Competency 15 Section 3 Flashcards
- The Older Americans Act Program is the largest government source of long-term care funding
False. Medicaid and Medicare are the two largest long-term care funding sources. Medicaid is the largest long-term care funding government program. (LO 15-3-1)
- Medicare was designed to handle the long-term care expenditures of enrolled U.S. citizens over the age of 55.
False. Medicare was designed for people over the age of 65 and was not designed to be a significant financing vehicle for long-term care. (LO 15-3-1)
- If someone qualifies for Medicare post-acute skilled nursing care, the first 20 days are 100% covered by Medicare
True. (LO 15-3-1)
- Medicare eligible post-acute skilled nursing care services include housing in a private room and care from private duty nurses for up to 100 days.
False. Medicare qualified and covered post-acute skilled nursing care includes stay in a semi-private room and nursing services. However, Medicare does not cover private duty nurses. (LO 15-3-1)
- Medicare eligibility for post-acute skilled nursing care services no longer requires that the individual’s health is maintaining or improving
True. In 2012, Medicare decided the focus would remain on the need for care and not on whether the individual’s health is improving. (LO 15-3-1)
- The Deficit Reduction Act of 2006 extended the look-back rules for Medicaid eligibility from 36 to 60 months
True. (LO 15-3-1)
- Veterans Administration benefits for long-term care can include adult day care, housing, and domiciliary care.
True. (LO 15-3-1)
- Some Veterans Administration benefits are only available to eligible veterans with service related injuries
True. (LO 15-3-1)
- Medicaid is federally funded but state operated, requiring all states to enforce the same Medicaid qualification tests
False. Medicaid is a joint funded program, however, states can and do apply different qualification tests. (LO 15-3-2)
10.State Medicaid income qualification tests are solely based on Supplemental Security Income Benefit standards.
False. While many states base the income qualification test on SSI benefits, other states set the requirements based on the Federal Poverty level. (LO 15-3-2)
11.SSI benefits can be reduced if an individual’s food and shelter is being provided by a third party.
True. SSI benefits are reduced by 1/3 if someone else is providing your food and shelter. (LO 15-3-2)
12.Under Medicaid, the community spouse is the individual receiving long-term care services funded by the government
False. The community spouse is the healthy spouse still living in the home or in the community. (LO 15-3-2)
13.Under Medicaid spousal impoverishment provisions, a certain amount of a couple’s combined resources are protected for the community spouse
True. (LO 15-3-2)
14.The federal government sets a minimum monthly needs allowance for community spouses.
True. The range was from $1,838 to $2,841 in 2012. (LO 15-3-2)
15.SSI and Medicaid benefits can both have asset resource eligibility requirements.
True. $2,000 individual/$3,000 with community spouse. (LO 15-3-2)
16.A primary residence, automobile, and personal belongings, such as clothing and jewelry, are considered exempt assets and not countable for purposes of Medicaid’s asset resource eligibility requirements
True. (LO 15-3-2)
17.Income-cap states require Medicaid applicants to provide for their own cost of care until they spend down their assets below the income cap amount
False. This statement correctly describes a spend-down state, not an income cap state. In an income cap state, if the income is $1 over the cap, you do not qualify for Medicaid. (LO 15-3-2)
18.The Deficit Reduction Act of 2006’s “look back” provision prohibits all property transfers within 60 months of the date of application to Medicaid
False. The DRA does not prohibit the transfers, instead it only requires Medicaid to examine transfers below market value in the previous 60 months prior to the application for Medicaid. (LO 15-3-2)
19.An invalid or below market transfer could result in a Medicaid applicant becoming ineligible for up to five years.
True. (LO 15-3-2)
20.Purchase of a qualified annuity does not violate the Deficit Reduction Act of 2006’s look-back requirements.
True. (LO 15-3-2)
21.A Medicaid applicant can transfer his or her assets into exempt assets for the purposes of qualifying for Medicaid without violating the Deficit Reduction Act of 2006’s look-back provisions
True. (LO 15-3-2)
22.States can recover assets paid under Medicaid from a beneficiary’s estate.
True. (LO 15-3-2)
23.The Older American Act Programs provide long-term care services in the form of Alzheimer’s Disease services
True. (LO 15-3-3)
24.The Own Your Future Awareness Campaign offers a variety of State and Federal funded long-term care living facilities
False. The Own Your Future Awareness Campaign was designed to help individuals plan for long-term care and disseminate free planning information. (LO 15-3-3)
25.State Partnership Long-Term Care Insurance Programs offer government funded long-term care insurance policies.
False. The program was designed to incentivize the purchase of policies but not to provide the funding for them. (LO 15-3-4)
26.While the Deficit Reduction Act of 2006’s “look back” period changes made it easier to qualify for Medicaid, the Partnership Program made it more difficult to spend down assets to qualify for Medicaid
False. The Deficit Reduction Act of 2006 extended the “look back” period making it harder to qualify for Medicaid. The Partnership Programs make it easier to spend down assets to qualify for Medicaid by exempting more of the applicant’s assets from the limits. (LO 15-3-4)
27.Most states put a $100,000 policy limit on qualified State Partnership Program long-term care policies
False. Most states do not put any policy amount limitations on qualified long-term care insurance policies for State Partnership Program eligibility. (LO 15-3-4)
28.Qualified State Partnership Program long-term care insurance policies must have specific inflation protections built into the contracts.
True. (LO 15-3-4)
29.Qualified State Partnership Program long-term care insurance policies can be used to protect an individual’s legacy goals.
True. These policies can be used in conjunction with other planning techniques to protect assets against Medicaid spend-down. (LO 15-3-4)
30.Qualified State Partnership Program long-term care insurance policies are almost always the most affordable policies available.
False. These policies, because of the inflation protections, are typically expensive compared to policies without the inflation protections. (LO 15-3-4)
- Andrew, preparing to enter a nursing home, files his Medicaid application. Because the average nursing home cost in his area is $5,000/month, Andrew wants to make sure he qualifies for Medicaid. As such, Andrew gives away $200,000 to his sister. How long will Andrew be ineligible for Medicaid due to this transfer? (LO 15-3-2)
A. Andrew will not be ineligible for Medicaid.
B. Andrew will be ineligible for the full 60-month look-back period.
C. Andrew will be ineligible for 40 months.
D. Andrew will be ineligible for 20 months
- The answer is C. Transfer/average Nursing Home care = 200,000/5,000 – 40 months
- Which of the following statements is true regarding The Older American Act Program? (LO 15-3-3)
A. It was initially enacted to provide coordination of Alzheimer’s disease care services.
B. It provides long-term care housing.
C. It worked in conjunction with the Federal government to create “The Own Your Future Awareness Campaign,” designed to raise awareness about Alzheimer’s disease.
D. It provides respite care services to family caregivers
- The answer is D. The Older American Act Program – Life-Span Respite Care Program helps provide respite care to family caregivers.
- Which of the following is a benefit of a qualified State Partnership Program long-term care insurance policy? (LO 15-3-4)
A.Qualified plans are typically the most affordable.
B.Qualified plans do not need expensive inflation protections.
C.Qualified plans are partially funded by the State.
D.Qualified plans enable more effective Medicaid “spend-down” planning.
- The answer is D. The benefit of the qualified policy is to protect assets from Medicaid spend-down and asset eligibility requirements.
- Which of the following statements concerning the Deficit Reduction Act of 2005 (DRA) is (are) correct? (LO 15-3-1)
I. The DRA tightened the Medicare long-term care coverage eligibility requirements.
II. The DRA shortened the look-back period from 60 months to 36 months.
A. I only
B. II only
C. Both I and II
D. Neither I nor II
- The answer is D. The DRA restricted Medicaid not Medicare eligibility requirements and lengthened the look-back period
53. Which of the following is (are) often exempt from the Medicaid resource eligibility tests? (LO 15-3-2) I. Pre-paid burial plots and contracts II. Household belongings and furnishings A. I only B. II only C. Both I and II D. Neither I nor II
- The answer is C. Both of these assets are typically exempt from Medicaid resource eligibility tests
- All of the following are excluded from impacting the amount of Supplemental Security Income benefits EXCEPT (LO 15-3-2)
A. $30/month from any source
B. Food and shelter provided by a family member
C. A small amount of monthly wages
D. $20/month of nonrecurring items
- The answer is B. Food and shelter provided by a family member can decrease the SSI benefit by 1/3.
