Ohio Admin. Code 5160:1-6-02.2 - Medicaid: treatment of qualified long-term care insurance policies
(A)
This rule describes the qualified long-term care
partnership (QLTCP) program.
(B)
Definitions.
(1)
"Estate recovery" means the program set forth in rule
5160:1-2-07
of the Administrative Code.
(2)
"Qualified
long-term care partnership" (QLTCP) means the program established under section
5164.86 of the Revised Code,
under which an individual's assets or resources are disregarded in eligibility
determinations and at estate recovery in the amount of insurance benefit
payments made to or on behalf of the individual who is a beneficiary of a QLTCP
policy.
(C)
A QLTCP policy is one that meets all of the following
requirements:
(1)
On the date the policy was issued, the state in which
the insured resided had in place an approved state plan amendment which
provides, pursuant to
42
U.S.C. 1396p(b) (as in
effect on October 1, 2016), for the disregard of assets or resources in an
amount equal to the insurance benefit payments made to or on behalf of an
individual who is a beneficiary of a QLTCP policy; and
(2)
The policy is a
qualified long-term care insurance policy, as defined in
26 U.S.C.
7702B(b) (as in effect
October 1, 2016); and
(3)
The policy meets the requirements set forth by the Ohio
department of insurance in section
3923.41 of the Revised Code, or,
if purchased outside Ohio, meets the requirements of an approved state plan
amendment, as described in paragraph (C)(1) of this rule, in the state of
purchase.
(D)
Upon the request for, or renewal of, a determination of
eligibility for medicaid payment of long-term care (LTC) services, an
individual's resources will be disregarded up to the dollar amount of insurance
benefit payments made to or on behalf of the individual who is a beneficiary of
a QLTCP policy.
(1)
The administrative agency shall determine eligibility
for medical assistance in accordance with the rules contained in Chapters
5160:1-1 to 5160:1-6 of the Administrative Code.
(2)
An individual may
request a determination of eligibility for medicaid payment of LTC services
before exhausting the benefits of a QLTCP policy. If an individual requests and
is determined eligible for medicaid payment of LTC services before the QLTCP
policy is exhausted, the QLTCP insurer must make payment for medical care to
the maximum extent of its liability before medicaid funds may be used to pay
providers for covered LTC services.
(3)
If an individual
has requested and been determined eligible for medicaid payment of LTC
services, then he or she accumulates additional resources, the individual
continues to be eligible for medicaid payment of LTC services to the extent
that the total value of all disregarded resources does not exceed the
individual's QLTCP disregard plus the applicable resource
limit.
(4)
A QLTCP disregard cannot reduce patient liability or
cost of care.
(E)
Improper transfers of assets, as described in rule
5160:1-6-06
of the Administrative Code, are treated as follows when there is a QLTCP
disregard.
(1)
If an individual becomes eligible for medicaid payment of
LTC services through the application of a QLTCP disregard, then he or she makes
a transfer of disregarded assets that would otherwise be considered an improper
transfer, no restricted medicaid coverage period applies. The disregarded value
of the transferred asset continues to be considered part of the individual's
QLTCP disregard.
(2)
If an individual becomes eligible for medicaid payment
of LTC services through the application of a QLTCP disregard after making a
transfer that would otherwise be considered an improper transfer:
(a)
If the value of
the individual's remaining countable assets plus the value of the transferred
assets is less than or equal to the individual's QLTCP disregard plus the
applicable resource limit, no restricted medicaid coverage period applies. The
disregarded value of the transferred asset is considered part of the
individual's QLTCP disregard.
(b)
If the value of
the individual's remaining countable assets plus the value of the transferred
assets is greater than the individual's QLTCP disregard plus the applicable
resource limit:
(i)
The individual's remaining QLTCP disregard is
determined by adding the individual's original QLTCP disregard amount to the
applicable resource limit, then subtracting the individual's current countable
resources and any amounts that had previously been transferred without a
restricted medicaid coverage period as a result of a QLTCP
disregard.
(ii)
The individual's remaining QLTCP disregard is
subtracted from the amount that would otherwise have been considered improperly
transferred. The difference is the amount improperly transferred; a restricted
medicaid coverage period is calculated for the difference in accordance with
rule 5160:1-6-06.5 of the Administrative Code.
Replaces: 5160:1-3- 02.8
Notes
Promulgated Under: 111.15
Statutory Authority: 5162.03, 5162.21, 5163.02, 5164.86
Rule Amplifies: 5162.03, 5162.21, 5163.02, 5164.86
Prior Effective Dates: 9/1/2007, 12/1/2014
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