State all rights to medical support and third party support payments (hospital and medical benefits). Must apply for all other benefits except Veterans Administration Improved Pension. Must apply for a Social Security Number. LONG-TERM CARE MEDICAID COVERAGE GROUPS A. Nursing Home Aged, or disabled individuals needing long-term nursing care may be eligible for Medicaid benefits. Long term care is defined as nursing care provided for at least thirty (30) days, whether the nursing care is provided in a hospital, nursing home or at home through the home and community based health care program (i.e. Community Care Services Program). B. Community Care Waiver Services (CCSP) Aged, blind or disabled individuals who are in need of nursing home care but remain at home with the aid of Community Care Services may be eligible for Medicaid benefits. Community Care Services are specific health care services rendered to an individual at home in lieu of nursing home placement. Services provided include: Home-delivered services; Homemaker Aide Services; Emergency Response Services; Respite Care; Adult Day Rehabilitation and Alternative Living Services. C. Katie Beckett or Deeming Waiver Coverage Children under age eighteen (18) who are chronically sick and need nursing home care but could stay home with good home care that costs less than nursing home care are eligible for this coverage. The parents of these children must have income or resources that make the children ineligible for SSI. The parents income and resources are not counted when determining these children s eligibility. 4

6 D. The Independent Care Medicaid Waiver Program (ICWP) Severely disabled individual who are twenty-one (21) years of age or older, who are medically stable enough to leave the hospital but cannot do so without the support services available through this program, and who are at risk of out-of-state nursing home placement may be eligible for Medicaid benefits. The services available under this program are: Case Management, Homemaker, Personal Care Services, Environmental Modification, Skill Nursing, Transportation, Specialized Medical Equipment and Supplies, Personal Emergency Response Systems, Companion Services, Counseling and Occupational Therapy. E. Hospice Care Available to individuals who are terminally ill; has a medical prognosis of six months or less life expectancy; and the individual receives hospice care from an approved hospice care provider. The services available under this program include but are not limited to; nursing care, medical social services, physician services, counseling services, respite care, and home health aide services. F. Mental Retardation Waiver Program and Community Habilitation Support Services Designed to provide in-home and community based services to Medicaid eligible mentally retarded and developmentally disabled individuals who do not receive Medicaid benefits under a cash assistance program. MRWP Services include: Day Supports; Day Habilitation; Residential Training and Supervision; Natural Support Enhancements; Therapeutic Services; Respite Care; Supported Employment; Personal Support Services; Environmental Modifications; Vehicle Adaptations; Specialized Medical Equipment and Supplies. CHSS Services include: Community Habilitation and Support Services. Specialized Medical Equipment and Supplies; Environmental Modifications. 5

7 Providing Documentation of Citizenship for Medicaid In the past, if you had Medicaid or applied for Medicaid, you had to declare that you were a U.S. citizen or national, or that you were a Qualified Alien. All States have required that you be able to document Qualified Alien status, and some States have required you to document citizenship status. What is changing? Congress passed a new law. Beginning on July 1, 2006, all people who get Medicaid or people who apply for Medicaid must be able to document that they are U.S. citizens or nationals. If you are enrolled in Medicare or receive Supplemental Security Income (SSI), or are a Qualified Alien, you will not be affected by this new law. What kind of documentation do you need? The best way to document that you are a citizen is with one of these: A U.S. Passport A Certificate of Naturalization (DHS Forms N-550 or N-570) A Certificate of U.S. Citizenship (DHS Forms N-560 or N-561) (If you do not have any of these items, you will need two documents, one document to show you are a citizen and one document to show who you are.) Document you are a citizen with: Your birth certificate, or A Report or Certification of Birth Abroad of a U.S. Citizen (Form FS-240 or FS-545), or U.S. Citizen I.D. card (DHS Form I-197), or Adoption Papers, or Military Record if it shows where you were born

8 Show who you are with: Your picture on your current State driver s license or State identity card, or School identification card, or A Federal, State or Local government identification card, or A U.S. Military identification card What should you do if you don t have any of these things? Check with Medicaid about other ways to document you are a citizen and to show who you are Tell Medicaid why you can t get documents, and Give Medicaid any documents you have (Each document you provide must be an original or a copy certified by the Agency that has the original. You cannot use a photocopy or a notarized copy of your document.) How much time do you have to show this documentation to Medicaid? Medicaid must give you a reasonable amount of time to get your documents. Check with Medicaid to see exactly how much time you have to get your documents. What if you still have questions? If you still have questions, contact Medicaid, or call MEDICARE ( ). TTY users should call Information is also available on the cms.hhs.gov web site.

9 MEDICAID INCOME AND ASSETS LIMITATIONS Financial need must exist in order for an individual to be eligible under all Medicaid programs including the long-term care coverage programs listed above. Financial criteria are divided into two groups, income and assets. Income Income is any item an individual receives in cash or in-kind that can be used to meet his or her need for food or shelter. The income retirement for Medicaid states that gross monthly income of the applicant cannot exceed a certain figure. The 2008 figure has been set at $1, The State of Georgia determines the income requirement, which changes each January. However, if an individual s income exceeds the income limit listed above the individual may establish an Irrevocable Qualified Income Trust (QIT), also know as a Miller Trust. (Contact your local county Department of Family and Children Services for additional information). Assets Assets include all income and resources of the individual and of the individual s spouse, including income and resources which the individual or such individual s spouse is entitled to but does not receive. To meet the asset criteria, an individual must have countable resources of $2,000 or less. Resources are those assets, both real and personal property, which an individual or couple owns and can apply, either directly or by sale or conversion, by meeting basic needs of food, clothing and shelter (like bank accounts, real property, or other items that can be sold for cash). If the long-term care individual has a spouse who is not institutionalized or receiving home and community based services, the resources of the spouse MUST be considered in the eligibility determination. The total combined resources of the individual and the non-institutionalized spouse must be $106,400 or less for Family Size Monthly Income Limit Resource Limit Individual $ 1, $2,000 *Couple $3, $3,000 *If both are receiving long-term services. 8

10 Eligibility Criteria Georgia Medicaid Eligibility for Medicaid coverage providing Long-Term Care or Community Care and Services SSI Recipients Aged, blind or disabled individuals who receive Supplemental Security Income (SSI) Income Limits Individual - $623 per month ($7,644 per year) Couple - $956 per month ($11,472 per year) Resource Limits Individual - $2,000 Couple - $3,000 Nursing Homes Aged, blind or disabled individuals who live in nursing homes and have low income and limited assets. Income Limits Resource Limits $1,911 per month ($22,932 per year) Individual - $2,000 Couple - $3,000 Community Care Aged, blind or disabled individuals who need regular nursing care and personal services but can stay at home with special community care services. Income Limits Resource Limits $1,911 per month ($22,932 per year) Individual - $2,000 Couple - $3,000 Hospice Terminally ill individuals who are not expected to live more than six months may be eligible for coverage. Recipients must agree to receive hospice services through a Medicaid participating hospice care provider. Income Limits Resource Limits $1,911 per month ($22,932 per year) Individual - $2,000 Couple - $3,000 Medically Needy Pregnant women, children, aged, blind, and disabled individuals whose family income exceeds the established income limit may be eligible under the Medically Needy program. The Medically Needy program allows a person to use incurred/unpaid medical bills to "spend down" the difference between their income and the income limit to become eligible. Income Limits Individual: $317 per month ($3,804 per year) Couple: $375 per month ($4,500 per year) Aged, Blind and Disabled Resource Limits Individual: $2,000 Couple: $4,000 9

11 ASSET PROTECTION UNDER THE GEORGIA LONG-TERM CARE PARTNERSHIP PROGRAM Most people do not like to think about the fact they may one day need long-term care services. Most people are also surprised at the costs of long-term and do not think of having to use their entire life savings to pay for those needs and services. The average private pay rate for a semiprivate room in a Georgia nursing home in 2006 was $ a day, or over $53,000 per year. The Georgia Long-Term Care Partnership (Partnership) is designed to reward Georgians who plan ahead for future long-term care needs. The most unique aspect of a Georgia Partnership policy is the Medicaid asset protection feature. This feature provides dollar-for-dollar asset protection: for every dollar that a Partnership policy pays out in benefits, a dollar of assets can be protected from the long-term care Medicaid asset limit. When determining long-term care Medicaid eligibility, any assets you have up to the amount the Partnership insurance policy paid in benefits will be disregarded. EXAMPLE If your Partnership policy paid $200,000 in benefits, Georgia s Medicaid program would allow you to keep $200,000 in assets and still qualify for Medicaid benefits. The amount of assets you are able to protect under the Partnership is in addition to the $2,000 everyone is allowed to keep, including any assets your spouse may be allowed to retain. The protected assets will also be exempted from estate recovery in an amount equal to the benefits paid by the long-term care insurance policy. REMEMBER: The Partnership s Medicaid asset protection feature is not available under other long-term care insurance policies. The purchase of a Partnership Policy does not automatically qualify you for Medicaid. 10

12 LONG-TERM CARE INSURANCE Long-term care insurance helps pay for a variety of services that assist people with health or personal issues that might result from a chronic disease, serious accident, sudden illness, or cognitive impairment such as Alzheimer's disease. Long-term care services are different from traditional medical care in that their focus is not necessarily to improve the medical condition of the individual but to maintain the individual's quality of life. Contrary to popular belief, long-term care is not an issue just for the elderly. Today, the cost of nursing home care in the US varies from $50,000 to over $100,000 per year. Home health care can be just as expensive as care in a nursing facility, depending on the frequency and type of home health care services required. Health Insurance Plans and Long-Term Care Traditional health and disability insurance plans do not typically cover long-term care, neither does Medicare and Medicare supplement insurance (Medigap). Many Americans are unable to afford long-term care through their income and personal savings. For most people the only options for financing long-term care are long-term care insurance or Medicaid (after spending down personal assets). Smart Financial Protection Quality LTC insurance provides a means of protecting your financial independence against the event of costly long-term care in the future. The State of Georgia and the federal government consider LTC insurance a viable financing option and, therefore offer long-term care insurance to their active and retired employees and their family members. Many financial experts today recommend LTC insurance as a key element for most personal financial and retirement plans. Do You Really Need Insurance? When you need long-term care, it is too late to start thinking about LTC insurance. It is important to plan now so that you don't become a liability to your family. The thought of being a financial burden to our family is reason enough to plan for long-term care. After all, we don't like to think of ourselves as frail and dependent in the future, but denial can be detrimental to our and our families' best interest. A very real need The possibility of needing long-term care at some point in life is a reality. Most Americans will need long-term care at some point in our lifetimes, and the cost of long-term care is very expensive. Most Americans cannot afford to pay for the long-term care services that they need in their lifetime. LTC insurance pays for part or all of the long-term care services you need. There are several reasons why you need to consider purchasing LTC insurance: 11

13 The cost of long-term care is very high. A Partnership Policy protects a portion of your assets in the event you need long-term care in the future. It works in the same way you protect yourself with auto and homeowners insurance. Medicare and other health insurance do not pay for the majority of long-term care. While Medicaid (the federal and state health insurance program for the poor) will pay for nursing facility care and some home care, you must be poor in order to qualify for assistance. For example, a single person can have no more than $2,000 in countable assets to qualify for Georgia s Medicaid program. The risk of needing long-term care is high. According to a national study conducted in 2005, 69% of persons who reach the age of 65 will need some long-term care. Taxes and LTC Insurance The Internal Revenue Code allows favorable tax treatment of long-term care policies that qualify under the law. Generally, benefits you receive from tax-qualified policies will not be considered as taxable income under either federal or state law. The premiums charged for tax-qualified policies are treated as medical expenses under your federal return for purposes of itemized deductions up to certain dollar limits that are indexed annually. You should consult with an attorney, accountant, or tax advisor regarding the tax implications of purchasing a tax-qualified policy. The Specifics of LTC Insurance LTC insurance policies vary in the amount and scope of services they cover and the settings in which services are delivered. Contact your insurance agent, broker, financial planner, or insurance company for specifics. Purchasing LTC Insurance Long-term care insurance is available from any licensed insurance company that sells LTC insurance. To purchase it, contact a licensed insurance agent or an insurance company. Please note, the State of Georgia and the Department of Medical Assistance do not sell LTC insurance. What about the cost? For LTC insurance, your age at the time of purchase is an important factor. The younger you are when you purchase LTC insurance, the lower the premium. The premium also depends on the benefits and features you choose. Each insurance company sets its own rates. Talk with an insurance agent or the insurance company to get specific rates. Shop around. Premiums can vary greatly across companies and within companies depending on what features are included in your policy. 12

14 Cost Factors Factors that influence the cost and quality of LTC insurance policies: Age This is the single most important factor -- the older you are, the more expensive your premium will be. Should you buy LTC insurance now or wait? Don't wait until it's too late. The timing may be important; consult with your family, financial and legal advisors, and an insurance agent. Elimination Period (deductible period) Just like car insurance, LTC insurance has a deductible, which is referred to as the elimination period (or waiting period). This is the number of days you are responsible for your long-term care costs before qualifying for payments from the LTC insurance policy. The shorter the elimination period, the more expensive your premium will be. Daily Benefits The higher the daily benefit, the less you may need to pay out-of-pocket for care, but your premium will be higher. Lifetime Benefits This is the total amount the policy will pay out for long-term care services. Covered Services Some policies provide a comprehensive pool of dollars that can be used to pay for care received in the home, in the community, or in a nursing facility. Others only pay for care received in a nursing facility or assisted living facility. The more comprehensive the policy, the more choices you will have, and the more expensive the premium will be. Health Factors Some companies charge lower premiums for applicants in very good health and higher premiums for applicants with particular health conditions or health histories. Inflation Protection This increases the benefit levels to account for anticipated increases in the cost of services over time. It is important to know that long-term care costs have been increasing about 5% per year. Inflation protection can dramatically reduce your out-ofpocket expenses for long-term care services. All Partnership Policies purchased by individuals under age 76 must include inflation protection. 13

15 Medical Underwriting To purchase LTC insurance, you must pass the medical underwriting requirements of the insurer this applies to Partnership Policies and non-partnership policies. In the event of rejection, you may apply for coverage from another insurance company since underwriting standards vary by company. Insurance companies are not required to sell you a policy if you do not meet their underwriting standards. The best way to avoid medical underwriting problems is to purchase LTC insurance when your overall health is good. Paying the Premiums Purchasing LTC insurance is a major financial decision. Keep in mind that the insurance coverage will only protect you if you keep the policy in force, by paying premiums. Thus, it is essential to plan to ensure your ability to maintain your long-term care policy whether through your own resources or with some partial contribution to premiums from those likely to benefit someday from your protected assets. Georgia LTC Partnership Policy Georgia Partnership Policies for LTC insurance are only sold by certain insurance companies. These companies are listed on the Georgia LTC Partnership website: Partnership policies are only sold through licensed insurance agents who have completed special training required by the State of Georgia. A Partnership Policy, with its unique Dollar- For-Dollar Asset Protection feature assures that you will not be forced to spend your life's savings on long-term care. Who can purchase a Partnership Policy? Any Georgia resident can apply for a Partnership Policy. The ideal applicant is generally healthy, meets the issue age limits established by the insurance company, and is able to afford the cost of the insurance. Tips on the Georgia LTC Partnership 1. Be a smart consumer. 2. Don't wait until it's too late to purchase long-term care coverage. 3. Shop around and compare policies and prices based on your needs, where you live, and what you can afford to purchase. 4. Confirm that the policy you purchased is, in fact, a Partnership Policy. A Partnership Disclosure Notice will be included with your policy if it is a Georgia Long-Term Care Partnership Policy. 14

16 Useful Links & Information Administration on Aging Georgia Cares - Federal focal point and advocate agency for older persons and their concerns. The AoA seeks to educate older people and their caregivers about the benefits and services available to help them A.M. Best - Offers insurance-buying guides for consumers and reports on the condition of insurance companies Centers for Medicare and Medicaid Services - It is part of the U.S. Department of Health and Human Services. Their goal is to ensure effective, up-to-date health care coverage and to promote quality care for beneficiaries ElderLiving Source - A comprehensive directory of assisted living communities, nursing homes, retirement communities, Alzheimer's care facilities, home health care services, and independent living communities Georgia Mason University Center for Health Policy Research and Ethics - Medicare - Official U.S. Government site for People with Medicare National Clearinghouse for Long-Term Care Information - Developed by the U.S. Department of Health and Human Services to provide information and resources to help you and your family plan for future long-term care needs National Nursing Home Database - Provides detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country Social Security Administration - Standard & Poor's - An independent company that assesses the financial strength of insurance companies U.S. Department of Health and Human Services

17 Georgia Division of Aging Services Toll Free: AGING or This state organization works with local Area Agencies on Aging (AAAs) as well as various other public and private organizations to help older Georgians, their families and loved ones find the services and information they need Georgia Office of Insurance Commissioner - (404) or (toll-free) Georgia's regulatory body for insurance and insurance companies Georgia Department of Community Health, Division of Medical Assistance provides these links only for the convenience of our users, and is not responsible for the availability or content of these external sites. The Department does not endorse, warrant or guarantee the products, services or information described or offered at these other Internet sites. 16

18 APPENDIX GEORGIA CODES, REGULATIONS AND FORMS 17

19 Georgia Code enacting the Georgia Long-Term Care Partnership: Short title GEORGIA CODE Copyright 2008 by The State of Georgia All rights reserved. *** Current through the 2008 Regular Session *** TITLE 49. SOCIAL SERVICES CHAPTER 4. PUBLIC ASSISTANCE ARTICLE 7A. LONG-TERM CARE PARTNERSHIP PROGRAM O.C.G.A (2008) This article shall be known and may be cited as the "Georgia Long-term Care Partnership Program Act." HISTORY: Code 1981, , enacted by Ga. L. 2005, p. 823, 1/HB 643; Ga. L. 2006, p. 72, 49/SB Definitions As used in this article, the term: O.C.G.A (2008) (1) "Asset disregard" means, with regard to state Medicaid benefits, the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a qualified long-term care insurance partnership policy. (2) "Commissioner" means the Commissioner of Insurance. (3) "Department" means the Department of Community Health. (4) "Georgia Qualified Long-term Care Partnership Program approved policy" means a long-term care insurance policy that meets the model regulations and requirements of the National Association of Insurance Commissioners' long-term care insurance model regulation and long-term care insurance model act as specified in 42 U.S.C. 1917(b) and Section 6021 of the Federal Deficit Reduction Act of 2005 and the Commissioner certifies such policy as meeting these requirements. (5) "State Medicaid program" means the medical assistance program established in this state under Title XIX of the federal Social Security Act. (6) "State plan amendment" means a state Medicaid plan amendment made to the federal Department of Health and Human Services that provides for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a qualified long-term care insurance partnership policy. 18

20 HISTORY: Code 1981, , enacted by Ga. L. 2005, p. 823, 1/HB 643; Ga. L. 2006, p. 72, 49/SB 465; Ga. L. 2006, p. 185, 1/HB O.C.G.A (2008) Program established; purposes; assets to be disregarded with respect to Medicaid eligibility or payment or recovery by the state of payments for medical services (a) In accordance with Section 6021 of the Federal Deficit Reduction Act of 2005, there is established the Georgia Qualified Long-term Care Partnership Program which shall be administered by the Department of Community Health, with the assistance of the Commissioner of Insurance and the Department of Human Resources, and which shall be for the following purposes: (1) To provide incentives for individuals to insure against the costs of providing for their long-term care needs; (2) To provide a mechanism for individuals to qualify for coverage of the cost of their long-term care needs under the state Medicaid program without first being required to substantially exhaust their resources; (3) To provide counseling services through the Division of Aging Services of the Department of Human Resources to individuals in planning of their long-term care needs; and (4) To alleviate the financial burden on the state's Medicaid program by encouraging the pursuit of private initiatives. (b) Upon the exhaustion of benefits or upon the diminishment of assets below the anticipated remaining benefits under a Georgia Qualified Long-term Care Partnership Program approved policy, certain assets of an individual, as provided in subsection (c) of this Code section, shall not be considered when determining any of the following: (1) Medicaid eligibility; (2) The amount of any Medicaid payment; and (3) Any subsequent recovery by the state of a payment for medical services. (c) The department shall: (1) Not later than November 15, 2006, make application to the federal Department of Health and Human Services for a state plan amendment to establish that the assets an individual owns and may retain under Medicaid and still qualify for benefits under Medicaid at the time the individual applies for benefits is increased dollar for dollar for each dollar paid out under the individual's long-term care insurance policy if the individual is the beneficiary of a qualified long-term care insurance partnership policy purchased through the Georgia Qualified Long-term Care Partnership Program; and (2) Provide information and technical assistance to the Commissioner to assure that any individual who sells a qualified long-term care insurance partnership policy receives training 19

21 and demonstrates evidence of an understanding of such policies and how they relate to other public and private coverage of long-term care. HISTORY: Code 1981, , enacted by Ga. L. 2005, p. 823, 1/HB 643; Ga. L. 2006, p. 72, 49/SB 465; Ga. L. 2006, p. 185, 2/HB O.C.G.A (2008) Eligibility for asset disregard; reciprocal agreements with other states to extend asset disregard mutually (a) An individual who is a beneficiary of a Georgia Qualified Long-term Care Partnership Program approved policy is eligible for assistance under the state Medicaid program using asset disregard pursuant to the provisions of subsection (c) of Code Section (b) If the Georgia Qualified Long-term Care Partnership Program is discontinued, an individual who purchased a Georgia Qualified Long-term Care Partnership Program approved policy prior to the date the program was discontinued shall be eligible to receive asset disregard if allowed as provided by Title VI, Section 6021 of the Federal Deficit Reduction Act of (c) The department may enter into reciprocal agreements with other states to extend the asset disregard to residents of the state who purchase long-term care policies in another state which has asset disregard provisions as established under this article as provided by Title VI, Section 6021 of the Federal Deficit Reduction Act of HISTORY: Code 1981, , enacted by Ga. L. 2005, p. 823, 1/HB 643; Ga. L. 2006, p. 72, 49/SB 465; Ga. L. 2006, p. 185, 3/HB O.C.G.A (2008) Requirements for selling qualified long-term care insurance partnership policies; rules and regulations; reports (a) The Commissioner shall: (1) Develop requirements to ensure that any individual who sells a qualified long-term care insurance partnership policy receives training and demonstrates evidence of an understanding of such policies and how they relate to other public and private coverage of long-term care; and (2) Not impose any requirement affecting the terms or benefits of qualified long-term care partnership policies unless the Commissioner imposes such a requirement on all long-term care policies sold in this state without regard to whether the policy is covered under the partnership or is offered in connection with such partnership. (b) The department and the Commissioner are authorized to promulgate rules and regulations to implement and administer the provisions of this article. (c) The issuers of qualified long-term care partnership policies in this state shall provide regular reports to both the Secretary of the Department of Health and Human Services in accordance with federal law and regulations and to the department and the Commissioner as provided in Section 6021 of the Federal Deficit Reduction Act of

22 HISTORY: Code 1981, , enacted by Ga. L. 2005, p. 823, 1/HB 643; Ga. L. 2006, p. 185, 4/HB Notice to consumers O.C.G.A (2008) (a) A qualified long-term care insurance partnership policy shall contain a summary notice to the consumer in plain language on the current law pertaining to asset disregard and asset tests. (b) The notice to the consumer under subsection (a) of this Code section shall be developed by the Commissioner of Insurance. HISTORY: Code 1981, , enacted by Ga. L. 2005, p. 823, 1/HB 643; Ga. L. 2006, p. 185, 5/HB

23 Georgia Long-Term Care Insurance Partnership Program. (1) In accordance with 6021 of the Deficit Reduction Act of 2005 (Pub.L ) and O.C.G.A. Section , in addition to the applicable provisions of this Rule Chapter, the provisions of this section shall apply to any qualified state longterm care insurance partnership policy. (2) "Qualified state long-term care insurance partnership policy'' or "partnership policy'' means an insurance policy that meets all the requirements specified in O.C.G.A Section and and meets the following requirements: (a) The policy covers an insured who was a resident of the State of Georgia (a Partnership State) when coverage first became effective under the policy. (b) The policy is a qualified long-term care insurance policy as defined in 7702B(b) of the Internal Revenue Code of 1986 and was issued no earlier than January 1, (c) The policy meets all the applicable requirements of this Rule and the requirements of the National Association of Insurance Commissioners long-term care insurance model act and model regulation as those requirements are set forth in 1917(b)(5)(A) of the Social Security Act (42USC 1396p(b)(5)(A)). (d) The policy provides the following inflation protections: 1. If the policy is sold to an individual who has not attained age 61 as of the date of purchase, the policy shall provide compound annual inflation protection;

24 2. If the policy is sold to an individual who has attained age 61 but has not attained age 76 as of the date of purchase, the policy shall provide some level of inflation protection; 3. If the policy is sold to an individual who has attained age 76 as of the date of purchase, the policy may provide inflation protection, but is not required. (e) The Commissioner may also approve new and innovative inflation protection methods so long as such method is submitted to the Commissioner with an explanation and demonstration as to how the alternative method provides for benefit levels to increase with benefit maximums or reasonable durations which are meaningful to account for reasonably anticipated increases in the costs of long-term care services covered by the policy. No such method may be used until the Commissioner has approved such method. (3) (a) An insurer or its agent, soliciting or offering to sell a policy that is intended to qualify as a partnership policy, shall provide to each prospective applicant a Partnership Program Notice (Form LTCP 200-A), outlining the requirements and benefits of a partnership policy. A similar notice may be used for this purpose if filed and approved by the Commissioner. The Partnership Program Notice shall be provided with the required Outline of Coverage. (b) A partnership policy issued or issued for delivery in the State of Georgia shall be accompanied by a Partnership Disclosure Notice (Form LTCP 200-B) explaining the benefits associated with a partnership policy and indicating that at the time issued, the policy is a qualified state long-term care insurance partnership policy. A similar notice may be used if filed and approved by the Commissioner. The Partnership Disclosure Notice shall also

25 include a statement indicating that by purchasing this partnership policy, the insured does not automatically qualify for Medicaid. (4) (a) A partnership policy shall not be issued or issued for delivery in this State unless filed with and approved by the Commissioner in accordance with the procedures set forth in O.C.G.A. Section Any policy submitted for approval as a partnership policy shall be accompanied by a Partnership Certification Form (Form LTCP 200-C), or a similar form filed and approved by the Commissioner. (b) Insurers requesting to make use of a previously approved policy form as a qualified state long-term care partnership policy shall submit to the Commissioner a Partnership Certification Form signed by an officer of the company. The Partnership Certification Form shall be accompanied by a copy of the policy or certificate form listed, the approval date, and a bookmark for each of the requirements listed in sections II and III of the form. A Partnership Certification Form shall be required for each policy form submitted for partnership qualification. (5) Agent training requirements. On and after October 1, 2008 an individual may not sell, solicit or negotiate a partnership policy unless the individual is a licensed and appointed insurance agent in accordance with provisions of O.C.G.A. Chapter and has completed an initial training component and ongoing training every 24 months thereafter. The training shall meet the following requirements: (a) All training shall be approved as continuing education by the Commissioner in accordance with O.C.G.A. Section (b) The initial training required by this subsection shall be no less than eight hours, and the on-going training required by this subsection shall be no less than four hours.

26 (c) The training required under subdivision (b) of this subsection shall consist of topics related to long-term care insurance, long-term care services, and qualified state long-term care insurance partnership programs, including, but not limited to: 1. State and federal regulations and requirements and the relationship between qualified state long-term care insurance partnership programs and other public and private coverage of long-term care services, including Medicaid; 2. Available long-term care services and providers; 3. Changes or improvements in long-term care services or providers; 4. Alternatives to the purchase of private long-term care insurance; 5. The effect of inflation on benefits and the importance of inflation protection; and 6. Consumer suitability standards and guidelines (6) Insurers offering a partnership policy shall obtain verification that an agent has received the training required by subsection (5) of this section before the agent is permitted to sell, solicit or negotiate the insurer's partnership policy. (7) Each insurer shall maintain records with respect to the training of its agents qualified to sell, solicit or negotiate partnership policies, to include training received and that the agent has demonstrated an understanding of the partnership policies and their relationship to public and private coverage of long-term care, including Medicaid, in this State. These records shall be maintained for a period of not less than five years and shall be made available to the Commissioner upon request.

27 (8) Each insurer issuing a partnership policy shall provide regular reports to the United States Secretary of Health and Human Services in accordance with regulations of the Secretary that include notification of the date benefits were paid, the amount paid, the date the policy terminates, and such other information as the Secretary determines may be appropriate to the administration of partnerships. Authority O.C.G.A. Secs , , , , History. Original Rule entitled Georgia Long-Term Care Insurance Partnership adopted. F. Mar. 27, 2008; eff. Apr. 16, 2008.

28 Office of Commissioner of Insurance State of Georgia Form LTCP 200-A PARTNERSHIP PROGRAM NOTICE Important Consumer Information regarding the Georgia Long Term Care Insurance Partnership Program Some long term care insurance policies [certificates] sold in Georgia may qualify for the Georgia Long tern Care Insurance Partnership Program (the Partnership Program). The Partnership Program is a partnership between state government and private insurance companies to assist individuals in planning their long term care needs. Insurance companies voluntarily agree to participate in the Partnership Program by offering long term care insurance coverage that meets certain sate and federal requirements. Long Term care insurance policies [certificates] that qualify as partnership policies [certificates] may protect the policyholder s [certificateholder s] assets through a feature known as asset disregard under Georgia s Medicaid Program. Asset Disregard means that an amount of the policyholder s [certificate holder s] assets equal to the amount of long term care insurance benefits received under a qualified Partnership Policy [Certificate] will be disregarded for the purpose of determining the insured s eligibility for Medicaid. This generally allows a person to keep assets equal to the insurance benefits received under a qualified Partnership Policy [Certificate] without affecting the person s eligibility for Medicaid. All of the Medicaid eligibility criteria will apply and special rules may apply to persons whose home equity exceeds $500,000. Asset Disregard is not available under a long term care insurance policy [certificate] that is not a Partnership Policy [Certificate]. Therefore, you should consider if

29 Asset Disregard is important to you, and whether a Partnership Policy meets your needs. The purchase of a Partnership Policy does not automatically qualify you for Medicaid. What are the Requirements for a Partnership Policy [Certificate]? In order for a policy [certificate] to qualify as a Partnership Policy [Certificate], it must, among other requirements: 1. Be issued to an individual after January 1, 2007; 2. Cover an individual who was a State of Georgia resident when coverage first becomes effective under the policy; 3. Be a tax-qualified policy under Section 7702(B)(b) of the Internal Revenue Code of 1986; 4. Meet stringent consumer protection standards; and 5. Meet the following inflation protection requirements: For ages 60 or younger provides compound annual inflation protection For ages 61 to 75 provides some level of inflation protection For ages 76 and older no purchase of inflation protection is required If you apply and are approved for long term care insurance coverage, [carrier name] will provide you with written documentation as to whether or not your policy [certificate] qualifies as a Partnership Policy [Certificate]. What Could Disqualify a Policy [Certificate] as a Partnership Policy. Certain types of changes to a Partnership Policy [Certificate] could affect whether or not such policy [certificate] continues to be a Partnership Policy [Certificate]. If you purchase