1 Tex. Admin. Code § 358.355 - Qualified Long-Term Care Partnership Program Insurance Policies
(a) This section
describes the Long-Term Care Partnership Program under which a person's
resources are disregarded in the eligibility determination equal to the amount
of benefits paid to or on behalf of a person by a Long-Term Care Partnership
policy.
(b) The Texas Health and
Human Services Commission (HHSC) administers the Long-Term Care Partnership
Program.
(c) In this section, the
following words and terms have the following meanings, unless the context
clearly indicates otherwise:
(1) "Long-Term
Care Partnership Program" means the program established under the Texas Human
Resources Code, Chapter 32, Subchapter C.
(2) "Qualified plan holder" means the
beneficiary of a qualified long-term care benefit plan that meets the
requirements set forth in subsection (d) of this section.
(3) "Resource disregard" means the total
equity value of resources not exempt under rules governing Medicaid eligibility
that are disregarded in determining eligibility for Medicaid.
(4) "Resource protection" means the extension
to a plan holder of an approved plan of a dollar-for-dollar resource disregard
in determining Medicaid eligibility.
(5) "Dollar-for-dollar resource disregard"
means a resource disregard in which the amount of the disregard is equal to the
sum of benefit payments made on behalf of the approved plan holder.
(d) A Long-Term Care Partnership
Program 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 Medicaid state plan
amendment under
42
U.S.C. 1396p(b).
(2) The policy meets the requirements set
forth by the Texas Department of Insurance under Title 28, Part 1, Chapter 3 of
the Texas Administrative Code (relating to Life, Accident and Health Insurance
and Annuities).
(e) At
application for long-term care services, the qualified plan holder receives a
dollar-for-dollar disregard of his or her resources.
(1) HHSC determines Medicaid eligibility in
accordance with this chapter.
(2) A
person may apply for Medicaid before exhausting the benefits of a Long-Term
Care Partnership Program policy. If a person applies for and is eligible to
receive Medicaid before the Long-Term Care Partnership Program policy is
exhausted, the Long-Term Care Partnership Program insurer must make payment for
medical assistance to the maximum extent of its liability before Medicaid funds
may be used to pay providers for covered services as established in this
chapter.
(3) If a person has
applied for and been found eligible to receive Medicaid and subsequently
receives additional resources, the person continues to be eligible for Medicaid
if the total resources do not exceed the individual resource limit after
applying the dollar-for-dollar resource disregard.
(f) If the Long-Term Care Partnership Program
is discontinued, a person who purchased a Long-Term Care Partnership Program
policy before the date the program is discontinued remains eligible to receive
the dollar-for-dollar resource exclusion.
Notes
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