The ABC s of Elder Law

Transcription

1 SECTION 6 The ABC s of Elder Law Laura J. Zdychnec Long Reher & Hanson PA St. Louis Park The 21 st Annual Elder Law Institute October 6 & 7, 2011

2 ABC S OF ELDER LAW TABLE OF CONTENTS I.... Introduction...1 II.. Income Sources...1 A. Social Security Retirement Benefits...1 B. Social Security Disability Benefits...2 C. Supplemental Security Income...2 D. Minnesota Supplemental Aid...3 E. Veterans Pensions Disability Compensation Basic/Improved Pension...3 III. Federal Health Care Programs...3 A. Medicare...3 B. Veterans Health Care Benefits Standard Medical Benefits Extended Care Services Nursing Home Care...5 IV. Federal/State Health Care Programs...5 A. Medical Assistance/Medicaid...5 B. Medicare Savings Programs Qualified Medicare Beneficiary Service Limited Medicare Beneficiary Qualified Individual Qualified Working Disabled...7 C. Home and Community-Based Waiver Programs Elderly Waiver Community Alternative Care Community Alternatives for Disabled Individuals Developmentally Delayed Brain Injury...9 V. State Health Care Programs...10 A. MinnesotaCare...10 B. Minnesota Comprehensive Health Association...11 C. Alternative Care...11 D. Minnesota Veterans Home...12 VI. Housing...12 A. Group Residential Housing...12 B. Senior Housing Options Independent Senior Housing Housing with Services Public Housing...13 VII. Conclusion...13 APPENDIX COMPILATION OF COMMONLY USED ACRONYMS

3 I. INTRODUCTION 1 The ABCs of Elder Law elder law n. a newly-coined vague term covering estate planning, wills, trusts and the problems of older people. Essentially it is a sales gimmick to attract older clientele. 2 The definition of elder law, still a relatively new area of practice, continues to evolve. Originally intended to address the specific needs of the elderly, elder law also includes planning for people of all ages with disabilities, or special needs. Elder law generally incorporates the practice of estate planning (wills, trusts), disability planning (health care directives, power of attorneys) probate (estate and trust administration, guardian and conservatorship). In addition, the elder law umbrella includes protection against elder abuse, neglect, and fraud; end-of-life planning; all levels of disability and long-term care; retirement planning; Social Security benefits; Medicare and Medicaid coverage; Medicaid planning; and consumer protection. A fundamental understanding of government programs for the elderly and disabled distinguishes the elder law practitioner from other practice areas. Helping clients understand how these programs are integrated into their planning is essential because these programs focus on meeting basic needs -- income, health care, food and housing. These materials will summarize government programs available for the elderly and disabled client for income, health care and housing. In the process, you will be indoctrinatedinto the world of acronyms commonly used in the practice of elder law. II. INCOME SOURCES A. Social Security Retirement Benefits (RSDI). 3 Social Security is a Federal program enacted in 1935, and is today a group of related programs, each with its own eligibility and payment rules: retirement, disability, survivors, and dependents benefits. The best known of these programs is retirement, through which Social Security provides income to retirees, as well as benefits to a worker's surviving spouse and to a retired worker's children under age 18. The average retirement benefit for retirees in 2011 is about $1,177 a month. The maximum benefit depends on the age a worker chooses to retire. For example, for a worker retiring at age 66 in 2011, the maximum amount is $2,366. Social Security retirement benefits are not based on need but rather on income earned during the recipient s earning life. Benefits are based on the average amount earned, provided a minimum number of work credits have been accumulated. 1 In preparing these materials, I have drawn shamelessly from Laurie Hanson s presentation, Overview of Government Programs and Benefits at the 2009 Minnesota CLE, The Basics of Elder Law. 2 Copyright by Gerald N. Hill and Kathleen T. Hill. 3 See

4 B. Social Security Disability Benefits (SSDI). 4 The Social Security Disability Income (SSDI) program is a federal program that pays cash benefits to people who are unable to work for a year or more because of a disability. Benefits continue until the person is able to work again on a regular basis, or until he or she reaches retirement age. At that point, the disability benefits automatically convert to retirement benefits, but the amount remains the same. After receiving SSDI benefits for two years, a person can also become eligible for Medicare. As with retirement benefits, a person must have accumulated a certain number of work credits before he or she can qualify for disability benefits. However, fewer credits are required to qualify for the disability program than for retirement. How many credits are needed to qualify for disability depends on the age the person becomes disabled. SSDI does not pay for partial disability or short-term disability. To qualify for Social Security benefits, the disability must prevent the person from doing any substantial gainful work, and it must last or be expected to last a year or to result in death. The spouse and minor or disabled children of the disabled person are also eligible for benefits. The most that the disabled person and his or her family can receive, however, is either 85 percent of the person s salary before he became disabled or 150 percent of his own disability benefit, whichever is less. C. Supplemental Security Income (SSI). 5 SSI is the basic federal safety net program for the elderly, blind, and disabled, providing them with a minimum guaranteed income. Currently, the maximum federal SSI benefit is $674 a month for an individual and $1,011 a month for a couple. 6 Eligibility for SSI benefits is based on financial need, and the financial eligibility rules are stringent. The program's criteria for determining disability are the same as those set out above for SSDI benefits. Many persons who are not eligible for Social Security retirement benefits because they have not accumulated enough work credits may nevertheless be eligible for SSI, and even many of those receiving Social Security retirement benefits may be able to supplement their benefits with SSI payments. The idea of the SSI program is to provide a floor income level. Actual payment amounts vary depending on income, living arrangements, and other factors. To be eligible for SSI, a person: Must be either age 65 or older, blind, or disabled; Must be a United States citizen or be a long-time resident who meets certain strict requirements; Must have monthly income that is less than a minimum threshold established by the person s state; and Must have less than $2,000 in available assets ($3,000 for a couple). 4 Id. 5 Id. 6 These amounts have historically increased on January 1 st of each year, but have remained stagnant in recent years

5 D. Minnesota Supplemental Aid. 7 Minnesota Supplemental Aid (MSA) is a state funded program that provides a monthly cash supplement to people who are aged, blind or disabled and who receive federal Supplemental Security Income (SSI) benefits. Some recipients who do not receive SSI because their other income is too high may still be eligible for MSA if they meet MSA eligibility criteria and their income is below the MSA standard. Applications for MSA must be made through the local county human services agency. E. Veterans Pensions. 1. Disability Compensation. Disability compensation is a monetary benefit paid to veterans who are disabled by an injury or illness that was incurred or aggravated during active military service. These disabilities are considered to be service-connected. Disability compensation varies with the degree of disability and the number of a veteran s dependents, and is paid monthly. Veterans with certain severe disabilities may be eligible for additional special monthly compensation. The benefits are not subject to federal or state income tax. To be eligible, the service of the veteran must have been terminated through separation or discharge under conditions other than dishonorable. 2. Basic/Improved Pension. 8 Veterans, and surviving spouses of deceased veterans, are entitled to pension benefits to offset the cost of necessary health care. There are three types of pension available Basic (low income) pension, Housebound benefits, and Aid and Attendance benefits. This benefit is means-related and is available only to veterans or widows of veterans who served at least 90 days on active duty, one of which was during a period of war. III.FEDERALHEALTH CARE PROGRAMS A. Medicare. 9 Medicare is an insurance program that provides health care coverage to individuals eligible to receive Social Security and Railroad Retirement benefits who have reached age 65. People who are younger than 65 are eligible for Medicare if: They have received Social Security Disability benefits for 24 months; or Are eligible to receive Social Security disability benefits and have ALS or chronic kidney disease (no 24-month waiting period). 7 See U.S.C.A. 1521(d)(e); 38 U.S.C.A. 1541(a)(e) U.S.C et seq. 42 CFR Part

6 Part A provides inpatient hospital care, and helps cover skilled nursing facility, hospice and home health care. Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment. Note: the skilled nursing home and home health care benefits are very limited under Medicare and this is why individuals often need to qualify for Medicaid. For instance, and individual qualifies for Part A coverage for nursing home care for a period of up to 100 days per spell of illness only if: The individual spent three midnights in the hospital within 30 days of entering the nursing home; and The individual is receiving skilled care for the same condition for which he or she received care in the hospital. Medicare will pay the full cost for 20 days; there is a co-pay of $ for days A supplemental policy will cover the cost of the co-pay. Part B pays for physicians services, durable medical goods, home health care, ambulance services, and some preventive services. Premiums generally range between $96.50 and $ per month, and for most people are automatically withheld from their Social Security retirement income. Individuals with MAGI (Modified adjusted gross income) above $107,000, and married couples with MAGI above $214,000, pay higher premiums. Part C Medicare Advantage Plans (like an HMO or PPO) are health plans run by Medicare-approved private insurance companies that include Part A, Part B, and sometimes Part D. Part D a prescription drug option run by Medicare-approved private insurance companies, helps cover the cost of prescription drugs. B. Veterans Health Care Benefits Standard Medical Benefits. A person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable may qualify for VA health care benefits. For most veterans, entry into the VA health care system begins by applying for enrollment. 11 Once enrolled, veterans can receive health care at VA health care facilities anywhere in the country. The VA s standard medical benefits package is available to all enrolled veterans. 12 This plan emphasizes preventive and primary care, and offers a full range of outpatient and inpatient services within the VA health care system, and includes prescription drugs U.S.C.A et seq.;38 CFR et seq. 11 To apply, complete VA Form 10-10EZ, Application for Health Benefits, which may be obtained from any VA health care facility or regional benefits office, on line at or by calling VETS (8387). 12 For further information on enrollment, eligibility, and coverage, go to

7 2. Extended Care Services. The extended care services program can offer the following services to veterans who are enrolled in the health care system: Physical Medicine and Rehabilitation includes occupational, physical and speech therapy, and kinesiotherapy Specialized services to veterans in need of rehabilitation following amputation, stroke, traumatic brain injury and spinal cord injury. Extended care services can also be provided in a hospital-based transitional care unit. Extended care services can also provide certain long-term care services in a home or community-base environment, including such as adult day care, skilled and unskilled home care, and home hospice care. 3. Nursing Home Care. Federal VA Nursing Homes. Federal VA nursing home care is available to veterans with a service-connected disability of 70% or more, or when need for nursing home care is due to the serviceconnected disabling condition. There is no charge for care at the facility. VA Contract Nursing Homes. VA contract facilities are private nursing homes with VA contracts to provide care for veterans. The eligibility requirements care in a VA contract facility is the same as federal VA nursing homes. IV. FEDERAL/STATE HEALTH CARE PROGRAMS A. Medical Assistance (Medicaid). Medicaid is a state and federal program that provides health care coverage for financially eligible Minnesota residents who are either: under 21, 65 or over, a parent or caretaker of a dependent child, a pregnant woman, or certified blind or disabled. 13 Each state has its own Medicaid Program. In Minnesota, the Medicaid Program is called Medical Assistance. Medical Assistance pays for most medically necessary services, including prescription drugs, home health care services, and long-term care services. 14 Both federal and state laws govern medical assistance. 15 Following is a summary of asset and income limits for elderly and disabled individuals. Asset limits. To be eligible for MA, the MA recipient is limited to $3,000 in available assets. 16 A married couple, both of whom are applying for MA, is limited 13 See Minn. Stat. 256B See Minn. Stat. 256B See42 U.S.C. 1396a, et seq.;minn. Stat. Ch. 256b. 16 Available assets are all assets that are not excluded under the Medical Assistance program. For instance, personal property, household furnishings, homestead, and one motor vehicle of any value can be excluded. Minn. Stat. 256B.056; HCPM Chapter

8 to $6,000 in available assets. 17 Where only one spouse is applying for MA and that spouse resides in a nursing home or is receiving services under the Elderly Waiver program, spousal impoverishment rules apply and the spouse in the community will be allowed to retain one-half of the couple s assets subject to a minimum and maximum amount. 18 The maximum and minimum limits in 2011 are $109,560 and $31,094, respectively. Income standards for the elderly, blind, or disabled residing in the community and not receiving long-term care services. One-person household: The income limit is 100% of federal poverty guideline standards (FPG), 19 currently $908 per month. People with income over 100% of FPG may be eligible by spending down to 75% of FPG, currently $681. In other words, they can pay a "deductible" (for medical costs) equal to the amount by which their countable income exceeds $681. Two-person household: The income limit for a household of two is currently $1,227 per month. People with income over 100% of FPG may be eligible by spending down to 75% of FPG, currently $920. Income standards for individuals residing in a long-term care setting. A resident of a long-term care facility must pay all of his/her income to the nursing home less allowable deductions including a $89 personal needs allowance ($90 for certain veterans and spouses of veterans) and an allowance for payment of medical insurance premiums. Further, a community spouse is entitled to a spousal allocation to bring his or her income to $1,840/month, or up to $2,739 if shelter costs are greater than $552 per month. MA pays the rest of the long-term care costs. B. Medicare Savings Programs. 20 Federal law requires that State Medicaid programs pay Medicare costs for certain elderly and disabled persons with low incomes and very limited assets. There are three programs with three different income levels, all based on the Federal Poverty Guidelines. See HCPM For all programs, individuals may have $10,000 in assets and a couple may have $18, Qualified Medicare Beneficiary (QMB). 21 Individuals and couples whose income is below 100% FPG qualify for the QMB program. The QMB program pays Medicare Part A and Part B premiums, co-pays and deductibles. People who are enrolled or are eligible to enroll in Medicare Part A may receive help with Medicare costs through the Qualified Medicare Beneficiary (QMB) program. People who meet QMB requirements may receive QMB only, or may receive QMB in addition to Medical Assistance (MA). 17 Minn. Stat. 256B.056, Subd Minn. Stat. 256B HCPM Minn. Stat. 256B.057; HCPM HCPM

9 2. Service Limited Medicare Beneficiary (SLMB). 22 Individuals and couples whose income is below 120% FPG are eligible for the SLMB program. The SLMB program pays the Medicare Part B monthly premium. 3. Qualified Individual (QI-1). 23 Individuals and couples whose income is below 135% FPG are eligible for the QI-1 program. The QI-1 program pays the Medicare Part B monthly premium. This coverage is identical to the SLMB program; the only difference is that enrollment may be limited. 4. Qualified Working Disabled (QWD). 24 Some employed people under age 65 with disabilities may lose their Retirement, Survivors, and Disability Insurance (RSDI) and premium-free Medicare benefits because their income exceeds Substantial Gainful Activity (SGA) limits. These people may receive help with Medicare costs through the Qualified Working Disabled (QWD) program if they meet a blind or disabled basis and are eligible to enroll in Medicare Part A with a premium under the Qualified Working Disabled Adult provisions of the Social Security Act. C. Home- and Community-Based Waiver Programs. Home- and community-based waiver programs were established under section 1915(c) of the Social Security Act of 1981 to correct the institutional bias in Medicaid programs. The waivers allow states to offer a broad range of home- and community-based services to people who may otherwise be institutionalized. In all of these programs, the eligible person may have only $3,000 in assets and must apply his or her income to the cost of care. Each waiver is for a specific population. 1. Elderly Waiver (EW). 25 The EW program may provide funding for services in the community for an individual who: Is 65 years of age or older; Has had a long-term care consultation screening; Requires a nursing facility level of care; Can remain in the community rather than a nursing facility; Can receive services in the community at a cost to MA that does not exceed 100% of the cost to MA of institutional care; and Is eligible for MA (using spousal impoverishment rules for married couple). 1a. Special Income Standard Elderly Waiver (SIS EW). 26 The SIS EW program is for those persons who have income that does not exceed $2,022 (three 22 HCPM HCPM HCPM Minn. Stat. 256B.0915; HCPM HCPM

10 times the FBR). The requirements and services covered are the same as in the Elderly Waiver program, but the person is allowed to retain more of his or her monthly income for non-medical expenses than under the regular EW program, and the person's income spenddown is applied only to Elderly Waiver services and not to other medical expenses. 2. Community Alternative Care (CAC). 27 The CAC program may provide funding for alternative services in the community for an individual who: Is under age 65 at the time of long-term care consultation screening for eligibility in the program; Is a resident of a hospital or at risk of inpatient hospitalcare; Is eligible for MA (considering only the assets and income of the individual); Chooses community care or whose parent or guardian chooses community care of the individual; Can remain in the community at a cost to MA that is less than the cost to maintain the individual in a hospital; and Has an individual care plan that assures health and safety. 3.Community Alternatives for Disabled Individuals (CADI). 28 The CADI program may provide funding for alternative services in the community for an individual who: Is determined to be at risk of nursing facility placement. Has been screened by the long-term care consultation team and has a determination that he or she needs a nursing facility level of care. Is under age 65 at the time of the initial screening. People who are on CADI, and who continue to require CADI services, may remain on CADI after their 65th birthday if all other eligibility criteria are met. A person who is receiving CADI services and is nearing age 65 must be informed by the county representative of community support options so that the person can choose which alternative will best meet his or her needs. Options may include going on the Elderly Waiver program, remaining on CADI, or other alternatives that may meet the person s needs and preferences. Has a disability certification from the State Medical Review Team (SMRT) or the Social Security Administration. Is eligible for MA based only on the person s own income and assets. Needs community services not available through regular MA or other funding. Can remain in the community at a cost to MA less than 100% of institutional care if age 16 or older, or less than 115% of institutional care if under age 16. A conversion rate may be applied to individuals who are or were (at the time they requested a county waiver screening) residents of 27 Minn. Stat. 256B.49; HCPM Minn. Stat. 256B.49; HCPM

11 a nursing facility: for these individuals, the cost to MA for these services must not exceed the amount MA is reimbursing the nursing facility for the individual s care or the statewide average, whichever is higher. An individual must reside in a nursing facility for 30 consecutive days in order to be considered a resident. 4. Developmentally Delayed Waiver (DD). 29 The DD waiver provides home and community-based services to individuals who meet the following criteria: Is of any age; Has been diagnosed with mental retardation or a related condition and is at risk of placement in an intermediate care facility for people with mental retardation, or lives in a nursing facility in which the person was inappropriately placed; Is eligible for MA (considering only the assets and income of the individual); Has been screened by DD screening team; Chooses community care or whose guardian chooses community care for the individual; and Can remain in the community at a cost to MA that is less than the cost to MA for institutional care (state average). 5. Brain Injury (BI) Waiver. 30 The BI program may provide funding for alternative services in the community for an individual who: Has a diagnosis of traumatic, acquired, or degenerative brain injury; Is at risk of institutionalization because of significant behavior/emotional or cognitive problems that are related to the brain injury; Is under 65 years of age at the time of the initial screening. A person may continue on the BI waiver after age 65 if needs cannot be met by other programs; Has undergone long-term care consultation screening; Is currently residing in or requires a level of care provided in a specialized nursing facility or in a long-term neurobehavioral hospital as determined by the long-term care consultation screening team; Has been certified as disabled by the State Medical Review Team or the Social Security Administration Is eligible for MA (considering only the assets and income of the person) and/or will be eligible for MA with a spenddown; Has chosen community care, and in order to remain in the community, requires services that exceed those available through MA and are not available through other sources of funding (the BI waiver is a waiver of "last resort": the client must be unable to receive adequate services under other home and community based services waivers); Can receive services in the community at a cost to MA that will not 29 Minn. Stat. 256B.092; HCPM Minn. Stat. 256B.093; HCPM

12 exceed the MA expenditure to maintain the individual in a nursing facility. V. STATE HEALTH CARE PROGRAMS The programs below are all creatures of state law. Detailed information on each program can be found in the Minnesota Department of Human Services (MDHS) Health Care Programs Manual (HCPM) or Combined Manual (CM). A. MinnesotaCare. 31 MinnesotaCare covers basic preventive care and primary care for eligible individuals. To be eligible an individual (and each family member) must: Have a social security number or be willing to apply for one; Live in and be a resident of Minnesota ( residency has strict definition for MinnesotaCare eligibility); Not have had other health insurance for at least four months prior to the month of application (this includes Medicare); and Not be able to get health insurance through an employer who offers to pay at least half the monthly cost. There is no asset limit for pregnant women and children under 21. For all others, the asset limit is $10,000 for a family of one and $20,000 for a family of two or more. Assets in pension and retirement funds are excluded as well as those excluded for the Medical Assistance program. Income eligibility depends upon family makeup: Families with children under 21 and pregnant women are eligible if income is equal or less than 275% of the FPG. Single adults and households with no children are eligible if income is less than 175% of FPG. Premiums are computed, billed, and paid on a monthly basis and in advance. Premium payment must be received by the last day of the month or there is no coverage for the next month (with the exception of pregnant women and children under the age of two). There are two types of premiums Fixed premiums. Children with household income equal to or less than 150% FPG pay a fixed monthly premium of $4 per enrolled child. Sliding scale premiums. Children with household income over 150% FPG and all adult enrollees pay a sliding scale premium. The premium is computed based on the household size, income, and number of people covered. Sliding scale premiums change depending on whether 1, 2, or 3 or more people are covered. 31 Minn. Stat. 256L.01, et seq

13 B. Minnesota Comprehensive Health Association (MCHA). In 1976, the Minnesota Comprehensive Health Insurance Act was enacted to offer policies of individual health insurance to Minnesota residents who have been turned down for health insurance by the private market because of pre-existing health conditions. 32 MCHA is the non-profit Minnesota corporation organized to manage the administration of the risk pool. It is regulated by the Minnesota Department of Commerce. It currently contracts with Medica to perform day-to-day operations of the plan. An individual wishing to enroll in MCHA must do so through Medica. There are no asset or income requirements for MCHA, as it is not needs-based. An individual who applies for MCHA and meets the criteria cannot be turned down, regardless of preexisting conditions. An individual is eligible for MCHA if he or she: Is a Minnesota resident for the six months immediately preceding the completion of the application for MCHA; Has been rejected for individual health coverage within six months of the application either by a health insurance carrier or a licensed insurance agent; Has reached the age of 65 and is not eligible for Medicare; or Is an eligible individual under the Health Insurance Portability and Accountability Act (HIPAA); or Is eligible under the Trade Adjustment Assistance, alternative Trade Adjustment Assistance, or Pension Benefit Guaranty Corporation; or Has been treated within the last here years for one of the special Presumptive Conditions listed on the MCHA application form; or Other conditions or circumstances which may allow coverage. In other words, an individual who needs health insurance and has a preexisting condition should see a health insurance agent and apply. C. Alternative Care Program (AC). 33 The AC program provides social service funding for home care services for people who would otherwise need nursing facility care and who are not eligible for MA. The AC program is not a Medicaid program, so it does not cover medical expenses. It may provide funding for services in the community for an individual who: Is 65 years of age or older; Has had a long-term care consultation screening; Requires a nursing facility of care, as determined by the long-term care consultation team; Is able to remain in the community rather than a nursing facility, as determined by the long-term care consultation team; Chooses community care; Can receive services in the community at a cost that does not exceed 75% of the cost to MA of institutional care; and 32 Minn. Stat. 62E Minn. Stat. 256B

14 Has income and assets that would be inadequate to fund a nursing facility stay for more than 135 days. People eligible for AC may have to pay a monthly fee depending upon their income and assets. D. Minnesota Veterans Home. 34 The Minnesota Veterans Homes (MVH) were established to provide health care services to Minnesota veterans, spouses, and surviving spouses who meet eligibility requirements and have a medical need to live in a structured health care environment. The Minnesota Veterans Homes offer two types of care: board and care (also called domiciliary care) and nursing care. These facilities are located in Minneapolis, Silver Bay, Luverne, Fergus Falls, and Hastings (domiciliary only). A person seeking admission to or continued residency at a Minnesota Veterans Home is subject to the rules set forth in Minnesota law. 35 VI. HOUSING A. Group Residential Housing (GRH). 36 Group Residential Housing is a state-funded income supplement program that pays for room-and-board costs for low-income adults who have been placed in a licensed or registered setting with which a county human service agency has negotiated a monthly rate. Persons residing in a setting with a GRH rate are usually considered to be living in the community and thus can be entitled to home and community-based waiver programs. Some individuals who are on waiver programs (such as EW) may not have enough money to pay the room and board portion of the monthly cost and if eligible, GRH will pay those costs. B. Senior Housing Options. 37 There is a broad spectrum of senior housing options from which consumers can more readily buy what they need and want to buy. There are three primary types of senior housing in Minnesota: 1. Independent Senior Housing. Independent" senior housing includes rental housing and housing with ownership components (condominiums and cooperatives). This kind of housing may offer basic services such as meals, transportation, and housekeeping, but typically very little in the way of health care 34 Minn. Stat. 198; Minnesota Rules Minn. Rules Ch See the MVH website at: 36 Minn. Stat. 256I; 37 A comprehensive review of senior housing in Minnesota, including skilled care facilities, prepared by Suzy Scheller and Ken LaBore is available for download on the MSBA Elder Law Section s website at

15 or supportive services, such as home care services or assistance with personal laundry. 2. Housing with Services. This is senior housing that makes limited supportive services available, which may include specialized memory care services. They may be called senior housing with services, assisted living, memory care, personal care suites, adult foster care, and so forth. In addition to the basic services made available in independent housing, housing with services establishments also typically offer varying amounts of nursing care, personal care, and supportive services to residents, either directly through management or through arrangements management makes with other providers, rather than leaving the arrangements for such services up to the residents and their families. Any entity that calls itself assisted living to describe its facilities, programs, and services must comply with the minimum requirements of Minnesota Statutes, Ch. 144G. 3. Public Housing. Public housing was established to provide decent and safe rental housing for eligible low-income families, the elderly, and persons with disabilities. Public housing comes in all sizes and types, from scattered single family houses to high rise apartments for elderly families. There are approximately 1.2 million households living in public housing units, managed by some 3,300 Housing Authorities. 38 VI. CONCLUSION The human frailties that make elder law necessary await us all. - Anonymous There are complicated eligibility criteria for each of these programs. The important thing for your practice is awareness of the benefits available to assist your clients and that those benefits generally have a needs-based component. Estate, disability and end-of-life planning must take eligibility for these programs into account. 38 For more information:

16 AC ADL AFB AFDC BFE BEER BI BS BSI BRS CAC ABC s of ELDER LAW 2011 Elder Law Institute Alternative Care. A state-funded program, administered by county social services agencies, which provides home and community-based services for clients age 65 or older in an effort to keep the client in the community and avoid a nursing facility placement. Activity of Daily Living. Activities of daily living" means grooming, dressing, bathing, transferring, mobility, positioning, eating, and toileting. Annuity-Funded Burial. An annuity contract with an irrevocable designation of the cash surrender value (CSV) to a funeral provider as the primary beneficiary. The value of the contract is to be paid to a funeral provider in exchange for agreed-upon goods and services. Aid to Families with Dependent Children. The program formerly authorized under Title IV-A of the Social Security Act to provide financial assistance and social services to needy families with dependent children. AFDC was replaced by the Temporary Assistance to Needy Families (TANF) block grant in Minnesota's TANF program is the Minnesota Family Investment Program (MFIP). Burial Fund Exclusion. Allows clients to set aside, or designate, up to $1500 in assets to cover certain burial expenses. Assets designated toward the BFE are not counted in the client's net asset total Beneficiary Earnings and Exchange Record. A monthly IEVS tape exchange between the Social Security Administration and DHS reporting wages, self-employment, and federal pension earnings from federal tax returns. The original source is the Internal Revenue Service. Brain Injury waiver program. Formerly known as the Traumatic Brain Injury waiver (TBI), the name was changed to more accurately reflect the people eligible for the program. The BI waiver serves people with a traumatic, acquired or degenerative brain injury. Burial Space. Any repository for the remains of the deceased such as cemetery plots, urns, niches, crypts, and caskets. Burial Space Items. Items which add to or improve burial spaces such as markers, engraving, vaults, opening and closing of the grave, and one-time charges for preservation/care of the space (perpetual care). Benefits Recovery Section. A section of DHS which pursues collection of third party payments and determines if health insurance is cost effective. Community Alternative Care. A federally approved home and community-based services waiver program for chronically ill people under age 65. APPENDIX ABCs of Elder Law 2011 Page 1

17 CADI CAF CCRC CDCS CHAMPVA CHIP CM CMS CSAA CSG Community Alternatives for Disabled Individuals. A federally approved home and community-based waiver program for people under age 65 who would otherwise require the level of care provided in a nursing facility. Combined Application Form. A form on which people can apply for multiple programs administered by DHS, including but not limited to General Assistance (GA), Food Support (FS), Minnesota Family Investment Program (MFIP), Medical Assistance (MA), Minnesota Supplemental Aid (MSA), and Emergency Medical Assistance (EMA). Continuing Care Retirement Community. An organization that enters into a written agreement with a client to offer a range of continuing care services while providing flexible accommodations, which may change with the client's needs. A CCRC may also be referred to as a life care community. Consumer directed community supports. CDCS is a unique service option that gives persons more flexibility and responsibility for directing their services and supports, including hiring and managing direct care staff. CDCS may include services, support and/or items currently available through the Medical Assistance waivers, as well as additional allowable services that provide needed support to persons. A Department of Veterans' Affairs program that provides health care coverage for the spouse and children of certain disabled or deceased veterans. This coverage is provided for these family members if they are not eligible for TRICARE benefits. Children's Health Insurance Program (CHIP). This program provides federal matching funds to help states expand health care coverage for the nation's uninsured children. (See also SCHIP) Combined Manual. The CM contains the policies and procedures for the following programs: Minnesota Family Investment Program (MFIP), Work Benefit (WB), Diversionary Work Program (DWP), Food Support (FS), Minnesota Supplemental Aid (MSA), General Assistance (GA), Group Residential Housing (GRH), Refugee Cash Assistance (RCA) and emergency programs. The Centers for Medicare & Medicaid Services (previousy known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards. Community spouse asset allocation. Consumer Support Grant. This state program allows a recipient to convert the state portion of Medicaid payments for specific home care services into a cash grant. Eligible participants receive monthly cash APPENDIX ABCs of Elder Law 2011 Page 2

18 CSV DD WAIVER DHHSD DHS DNR/DNI grants to replace fee-for-service home care services payments. With county assistance, consumers can manage and pay for a variety of home and community-based services. Cash-surrender value. The amount a life insurance policy owner, including an annuity owner, would receive if the policy were cashed in. Developmental Disabilities Waiver. A federally approved home and community-based services program for children and adults with mental retardation or a related condition who need the level of care provided in an Intermediate Care Facility for Persons with Mental Retardation or Related Conditions (ICF/MR). The DD Waiver provides funding for home and community-based services for children and adults with developmental disabilities or related conditions. Deaf and Hard of Hearing Services Division a division of the Minnesota Department of Human Services Department of Human Services. DHS is tasked with administering the state s Medicaid program, as well as providing or administering economic assistance, and a variety of services for children, people with disabilities, and older Minnesotans. Do not resuscitate/do not intubate. A do not resuscitate and/or do not intubate order is a doctor s instruction that no attempt will be made to interrupt the process of dying. DRA Deficit Reduction Act of Federal law effective February 8, 2006, which affects many aspects of domestic entitlement programs, including both Medicare and Medicaid. DSPM DT&H DWP EBT Disability Services Program Manual. The DSPM is a reference tool for lead agencies who administer home and community-based services in Minnesota. Day Training and Habilitation. Services for adults with developmental disabilities that include supervision, training, assistance, and supported employment, work-related activities, or other community-integrated activities designed and implemented in accordance with the individual service and individual habilitation plans required under Minnesota Rules, parts to , to help an adult reach and maintain the highest possible level of independence, productivity, and integration into the community. Diversionary Work Program. DWP is a four-month program that helps low-income Minnesota families find a job. The goal of DWP is to help parents immediately go to work rather than go on welfare. Parents are expected to sign an employment plan before their family is approved for DWP. After families have an employment plan, they can receive financial assistance to meet their basic needs and get other supports, such as food support and child and health care assistance. Electronic Benefit Transfer. EBT is an electronic system that allows a APPENDIX ABCs of Elder Law 2011 Page 3

19 EIC EMV EOMB EW FBR FFP FMV FPG GA GAMC recipient to authorize transfer of their government benefits from a Federal account to a retailer account to pay for products received. EBT is used in all 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam. State food stamp agencies work with contractors to procure their own EBT systems for delivery of Food Stamp and other state-administered benefit programs. Earned Income Credit. A federal tax credit given to low income people. Household members may receive an EIC once a year as a refund or as an advance payment or tax reduction with each paycheck. Estimated Market Value. The value assigned to real estate by the county assessor for the purpose of levying property taxes. EMV is found on the annual property tax assessment statement. Explanation of Medical Benefits. A statement from DHS, an insurance company, or a health plan reporting amounts paid, reduced, or denied for the client's health care expenses. Elderly Waiver. The Elderly Waiver (EW) program funds home- and community-based services for people age 65 and older who are eligible for Medical Assistance (MA) and require the level of care provided in a nursing home, but choose to reside in the community. The Minnesota Department of Human Services operates the EW program under a federal waiver to Minnesota s Medicaid State Plan. Federal Benefit Rate. The maximum federal benefit rate for the Supplemental Security Income (SSI) program. This amount is updated each January and is used to determine the Pickle Disregard and the Special Income Standard (SIS) for the Elderly Waiver (EW) program. Federal Financial Participation. Federal reimbursement to DHS for some of the cost of a client's health care services. People must meet certain criteria to be eligible for health care programs with FFP. Fair Market Value. The price an item would sell for on the open market in a local geographic area. Federal Poverty Guidelines. The amount of income below which a household of a given size is considered impoverished. The federal government updates the FPG annually. All Minnesota Health Care Programs income standards are based on the FPG. General Assistance. A program authorized under Minnesota Statutes 256D to provide cash assistance to needy individuals and couples without children. General Assistance Medical Care. GAMC was a state-funded program for low-income adults without children who did not qualify for federally funded health care programs. The program ended Feb. 28, 2011 and enrollees were automatically moved to Medical Assistance (MA), Minnesota s Medicaid program. APPENDIX ABCs of Elder Law 2011 Page 4

20 GRH HCAPP HCFA HCFA Transmittal 64 HCPM HIPAA ICAMA ICF/DD IEVS IFB LTCC State-funded income supplement program that pays for room-andboard costs for low-income adults who have been placed in a licensed or registered setting with which a county human service agency has negotiated a monthly rate. Health Care Application. A form which people can use to apply for Minnesota Health Care Programs. Health Care Financing Administration predecessor of CMS federal agency that administers Medicare, and works with state governments to administer Medicaid, State Children s Health Insurance Programs and Minnesota Department of Human Services Health Care Programs Manual. Health Insurance Portability and Accountability Act A federal law passed in 1996 that protects health insurance coverage for workers and their families when they change or lose their jobs. Title II Administration Simplification provides national uniformity of transaction coding and national identifiers for providers. Data privacy is included in Title II. Interstate Compact on Adoption and Medical Assistance. The Interstate Compact on Adoption and Medical Assistance (ICAMA) is a federal contract between Minnesota and other states designed to prevent and overcome barriers to interstate adoptions and to coordinate services to adopted children with special needs. Intermediate Care Facility for the Developmentally Disabled. A residential facility licensed as a health care institution and certified by the Minnesota Department of Health to provide health or rehabilitative services for persons with developmental disabilities who require active treatment. Income and Eligibility Verification System. A set of data exchanges with other state and federal sources used to verify income and assets of MA applicants and enrollees. Insurance-Funded Burial. A life insurance policy with an irrevocable designation of the cash surrender value (CSV) to a funeral provider as the primary beneficiary. The value of the policy is to be paid to a funeral provider in exchange for agreed-upon goods and services. Long-term care consultation. The LTCC program provides assessment and support planning for any individual with long-term or chronic care needs, and access to publicly-funded long term care services and programs. The state-funded Alternative Care (AC) and the medical assistance-funded Elderly Waiver (EW) programs provide APPENDIX ABCs of Elder Law 2011 Page 5

21 LTCF MA funding to purchase home and community-based services and supports for financially eligible people age 65 and older who meet nursing facility level of care and other requirements. Services provided under these programs are intended to prevent or delay admission to a nursing facility..\ Long-term care facility. A place such as a skilled nursing facility, Intermediate Care Facility for the Developmentally Disabled (ICF/MR) or medical hospital in which the individual receives skilled nursing services. Group Residential Housing (GRH) and Housing with Services Establishments are not long-term care facilities. Medical Assistance. A Minnesota Health Care Program administered by county agencies that provides health care for needy people. People may receive MA as a separate program or in conjunction with an MSA grant. Known federally as Medicaid. MA-AWC Medical Assistance for adults without children. Beginning March 1, 2011, low-income adults without children in the home qualified for this expansion program MA-BC MA-EPD MAXIS MCHA Medical Assistance for Breast and Cervical Cancer. An MA basis of eligibility for women who have been screened through the Sage Screening Program and found to need treatment for breast or cervical cancer. Medical Assistance for Employed Persons with Disabilities. Program which provides MA coverage to certain employed disabled people who would not otherwise be eligible. Minnesota's statewide automated eligibility system for countyadministered programs, including Food Support (FS), General Assistance (GA), Medical Assistance (MA), Minnesota Family Investment Program (MFIP), and Minnesota Supplemental Aid (MSA). The Minnesota Comprehensive Health Association (MCHA) offers policies of individual health insurance to Minnesota residents who have been turned down for health insurance coverage in the private marketplace because they have a pre-existing health condition. MCHA is sometimes referred to as Minnesota s high risk pool for health insurance, the insurance of last resort, or the safety net. Currently, about 27,000 Minnesota residents are insured by MCHA. Medicare A Medicare B Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care. Part B helps cover medically-necessary services like doctors' services, outpatient care, home health services, and other medical services. Part APPENDIX ABCs of Elder Law 2011 Page 6

22 B also covers some preventive services. Medicare C Medicare D MFAP MFIP MHCP MIP MMIA MMIS MSA A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called Part C or MA Plans, are offered by private companies approved by Medicare. Medicare prescription drug coverage. Minnesota Food Assistance Program. The Minnesota Food Assistance Program (MFAP) was created by the 1998 Minnesota Legislature in response to federal law changes, which made certain noncitizens ineligible for federally funded Food Support (formerly called Food Stamps). MFAP uses state funds to replace the benefits lost when federal Food Support eligibility ended. MFAP is only available to noncitizens 50 years of age or older. The Minnesota Family Investment Program is the state s welfare reform program for low-income families with children. MFIP helps families move to work and focuses on helping families. It includes both cash and food assistance. When most families first apply for cash assistance, they will participate in the Diversionary Work Program (DWP). This is a four month program that helps parents go immediately to work rather than receive welfare. Minnesota Health Care Programs A group of health coverage programs available through the State of Minnesota to people who qualify including: MinnesotaCare, Medical Assistance (MA) which includes QMB, QWD, SLMB, QI, MA-EPD, and federally funded waiver programs. Medicaid Integrity Program. MIP, created by CMS at the direction of Congress under DRA, dramatically increased the resources available to CMS to combat fraud, waste, and abuse in the Medicaid program. CMS is required to report to Congress annually on the use and effectiveness of the funds appropriated for the MIP. The annual reports to Congress are available at ww.cms.gov/deficitreductionact. Minimum monthly income allowance - The calculated amount of income needed by the community spouse. May include excess shelter expenses. Medicaid Management Information System. Minnesota's statewide automated system for MinnesotaCare, and payment of medical claims and capitation payments for all Minnesota Health Care Programs. Minnesota Supplemental Aid (MSA) is a state-funded program that provides a monthly cash supplement to people who are aged, blind or disabled and who receive federal Supplemental Security Income (SSI) benefits. Some recipients who do not receive SSI because their other APPENDIX ABCs of Elder Law 2011 Page 7