ADVISING SENIORS ON

PLANNING FOR MO HEALTHNET

Presented By:
Lois M. Zerrer, Esq.
Russell A. Fracassa, Esq.

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When all else fails, read the

directions
42 U.S.C. 1396 et seq
Chapter 208.010 et seq RSMo
effective date Aug. 28, 2007

42 C.F.R. 430 - 456

13 C.S.R. 15, 40, 70; 19 C.S.R. 15, 30
Income Maintenance Manual
www.dss.mo.gov/fsd/iman

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Privatized delivery of health care services

Purchase and monitor health care services for low
income and vulnerable Missouri citizens
Assure the provision of quality health care for MO
HealthNet participants through the development
of service delivery systems, standards setting and
enforcement, and education of participants and
providers and
To be fiscally accountable for maximum and
appropriate utilization of resources.

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Programs

MO HealthNet
For low income citizens -- children, pregnant
women, the aged, blind and disabled and
some low income families
Chronic Care Improvement Program
Improves the quality of care for participants
with chronic illnesses
Decreases complications associated with
chronic illness
Reduces costs associated with delivering care
One on one attention and education from
health care home and health care coordinator

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Programs (cont)

MoRx
Coordinates benefits with Medicare Part D
Additional assistance for incomes under 200%
of FPL
MoRx Price Compare
prescription prices for most commonly used
drugs
usual and customary price reported by
pharmacies
retail price to uninsured, cash paying
customer
available to any Missourian

www.morxpricecompare.mo.gov

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Chronic Care Improvement Program

Over 110,000 participants

Health care coordinator
Health care home
home base for health care
Patient, family and caregivers address
medical, behavioral and psychosocial
needs

Individualized plan

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CyberAccess

Web based electronic health record tool

Puts patient history at providers fingertips
Improves efficiency
7500+ health care providers
2000+ sites (doctors offices, hospitals, DME
providers)

Inter-Operable Records

Eliminate wait for patient records when seeing a

new provider

Instant access to participants health record

Eliminate duplicative tests, dangerous prescription
combinations
Plan of care being followed

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Department of Social Services

MO Health Net
Family Support Division
Blind and Visually Impaired Services Program
Community Services Block Grant
Food stamps and food distribution
Low income home energy assistance program
MO HealthNet (eligibility determination)
TANF
Supplemental Aid to the Blind and Blind
Pension
Supplemental Nursing Care
Child Support

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Department of Health and Senior

Services

Home and Community Based Services

Long Term Care

Provision of medical services in home

setting
Nursing home regulation

Ombudsman program

Advocate for nursing home residents

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Programs available dss.mo.gov/fsd/pap.htm)
MO HealthNet for the Aged, Blind, and
Disabled

Non-spenddown Income max:

$724/$970
Blind income max:
$851/$1141

MO

HealthNet for the Aged, Blind and

Disabled

Spenddown No income max, but must

meet all other eligibility requirements

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MO HealthNet Vendor Payments for

Nursing Facility
Institution for the Mentally Retarded,
State Mental Hospital (65 or older), or
psychiatric hospital (under age 22)

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Programs available (Cont)

Division of Assets
Elderly and Disabled Home and Community
Based Waiver Program
Supplemental Nursing Care
Blind Pension
Supplemental Aid to the Blind
Missouri Children with Developmental
Disabilities
Sara Lopez Waiver

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Programs available (cont)

MO HealthNet based on Section 1619(a) SSA

MO HealthNet based on Section 1619(b) SSA
MO HealthNet for Women receiving Breast or
Cervical Cancer Treatment
QMB Qualified Medicare Beneficiary
SLMB Specified Low Income Medicare
Beneficiary
QI Qualifying individual
Qualified Disabled and Working Individuals
(QDWI)
Ticket to Work Health Assurance (TWHA)

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Allowances for 2010

Minimum MMNA
allowance)

Maximum MMNA

Minimum CSRA

allowance)

(monthly maintenance needs

$1822

$2739

(community spouse resource

$21,912

Maximum CSRA

$109,560

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Other useful numbers for 2010

Medicare premium
$96.40 or
$110.50 if first time Medicare
recipient
Maximum SSI benefit
2010 $674 single
2010 $1011 couple

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Long

Term Care Partnership

Enacted as part of the MO

HealthNet legislation

Provide incentive for individuals to

purchase long-term care insurance. The
incentive is an asset disregard when
applying for Medicaid with a qualifying
LTC insurance policy

Section 208.690 - .698 RSMo

20 C.S.R. 400-4.050 to 4.110

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LTC insurance partnership has three

basic requirements

NAIC model law provisions

Tax-qualified (IRS does not tax
benefits)
Certain inflation protections at time of
sale
No grandfather protection for old
policies

See IMM #64 Aug 21, 2008

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What is the benefit?

For every dollar the long term care

insurance pays out in benefits, a dollar
of personal assets can be protected.
Disregarded for eligibility
determination, therefore, client can
save this amount above the $999.99
level

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Scenario

Married couple, 70-80 years old, 1st

marriage
Relatively good mental and physical
health
Made appointment to see what they
should do in case one goes into nursing
home

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Scenario

House is paid for

$100,000 in assets
Husbands Social Security $1,200
Wifes Social Security $800

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Scenario

Justifications for planning

Preserve assets for surviving/community
spouse
Allow for more than $30/month available
while one is in the nursing home
Transfer maximum assets to heirs

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Scenario

Steps for planning

Stay out of the nursing home

Embrace/accept health care continuum

In-home assistance & assisted living options

Investigate Long Term Care Insurance

Good for
in-home,
assisted living and
nursing home
Protection from future funding/law changes

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Scenario

Assistance other than MO HealthNet

Medicare

Follow at least 3 day hospital stay

In nursing home for purpose of rehab
Covers 20 to 100 days
Improvement not actually a requirement
Watch for Medicare replacement policies
One truth: it does end

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Scenario

Assistance other than MO HealthNet

Veteran Administration Pensions

www.vba.va.gov/bln/21/pension
Aid & Attendance
Low Income Pension
MO Veterans Commission
www.mvc.dps.mo.gov

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Scenario

Assistance other than MO HealthNet

Other states

Arkansas example

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Scenario

Necessity for Durable Powers of

Attorney

Important for estate planning in general

Important for planning later

Only other option is conservatorship

No options inside conservatorship

Include provisions in 404.710.6, RSMo

Especially 1-6 and 11

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Scenario

After all the above is considered

Consider 5 year look back

42 U.S.C. 1396p(c)

Consider individual holding assets

Their
Their
Their
Their

death
disability
potential creditors
spouses needs

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Scenario

Disclaimer:
This is not an answer to every problem
There are typically many options
Not only understand this, but other
options available to clients including VA
benefits

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Scenario

Commonly used synonyms

Medicaid Asset Protection Trusts
Intentionally Defective Grantor Trusts
Domestic Asset Protection Trusts

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Scenario

What are We Talking About

An Irrevocable Trust
That Maintains Grantor Trust Status

26 U.S.C. 671-679

That Allows Grantor to Qualify for

Government Long Term Care Benefits

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Scenario
Why It Works MO HealthNet
42

U.S.C. 1396p(c)(1)(A)
If an institutionalized individual or the
spouse of such an individual disposes of
assets for less than fair market value on or
after the look-back date, the individual is
ineligible for medical assistance

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Scenario
Why It Works MO HealthNet
Section

208.010.2, RSMo

Benefits shall not be payable to any claimant

who has or whose spouse with whom he or
she is living has given away or sold a
resource within the time and in the manner
specified in this subdivision

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Scenario
Why It Works MO HealthNet
42

U.S.C. 1396p(d)(3)(B)
In the case of an irrevocable trust-- if there
are any circumstances under which payment
from the trust could be made to or for the
benefit of the individual, the portion of the
corpus from which, or the income on the
corpus from which, payment to the individual
could be made shall be considered resources
available to the individual

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Scenario
Why It Works MO HealthNet
IMM

1025.015.04

Trust Funds and Restricted Accounts - Count

trust funds and/or restricted bank accounts
as resources or income in determining
eligibility only if they are actually available

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Scenario
Why It Works MO HealthNet

Note May need to consider Fraudulent

Transfer Laws and Bankruptcy Laws