THE 2017 OHIO MEDICAID MANUAL TABLE OF CONTENTS

Transcription

1 TABLE OF CONTENTS CHAPTER 1 CHAPTER 2 CHAPTER 3 CHAPTER 4 CHAPTER 5 CHAPTER 6 CHAPTER 7 CHAPTER 8 CHAPTER 9 CHAPTER 10 CHAPTER 11 CHAPTER 12 CHAPTER 13 CHAPTER 14 CHAPTER 15 CHAPTER 16 CHAPTER 17 CHAPTER 18 CHAPTER 19 CHAPTER 20 CHAPTER 21 CHAPTER 22 CHAPTER 23 CHAPTER 24 CHAPTER 25 INDEX APPENDIX A APPENDIX B APPENDIX C APPLICABLE LAW DEFINITIONS MEDICARE MEDICAID CRITERIA FOR NURSING HOME AND WAIVER PROGRAMS COMMUNITY SPOUSE MONTHLY INCOME ALLOWANCE AND FAMILY ALLOWANCE PATIENT LIABILITY TRANSFER OF ASSETS TRUSTS ANNUITIES PROMISSORY NOTES CAREGIVER AGREEMENTS PASSPORT PROGRAM ASSISTED LIVING WAIVER PROGRAM LONG-TERM CARE PARTNERSHIP DURABLE FINANCIAL POWER OF ATTORNEY PLANNING STRATEGIES FOR A SINGLE PERSON PLANNING STRATEGIES FOR A MARRIED COUPLE MODIFIED ADJUSTED GROSS INCOME (MAGI) APPLICATION AND APPEAL PROCESS MAINTAINING ELIGIBILITY TAX CONSIDERATIONS ESTATE RECOVERY PRACTICE CASES MEDICAID UPDATES VA AID & ATTENDANCE PENSION OHIO ADMINISTRATIVE CODE TEXT OF RELEVANT SECTIONS OHIO DEPARTMENT OF MEDICAID RELEVANT FORMS AND TABLES TAPS FORMS AND TABLES

2 TABLE OF CONTENTS CHAPTER 1 CHAPTER 2 CHAPTER 3 CHAPTER 4 CHAPTER 5 CHAPTER 6 CHAPTER 7 CHAPTER 8 APPLICABLE LAW Federal Law State Law Conversion from 209(b) to DEFINITIONS MEDICARE Introduction Skilled Nursing Care Benefits Criteria for Skilled Nursing Care Benefits Examples of Skilled Nursing Care Limited Coverage The Jimmo v. Sebelius Settlement MEDICAID CRITERIA FOR NURSING HOME AND WAIVER PROGRAMS Residency Age or Disability In Need of Medicaid-Funded Institutional Care Income Eligibility Asset Limits Resources COMMUNITY SPOUSE MONTHLY INCOME ALLOWANCE AND FAMILY ALLOWANCE Minimum Monthly Maintenance Needs Allowance (MMMNA) Excess Shelter Allowance (ESA) Family Allowance Extreme Financial Duress Increasing Spousal Income PATIENT LIABILITY Nursing Home Home and Community Based Services (HCBS) Waiver Program Unpaid Past Medical Expenses Prorated Partial Months TRANSFER OF ASSETS Introduction Improper Transfers Exempt Transfers Restricted Medicaid Coverage Period TRUSTS Category 1, Self-settled Trusts Created Before August 11, Category 2, Self-settled Trusts Created On or After August 11,

3 CHAPTER 9 Category 3, Exempt Trusts Category 4, Third-Party Trusts Category 5, Testamentary Trusts Sole Benefit Trusts What Law Applies? Qualified Income Trust Forms ANNUITIES Introduction Criteria Purchase of Annuity Any Time by the Applicant or Applicant s Spouse Instructions to the Insurance Company Purchase of Annuity In Lieu of SPLIMPA Appeal Purchase of Annuity Combined with Gifting Gifting / Annuity Planning Form Annuity Flow Chart CHAPTER 10 PROMISSORY NOTES Introduction Available Asset or Improper Transfer? Recalculation of Restricted Coverage Period How to Apply the Gift / Promissory Note Method Payments on Promissory Notes Alternate Uses of Promissory Note Planning Negotiable Promissory Note Form Promissory Note Planning Form CHAPTER 11 CAREGIVER AGREEMENTS Introduction Validity General Civil Context Validity Medicaid Context Beware the Catch-All Caregiver Otherwise Legally Obligated So, How Should a Caregiver Agreement be Drafted CHAPTER 12 PASSPORT PROGRAM Introduction Eligibility Requirements PASSPORT Services CHAPTER 13 ASSISTED LIVING WAIVER PROGRAM Introduction Eligibility Requirements Enrollment Date Assisted Living Services

4 CHAPTER 14 LONG-TERM CARE PARTNERSHIP Introduction Eligibility Requirements Qualified Long-term Care Partnership (QLTCP) Program Considerations CHAPTER 15 DURABLE FINANCIAL POWER OF ATTORNEY Introduction Special Provisions Powers Requiring Express Authority CHAPTER 16 PLANNING STRATEGIES FOR A SINGLE PERSON The Planning Process Transfers More Than Five Years Before Application Exempt Transfers of the Home Transfers During the Look-back Period CHAPTER 17 PLANNING STRATEGIES FOR A MARRIED COUPLE Introduction The Planning Process Transfers More Than Five Years Before Application Planning During the Look-back Period CHAPTER 18 MODIFIED ADJUSTED GROSS INCOME (MAGI) Introduction Eligibility Patient Liability (Post Eligibility Treatment of Income) Asset Test Spousal Impoverishment Rules CHAPTER 19 APPLICATION AND APPEAL PROCESS The Medicaid Application Process The State Hearing Process CHAPTER 20 MAINTAINING ELIGIBILITY Lump-sum Receipts Post-Eligibility Issues When There is No Spouse Post-Eligibility Issues When There is a Community Spouse CHAPTER 21 TAX CONSIDERATIONS Income Medical Expense Deductions Claiming a Parent as a Dependent Taxes on Sale of Home Trust Taxation Tax Free Exchanges of Insurance Contracts

5 Annuities and Long-Term Riders Tax Advantages Qualified Long Term Care Insurance Proceeds Household Care / Help CHAPTER 22 ESTATE RECOVERY When Did the Program Begin Who is Subject to Estate Recovery What Benefits are Subject to Estate Recovery When Does Estate Recovery Occur When May a Lien be Filed and Against What Property May a Lien be Filed What Property is Subject to Estate Recovery How is the Program Administered What is Undue Hardship What is the Procedure After the Death of the Medicaid Recipient What is a Transfer-on-Death Medicaid Estate Recovery Form Who May Come Knocking on Your Client s Door What Can You Do to Make Sure That They Do Not Knock Again How is the Value of a Life Estate Determined CHAPTER 23 CHAPTER 24 PRACTICE CASES MEDICAID UPDATES OMM Chapter 2 - Definitions OMM Chapter 4 - Medicaid Criteria OMM Chapter 5 CS Monthly Income Allowance and Family Allowance OMM Chapter 6 - Patient Liability OMM Chapter 7 - Transfer of Assets OMM Chapter 8 - Trusts OMM Chapter 9 - Annuities OMM Chapter 11 - Caregiver Agreements OMM Chapter 12 - PASSPORT Program OMM Chapter 13 - Assisted Living Waiver Program OMM Chapter 17 - Planning Strategies for a Married Couple OMM Chapter 18 Modified Adjusted Gross Income (MAGI) OMM Chapter 19 The Application and Appeal Process OMM Chapter 20 - Maintaining Eligibility OMM Chapter 22 - Estate Recovery OMM Chapter 25 - VA Aid & Attendance / Pension Medicaid Standards Update CHAPTER 25 VA AID & ATTENDANCE PENSION Types of VA Disability Benefits VA Pension Claim Process Planning

6 Benefits Based on Prior Spouse s Service Record Pending Regulations Important Information INDEX APPENDIX A APPENDIX B APPENDIX C OHIO ADMINISTRATIVE CODE TEXT OF RELEVANT SECTIONS OHIO DEPARTMENT OF MEDICAID RELEVANT FORMS AND TABLES TAPS FORMS AND TABLE