Long-term care partnership. Frequently Asked Questions
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Long-term care partnership. Frequently Asked Questions


Revised February 10, 2014



what is the Washington State Long-term Care Partnership Program

The Washington State Long-term care partnership program, administered by the Washington State Health Care Authority (HCA) and Washington State Office of Insurance Commissioner (OIC), provides an alternative to spending down or transferring assets by forming a partnership between medicaid and private long-term care insurers. 


What is long-term care? Where is it provided?

Long-term care includes a wide range of services provided to people who need continued help with Activities of Daily Living, (ADL) such as: bathing, dressing, eating, using the toilet, transferring from a bed to a chair.

Long-term care can be provided in a variety of places, including a person's home, an assisted living facility (boarding home), adult family home, or a nursing home.  You can search for a facility in your area at: http://www.adsa.dshs.wa.gov/pubinfo/housing/other/

 


What is the risk of needing long-term care?

Everyone is potentially at risk.  A 2005 study found that 69 percent of people turning 65 years of age will need some form of long-term care before they die.  Among those turning 65 years of age, 52 percent will need long-term care for at least one year before they die and 20 percent will need five years of care or more.  For more information see Long Term Care Medicare.

http://longtermcare.gov/medicare-medicaid-more/medicare/

 

 

 


What is the cost of long-term care?

The average private pay rate for a private room in a Washington State nursing home in 2011 is $246 per day or $89,790 per year.  The amount may vary based on facility and level of care.

Home or residential care (adult family home or assisting living facility) can be just as expensive, depending on the frequency and services required. 


Doesn't Medicare cover the cost of long-term care?

Many assume Medicare will pay for their long-term care expenses.  Medicare covers only a small portion of the country's long-term care costs.  Medicare will pay for care in a nursing home only when certain conditions are met, and even then, you are only fully covered for 20 days.  In certain situations, some people may qualify for partial payment up to 100 days. 

What is the current Medicare coverage for LTC, nursing home care and SNF care? 


What does Medicare cover when it comes to long-term care?

Medicare, a federal program providing health insurance for individuals 65 and older or individuals with disabilities, has specific rules that apply for payment of nursing home care.  Medicare requires a 3-day hospital stay prior to transferring to a nursing home.  Services received in a nursing home must relate to the illness or injury that caused the hospitalization.  Medicare coverage for nursing home care ends once an individual's needs change from skilled care to custodial care. 

Does the original Medicare plan pay for care in a nursing home?

Who can get Medicare-covered home health care, and what services does Medicare cover?


What is Medicaid and Title XIX?

Medicaid and Title XIX are the same program.  It is a program administered by the Washington State Health Care Authority (HCA) to provide health care for low income individuals, families and children.  Medicaid covers close to half of the nation's long-term care bill.

In addition, individuals must meet certain eligibility and income criteria before they receive benefits from Medicaid. 


How does Medicaid asset protection work?

The most unique benefit of a Partnership policy is the medicaid asset protection.  The difference between a Partnership policy and a non-partnership policy is the medicaid asset protection.

This includes protection from Estate Recovery after your death.

This feature provides dollar for dollar assets 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 resource limit and estate recovery.

When determining long-term care medicaid eligibility, any assets you have up to the amount the Partnership policy has paid out in benefits will be disregarded. 

For example, if your Partnership policy paid $200,000 in benefits, Washington State LTC Medicaid program would allow you to keep $200,000 in assets and still qualify for medicaid assistance as long as you meet all other medicaid eligibility requirements.  The amount of assets you are able to protect under the Partnership is in addition to the $2,000 in assets everyone on LTC Medicaid is allowed to keep, including any assets your spouse may be allowed to retain. 


Will Washington State medicaid try to recover my protected assets after I die?

No.  The estate recovery program will not recover the amount of assets disregarded for the purposes of Medicaid eligibility, less the amount of any disregarded assets that were transferred or disposed of prior to the individual's death. 

The Department of Social and Health Services (DSHS) administers the Estate Recovery Program, which files claims against the estates of deceased Medicaid recipients.  This helps the Department recover the cost of Medicaid benefits it has provided to those recipients.   

Learn more about the Estate Recovery Program

Example:  Your long-term care partnership program has paid out $200,000 in services.  You have designated your home valued at $150,000 as protected plus $50,000 in a savings account.  You have $2,000 in a checking account, which is allowed for Medicaid eligibility.

When you die, the Estate Recovery program will not recover the $200,000 assets you have designated as protected based on the amount the long-term care partnership has paid out.  The protected assets will go to your heirs.

NOTE:  If protected assets go to your heirs after you die, the protection is not passed on to that individual if they need to apply for medicaid. 

Example:  When you die, your $150,000 home and $50,000 savings is designated by you to go to your son John.  John is 65 years old and is now living in the home he received as an inheritance.  John needs long-term care medicaid and still has the $50,000 received through the inheritance plus $1800 in his checking account.  In this example, John is over the $2,000 resource limit for medicaid eligibility.  The asset protection does not carry over to another individual that has received the asset including a spouse.  The asset protection only applies to the individual with the LTC insurance. 

Estate Recovery Rules

Estate Recovery and Long-term care examples

 


Do I have to use up all my partnership policy before I can apply or become eligible for Washington State Medicaid?

If you have a long-term care partnership policy, you do not have to use up all the benefits of the policy before applying for Washington medicaid.

You do have to meet all other eligibility requirements for long-term care medicaid including income, resource requirements. 


Who do I contact for more information on Washington State Medicaid?

Health Care Authority (main medicaid agency) Contact us:  https://fortress.wa.gov/dshs/p1contactus/

Health Care Authority Medicaid:  1-800-562-3022

Eligibility for Medical Programs


More helpful information about Long Term Care Medicaid

EAZ manual long-term care  includes the Washington Administrative Code (WAC) rules used to determine eligibility for long-term care medicaid.

Long-term care partnership main page

Aging and Disability Services Administration

Adult and Senior Services and Information

In home and assisted living services

Nursing Facility Services

Modification Date: February 10, 2014