- TO:
- ALL FAMILY SUPPORT DIVISION OFFICES
- FROM:
- JULIE GIBSON, DIRECTOR
- SUBJECT:
- LONG TERM CARE INSURANCE PAYMENTS
- MANUAL UPDATE #33
0815.030.05
DISCUSSION:
The purpose of this memorandum is to remind staff of the correct policy and procedure for treatment of Long Term Care (LTC) insurance payments when determining eligibility for MO HealthNet programs.
Income Maintenance memorandum IM-95 LONG TERM CARE INSURANCE dated November 29, 2012 gave specific instructions on calculating the monthly payment amount, budgeting process and the correct entry in the Family Assistance Management Information System (FAMIS) for LTC payments. These procedures have not changed and ES should continue to follow the instructions provided in the memo, IM-#95.
LTC insurance payments made to the participant or the vendor facility are income to the participant and must be counted as unearned income in determining the surplus amount.
The discussion in IM-#95 the second NOTE: should say:
NOTE: A decrease in the surplus amount must be effective no later than the first day of the month following the month in which the change that caused the surplus amount to decrease was reported.
EXAMPLE: Ms. G is currently receiving vendor level coverage and her surplus was calculated based on her Social Security income and a LTC insurance payment she receives monthly. The LTC policy has a 5 year limit on the payments. Ms. G’s authorized representative reports on Jan 3, 2015 that the LTC payments ended December 15, 2014 due to reaching the 5 year limit. The eligibility specialist (ES) will make entries in FAMIS to end the LTC payment, when this is verified. An eligibility determination resolution (EDRES) will be completed and FAMIS will determine the new surplus based on the Social Security Ms. G continues to receive. This change must be effective the first day of the month after the report is made. In this example, the effective date would be February 2015. If the surplus is not adjusted by FAMIS due to delay in verifying the end of the LTC payments, etc, WIBCAs may be needed to decrease the surplus for the month following the month of report.
Income Maintenance Manual section 0815.030.05 Determining Adjusted Gross Income has been updated to clarify budgeting ongoing long term care insurance payments as unearned income in the month received.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
JG/vb