Public Forums

1
WHAT IS LONG TERM CARE?
A wide range of services designed to manage
limitations caused by a chronic condition and to
minimize further deterioration of physical and
mental health.
2
WHAT IS A FUNCTIONAL IMPAIRMENT

• A chronic condition that limits a persons
  ability to perform Activities of Daily Living
  (ADLs)
• Bathing, Dressing, Eating, Toileting,
  Transferring, Continence).
• Note Private long-term care insurance policies
  intending to be tax qualified will have an
  eligibility trigger for functional impairment
  defined as substantial assistance from another
  individual with at least two Activities of Daily
  Living. Tax qualified policies must include at
  least five of the Activities of Daily Living
  listed here in the functional impairment benefit
  trigger. Source Health Insurance Portability
  and Accountability Act of 1996.

3
ACTIVITIES OF DAILY LIVING

• ? Bathing
• ? Dressing
• ? Eating
• ? Toileting
• ? Transferring
• ? Continence

4
WHAT IS A COGNITIVE IMPAIRMENT

• Cognitive impairment is a disability due to a
  deterioration in mental capacity, which requires
  continued supervision. Alzheimers Disease and
  other forms of dementia are examples of cognitive
  impairment.
• Note Private long-term care insurance policies
  intending to be tax qualified will have an
  eligibility trigger for severe cognitive
  impairment that must be independent of the
  benefit trigger for functional impairment.
  Source Health Insurance Portability and
  Accountability Act of 1996.

5
WHERE IS LONG TERM CARE PROVIDED?

• Home
• Community
• Assisted Living
• Nursing Home

6
HOME AND COMMUNITY-BASED SERVICES

• Adult Day Health Care
• Chore Services
• Emergency Response System
• Home Delivered Meals
• Home Health Aid

7
HOME AND COMMUNITY-BASED SERVICES (contd)

• Homemaker Services
• Respite Care
• Visiting Nurse Services
• Therapies

8
AVERAGE HOME HEALTH RATES IN CT
Charge Per Hour
Charge Per Visit
Skilled Nursing Visit Registered Nurse LPN Home
Health Aide Physical Therapy Occupational
Therapy Speech Therapy
137 --- --- 60
--- 49 --- 30 142
--- 142 --- 145 ---
(Note See references in back pages for
additional information).
9
AVVERAGE COMMUNITY-BASED SERVICE RATES IN CT
Charge Per Hour
Charge Per Day
Adult Day Care Chore Services Companion
Services Homemaker Services Home Delivered Meals
(Charge Per Meal)
85 --- --- 21
--- 19 --- 20 ---
--- 7 ---
(Note See references in back pages for
additional information).
10
ASSISTED LIVING OPTIONS

• ? Congregate Housing
• ? Assisted Living Facilities
• ? Residential Care Homes
• ? Continuing Care Retirement Communities
  (CCRCs)

11
NURSING FACILITY RATES IN CONNECTICUT
390 142,000 5.5
Average Daily Rate
Average Annual Rate
Average Annual Inflation Rate (1988 2013)
(Note See references in back pages for
additional information).
12
MediCARE

• Federal Health Insurance for
• ? People age 65 years or older
• ? People with permanent kidney failure
• ? People under 65 with certain disabilities

13
MEDICAID

• The state and federal health insurance program
  for those with limited resources or, in some
  case, extremely high medical expenses.

14
WHO PAYS FOR LONG TERM CARE?
Other Gov. Programs 4.6
Out-of-Pocket 21.6
Medicaid 62.3
Private Insurance 11.6
Note Out of pocket expenditures include
payments made by patients and families. Source
National Spending for Long-Term Services and
Supports (LTSS), 2011 National Health Policy
Forum at George Washington University February
1, 2013.
15
INCOME TAX CLARIFICATION FOR INDIVIDUALS

• ? Premiums can count as an unreimbursed
  medical expense
• ? Out-of-pocket payments for qualified
  long-term care services can count as an
  unreimbursed medical expense
• ? Qualified insurance benefits paid will not
  count as taxable income

16
INCOME TAX CLARIFICATION FOR EMPLOYERS

• ? Premiums can be deducted in same manner as
  health insurance
• ? Employers can select or carve out groups of
  employees
• ? Insurance benefits received by the employee
  are not taxable

17
WHY LONG-TERM CARE INSURANCE?
18

• (1) Risk is high
• (2) Cost is high
• (3) MediCARE and health insurance do not pay for
  long-term care
• (4) While MedicAID pays for long-term care, you
  have to be poor and eligibility rules are
  restrictive
• (5) Partnership for Long-Term Care

19
UNIQUE ASPECTS

• ? State certification
• ? Medicaid Asset Protection
• ? Greater affordability
• ? Enhanced standards
• ? Public education

20
HOW ASSET PROTECTION WORKS

• If you continue to need care after your
  Partnership policy has paid benefits, you may
  apply for assistance from Medicaid.
• When determining eligibility, the Department of
  Social Services will disregard or ignore any
  assets you have up to the amount the Partnership
  policy has paid in benefits.

21
GUARANTEES OF MEDICAID ASSET PROTECTION

• Asset protection is a life-long promise
• 2. Payments granted asset protection before a
  policy lapse will still be honored by Medicaid.

22
GUARANTEES OF ASSET PROTECTION (contd)

• 3. The State of Connecticut cannot recover
  protected assets from a persons estate
• 4. Asset protection can accumulate anywhere
  the policy pays benefits.

23
RECIPROCITY COMPACT

• Dollar for dollar Medicaid Asset Protection
  between all states in Compact.
• States can opt out of Compact with 60 days notice
  to the Federal Government.
• (Note See references in back pages for
  additional information).

24
RECIPROCITY COMPACT (contd)

• Not important who CT has reciprocity with now,
  rather, the time reciprocity is important is when
  the policyholder applies to Medicaid.
• All CT Partnership policyholders have reciprocity
  regardless of when they purchased the Partnership
  policy.

25
References (contd)Slide 8, Average Home
Health Rates in Connecticut

• Note Per-hour charges for RN and LPN are applied
  after 2 - 4 hours. Skilled Nursing Visit charges
  apply for RN and LPN visits lasting 2 hours or
  less.
• Source State of Connecticut, Office of Policy
  and Management. Average actual self-pay (private
  pay) home health agency charges are rounded to
  the nearest dollar and reflect charges as of
  January 2014.

26
References (contd)Slide 9, Average
Community-Based Service Rates

• State of Connecticut, Office of Policy and
  Management, Average Private Pay Rates for Home
  and Community-Based Services. Rates are
  effective as of January 2014. Average actual
  self-pay (private pay) home and community-based
  services rates are rounded to the nearest dollar.
  

27
References (contd)Slide 11, Nursing Facility
Rates in Connecticut

• Source State of Connecticut, Office of Policy
  and Management, Survey of Connecticut Nursing
  Facilities. The Average Daily Rate refers to the
  weighted average of rates charged on September
  30, 2013 for a semi-private room in Connecticut
  nursing facilities. Average annual nursing
  facility rates have been rounded to the nearest
  100.00. Actual (not rounded) figures were used
  to calculate the average annual rates.
• Long-term care insurance products approved by the
  Connecticut Partnership include minimum daily
  benefits and automatic 5 compounded inflation
  protection.

28
References (contd)Slide 23 and 24--Must
Reside in CT (or any reciprocal state)

• The CT Partnership is a program for CT residents.
  Therefore, applicants must have a CT address
  (other than a P.O. Box), which reflects a place
  where they reside in CT. If an application is
  submitted with an out-of-state address, the
  application will not be processed by the carrier
  and will be returned to the agent. CT is a member
  of the National Reciprocity Compact (Compact).
  Members of the Compact agree to provide
  dollar-for-dollar Medicaid Asset Protection to
  Partnership policyholders from any other state
  that is a part of the Compact.
• Please see next pages reference on
  Reciprocity as well for additional information

29
References (contd)Slide 23 and 24, (contd)
Must Reside in CT or any reciprocal state

• Therefore, CT Partnership policyholders will be
  able to receive Medicaid Asset Protection in any
  other state that at the time they apply to
  Medicaid that state and CT are members of the
  Compact, and vice versa for Partnership
  policyholders applying to CTs Medicaid program.
  In addition, CT and Indiana have a separate
  reciprocal agreement to honor Medicaid Asset
  Protection. The reciprocal agreement means that
  CT Partnership policyholders who apply to
  Indianas Medicaid program will have
  dollar-for-dollar Medicaid Asset Protection
  recognized by the State of Indiana and vice versa
  for Indiana policyholders who apply to CTs
  Medicaid Program.