Md. Code Regs. 10.09.24.08-4

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.24.08-4 - Resource Consideration of Long-Term Care Partnership Policies

A. This regulation establishes the rules for applicants and recipients who:

(1) Own a long-term care (LTC) partnership policy; and

(2) Meet all factors of Medicaid eligibility in accordance with MAGI Exempt coverage groups described in this chapter.

B. Definitions.

(1) In this regulation, the following terms have the meanings indicated.

(2) Defined Terms.

(a) "Benefit payment amount" means the dollar value of LTC benefits which an insurance carrier has furnished on behalf of a partnership policyholder and which is disregarded from the resource amount when determining eligibility.

(b) "Insurance carrier" means an insurer who issues an insurance policy and makes benefit payment amounts on behalf of a partnership policyholder

(c) "Partnership policy" means a LTC insurance policy that meets the requirements as described under COMAR 31. 14.03.02 and whose benefit payment amount is disregarded from the resource amount when determining eligibility.

(d) "Partnership policyholder" means an individual who owns a partnership policy under the federal LTC partnership program.

(e) "Reciprocity compact" means an agreement among states having partnership programs that are approved under section 6021(b) of the Deficit Reduction Act of 2005, Public Law 109-171(DRA).

C. Partnership Policyholder Requirements.

(1) An applicant or recipient shall meet all factors of Medicaid eligibility in accordance with rules for MAGI Exempt coverage groups set forth in this chapter

(2) An applicant or recipient shall have:

(a) A Maryland partnership policy approved on or after January 1, 2009, that meets all certification requirements, as described in COMAR 31.14.03; or

(b) A partnership policy approved in another state that has joined the national reciprocity compact under the federal LTC partnership program.

(3) An applicant or recipient shall provide documentation of the partnership policy benefit payments that have been issued by an insurance carrier

(4) Subject to Regulation .10-2E of this chapter, an applicant or recipient who applies for LTC Medical Assistance in a nursing facility or through a waiver program shall be ineligible for payment for nursing facility services, or services under a home and community based waiver program, when the individual's equity interest in home property exceeds the maximum allowable home equity amount as set forth in Regulation .10-2 of this chapter

D. Eligibility Determination for a Partnership Policyholder

(1) When determining the resources of an individual in accordance with Regulation .08 of this chapter, there shall be disregarded a dollar value equal to the benefit payment amount

(2) The benefit payment amount for purposes of the disregard set forth in §D(1) of this regulation shall:

(a) For purposes of initial application, equal the dollar amount of benefits paid to or on behalf of the partnership beneficiary at the time of application; and

(b) For purposes of redetermination, equal the benefit payment amount in §D(2)(a) of this regulation and the value of any additional benefits paid to or on behalf of the partnership beneficiary up to the time of redetermination, until all benefits under the partnership policy are exhausted

(3) At the time of application and at each redetermination, the Department shall request documentation of the benefit payment amount

E. With the exception of an amount equal in value to the benefit payment amount applied at the most recent redetermination period, partnership policyholders will continue to be subject to a penalty for asset transfers for less than fair market value in accordance with Regulation .08 of this chapter

F. Estate recovery by the Department is limited as set forth in Regulation .15A-3(5) of this chapter

Md. Code Regs. 10.09.24.08-4

Regulations .08-4 adopted effective 42:7 Md. R. 568, eff.4/13/2015