LONG-TERM CARE INSURANCE POLICIES ISSUED UNDER THE NEW YORK STATE PARTNERSHIP FOR LONG-TERM CARE
TYPES OF POLICIES
As explained on pages 118-119 of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State, there are two types of long-term care insurance policies issued under the New York State Partnership for Long-Term Care: Total Asset Protection plans and Dollar for Dollar Protection plans.
When the book was published, there were two types of Total Asset Protection plans. The Total Asset 50 Protection Plan will pay for 3 years of care in a nursing home or 6 years of care at home, or some combination, with 2 home care days equaling 1 nursing home day. 11 NYCRR 39.3 refers to this as the 3/6/50 plan.
The Total Asset 100 Protection Plan will pay for 4 years of care in a nursing home or 4 years of care at home, with 1 home care day equaling 1 nursing home day. 11 NYCRR 39.5 refers to this as the 4/4/100 plan.
When the book was published, there were two types of Dollar for Dollar Protection plans. The Dollar for Dollar 50 Protection Plan will pay for 1.5 years of care in a nursing home or 3 years of care at home, or some combination, with 2 home care days equaling 1 nursing home day. 11 NYCRR 39.4 refers to this as the 1.5/3/50 plan.
The Dollar for Dollar 100 Protection Plan will pay for 2 years of care in a nursing home or 2 years of care at home, or some combination, with 1 home care days equaling 1 nursing home day. 11 NYCRR 39.6 refers to this as the 2/2/100 plan.
The sections of 11 NYCRR Part 39 mentioned above do not specify whether a given plan is Total Asset Protection or Dollar for Dollar. However, Social Services Law section 367-f (1)(a) discusses the Medicaid aspect of Partnership plans. It defined “Medicaid extended coverage” to mean eligibility for Medicaid without regard to the resource rules of Social Services Law section 366 [which would be Total Asset Protection]
OR
without consideration of an amount of resources equivalent to the value of the benefits received under the Partnership plan [which would be Dollar for Dollar Protection], for people with a Partnership plan which has a residential health care facility benefit of less than three years.
Social Services Law section 367-f was amended by Chapter 59, section 82 of the Laws of 2011. The law was enacted on March 31, 2011. This portion of it became effective on January 1, 2012. It replaced the word “three” in the preceding paragraph with the word “two.” In other words, it now states:
OR
without consideration of an amount of resources equivalent to the value of the benefits received under the Partnership plan [which would be Dollar for Dollar Protection], for people with a Partnership plan which has a residential health care facility benefit of less than three two years.
The reason for this change may be that 11 NYCRR 39.7 added a new type of Partnership Plan: the 2/4/50 plan. It will pay for 2 years of care in a nursing home or 4 years of care at home, with 2 home care days equaling 1 nursing home day. It became effective June 1, 2012.
The website of the New York State Partnership for Long Term Care may be found at www.nyspltc.org. It says that the new 2/4/50 plan is a Total Asset Protection Plan.
Under the old language of Social Services Law section 367-f (1)(a), the new 2/4/50 plan would have been a Dollar for Dollar Plan, because plans of less than three years did not provide Total Asset Protection. With the change to Social Services Law section 367-f (1)(a), the new 2/4/50 plan can be a Total Asset Protection Plan because it does not have a benefit of less than two years.
Question: what about the old 2/2/100 Plan? It was supposed to be a Dollar for Dollar Protection Plan. But the amended Social Services Law section 367-f (1)(a) seems to define Dollar for Dollar Protection Plans as those which have a residential health care facility benefit of less than two years. This plan does not have a residential health care facility benefit of less than two years.
USE OF MEDICAID EXTENDED COVERAGE IN OTHER STATES
Another recent change to Partnership plans involves Medicaid Extended coverage.
When the owner of a Partnership plan has used up his benefits under the policy, he can apply for Medicaid. Special Medicaid eligibility rules apply. Previously, he had to be in New York State when he went on Medicaid if he wanted to take advantage of the special Medicaid eligibility rules.
The federal Deficit Reduction Act of 2005 discusses reciprocity among states for Partnership plans. See section 6021 (b) of the DRA. Instructions on how to find the DRA are in the section of Medicaid Financial Eligibility Rules for Nursing Home Care in New York State which discusses how to find documents and information online.
The website of the New York State Partnership for Long Term Care had a bulletin which said that New Yorkers who move to one of the 40 other states which have Partnership plans will be able to take advantage of Medicaid extended coverage in those states. The bulletin said that reciprocity would be available as soon as New York State Department of Financial Services Insurance Regulation 144 became effective.
New York State Department of Financial Services Insurance Regulation 144 became effective on June 1, 2012. It added 11 NYCRR 39.8.
11 NYCRR 39.8 (a) states that insurers must provide disclosures. 11 NYCRR 39.8 (a)(3) states that the disclosure must advise that a person who leaves New York may not be eligible for Medicaid asset protection in another state if his destination is no longer a reciprocal state, so he should verify reciprocity.
11 NYCRR 39.8 (a)(5) states that a person will not be eligible for Medicaid asset protection in a non-Partnership state and in a non-reciprocal state.
11 NYCRR 39.8 (a)(7) states that if a person with a New York Total Asset Protection plan applies for Medicaid in a reciprocal state, he will only get Medicaid asset protection equal to the benefits paid by the plan. Thus, his Total Asset Protection plan becomes a type of Dollar for Dollar Protection plan.
To find Department of Financial Services Insurance Regulation 144, go to http://www.dfs.ny.gov/
Click on LEGAL at the toolbar near the top of the page.
Click on REGULATIONS.
Scroll down to FINAL ADOPTIONS.
Click on INSURANCE.
Click on 2012.
Scroll down to NOTICE OF ADOPTION OF 3RD AMENDMENT TO REGULATION 144 (11 NYCRR 39)(PDF FORMAT)
DEFINITION OF “ASSET” FOR PARTNERSHIP PLANS
Please note that when the term “asset” is used in connection with Partnership long-term care insurance plans, it refers to resources; it does not include income. Thus “total asset protection” means protection of resources but not protection of income. Medicaid Reference Guide, at glossary ii.
CITATION CHANGES
The Medicaid Reference Guide was updated since Medicaid Financial Eligibility Rules for Nursing Home Care in New York State was published.
On page 119, 1st full paragraph:
Change the Medicaid Reference Guide citation from page 684 to page 685.1.
On page 121, 2nd full paragraph:
Change the Medicaid Reference Guide citation from page 684 to page 685.1.
Posted 06/16/2012