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1、What is a Long-Term Care Partnership Program? Why is a Partnership Program important?,Endorsed by state Help consumers see LTC Insurance as ASSET PROTECTION Provide relief for the Medicaid program Should assist in making long-term care sales,How do partnership plans accomplish this? It all comes dow
2、n to who will be responsible to pay for long-term care expenses incurred in the future.,WHO PAYS NOW?,State governors concerns today focus on rising Medicaid costs Medicaid: 47 percent Out-of-pocket: 21 percent Medicare: 17 percent Private LTC insurance: 10 percent Other: 5 percent,Lets recap: Medic
3、aid: Is 1965 public program for the poor Has now become the default payer of LTC costs Approves people either through the spend- down process or by artificial qualification,MEDICAID,Generally pays for nursing home care Nursing home care is the primary driver today of increased Medicaid expenses Fact
4、or in the Boomers, and , SOMETHING HAS TO GIVE,MEDICAID AND LTC,Medicaids problems are not new Evidence in early 1980s that growing LTC expenses would over-burden this public program for the poor Study was appointed in the 1980s to investigate possible solutions to the coming crisis,RWJ FOUNDATION,T
5、he Robert Wood Johnson Foundation commissioned a study in the 1980s Report issued in 1987,RWJ FOUNDATION,The RWJ Foundation concluded that the best path for Medicaid to avoid a continued run-up in LTC expenses was to encourage consumers in the matter of personal responsibility by purchasing private
6、LTC insurance to take the pressure off the Medicaid program.,LTC PARTNERSHIP PROGRAMS,The result of this “encouragement” were insurance plans called LTC Partnership Policies States would give specific approval to LTC insurance contracts meeting certain standards,THE PARTNERSHIP PREMISE,To reduce Med
7、icaid expenditures by delaying or eliminating the need for people to rely on Medicaid Encourage purchase of private LTC insurance by giving an incentive for the consumer to buy,CONSUMER INCENTIVE,By purchasing a LTC policy sold through the Partnership, asset protection from Medicaid would equal the
8、amount of LTC insurance coverage This amount of assets would not have to be spent down to qualify for Medicaid,EXAMPLE,Consumer buys private LTCI with a total benefit value of $250,000 Consumer needs care Consumer uses LTCI first If they use up the entire $250,000, their application to Medicaid will
9、 allow them to keep that amount in addition to their primary protected assets like the home and car,Based on the RWJ Study, four states decided to formally develop partnership programs and encourage consumers to buy LTC insurance Two distinct models emerged,PARTNERSHIP MODELS,Dollar-for-dollar: doll
10、ar value of the protected assets equals the dollar value of benefits paid by LTC insurance contract Total Assets model: Required purchase of set minimum LTC coverage (6 years total) in exchange for complete protection of all assets,THE FOUR STATES,Connecticut: dollar-for-dollar model California: dol
11、lar-for-dollar model New York: total asset protection Indiana: hybrid of the two,WHY NO MORE STATES?,Concern that a public program was endorsing private insurance Believed it would increase Medicaid costs rather than reduce them by drawing attention to the programs coverage Would mostly benefit weal
12、thier individuals who could afford the private insurance,OBRA 1993,The Waxman Amendment Prevented states from acquiring the Medicaid waiver necessary to activate a partnership plan Iowa was stopped in mid-development,WHAT HAS BEEN THE RESULT FOR THESE FOUR STATES?,Average age of partnership policyho
13、lders is between 58 and 63 Majority of policyholders held assets greater than $350,000 (excluding home) Majority of policyholders had average monthly incomes of $5,000 or more,WHAT HAS BEEN THE RESULT FOR FOUR STATES?,Over 180,000 policies purchased Over 2,000 claims Less than 5 percent ultimately a
14、pplied for Medicaid,CONNECTICUT,Latest year surveyed: 2003-04 34 percent of purchasers of partnership plans had assets between $100,000 and $350,000 Average total benefit: $247,394 97 percent were first-time purchasers,NEW YORK,Now offering 4 different partnership models 2 Total Asset Protection 2 D
15、ollar-for-Dollar Still have minimum specified benefits, but now drawing broader appeal,CALIFORNIA,Average age at purchase: 57 56 percent were female 97 percent were first-time purchasers 38 percent bought policies with a minimum 5-year benefit period,INDIANA,Hybrid model: Total asset protection if p
16、urchase made for benefit amount of $188,000 or greater Dollar for dollar protection for policies less than $188,000,DEFICIT REDUCTION ACT OF 2005,1993 ban on LTC Partnership Programs lifted and Changes made to Medicaid eligibility,DEFICIT REDUCTION ACT OF 2005,LTC goals were: Make it more difficult
17、to qualify for Medicaid program artificially, and Encourage people to look to another source for LTC expense funding,DRA 05: NEW MEDICAID RULES,All transfers must occur 5 years prior to Medicaid application date Penalty period now imposed from the date of Medicaid eligibility not the date of the act
18、ual transfer,ASSET TRANSFERS,Medicaid application date: August 1, 2006 Look-back window: retro to August 1, 2001 Transfer of $180,000 made February 1, 2002 Penalty! $180,000 divided by $3,300 = 54 months Penalty used to be measured from date of transfer 2/1/02 + 54 months = eligibility on 8/1/06 NOW
19、 Penalty applied as of 8/1/06 eligibility will be on 2/1/2011,NEW MEDICAID RULES,Medicaid application can now be denied for person with home equity greater than $500,000 ($750,000 in some states) Annuities are now assets. Policyowners state of residence now required to be listed as a remainder benef
20、iciary.,NEW PARTNERSHIP ACTIVITY,Now there will be more than FOUR states Federal Medicaid waivers will be granted Each state that wants to offer LTC partnership policies must file a state plan amendment with the Department of HHS Unless related to this process, no additional state legislation is nec
21、essary,STATE PLAN AMENDMENT,Policies cover state residents Policies are tax-qualified Policies adhere to NAIC provisions Policies contain specified inflation options LTC agents have appropriate training Insurers subject to reporting requirements,WHOS READY TO GO?,Colorado Massachusetts Florida Michi
22、gan Oklahoma Georgia Minnesota Pennsylvania Idaho Missouri Rhode Island Illinois Montana South Dakota Iowa Nebraska Virginia Maryland New Jersey Washington,GRANDFATHERED,Connecticut California New York Indiana,CMS TEMPLATE,Clarification of: Inflation protection (ages 61+) Exchanges vs. grandfathering Reciprocity Agent training for certification Uniformity,