Current through Reg. 49, No. 38; September 20, 2024
(a) This section describes the Long-Term Care
Partnership Program under which a person's resources are disregarded in the
eligibility determination equal to the amount of benefits paid to or on behalf
of a person by a Long-Term Care Partnership policy.
(b) The Texas Health and Human Services
Commission (HHSC) administers the Long-Term Care Partnership Program.
(c) In this section, the following words and
terms have the following meanings, unless the context clearly indicates
otherwise:
(1) "Long-Term Care Partnership
Program" means the program established under the Texas Human Resources Code,
Chapter 32, Subchapter C.
(2)
"Qualified plan holder" means the beneficiary of a qualified long-term care
benefit plan that meets the requirements set forth in subsection (d) of this
section.
(3) "Resource disregard"
means the total equity value of resources not exempt under rules governing
Medicaid eligibility that are disregarded in determining eligibility for
Medicaid.
(4) "Resource protection"
means the extension to a plan holder of an approved plan of a dollar-for-dollar
resource disregard in determining Medicaid eligibility.
(5) "Dollar-for-dollar resource disregard"
means a resource disregard in which the amount of the disregard is equal to the
sum of benefit payments made on behalf of the approved plan holder.
(d) A Long-Term Care Partnership
Program policy is one that meets all of the following requirements:
(1) On the date the policy was issued, the
state in which the insured resided had in place an approved Medicaid state plan
amendment under
RSA
1396p(b).
(2) The policy meets the requirements set
forth by the Texas Department of Insurance under Title 28, Part 1, Chapter 3 of
the Texas Administrative Code (relating to Life, Accident and Health Insurance
and Annuities).
(e) At
application for long-term care services, the qualified plan holder receives a
dollar-for-dollar disregard of his or her resources.
(1) HHSC determines Medicaid eligibility in
accordance with this chapter.
(2) A
person may apply for Medicaid before exhausting the benefits of a Long-Term
Care Partnership Program policy. If a person applies for and is eligible to
receive Medicaid before the Long-Term Care Partnership Program policy is
exhausted, the Long-Term Care Partnership Program insurer must make payment for
medical assistance to the maximum extent of its liability before Medicaid funds
may be used to pay providers for covered services as established in this
chapter.
(3) If a person has
applied for and been found eligible to receive Medicaid and subsequently
receives additional resources, the person continues to be eligible for Medicaid
if the total resources do not exceed the individual resource limit after
applying the dollar-for-dollar resource disregard.
(f) If the Long-Term Care Partnership Program
is discontinued, a person who purchased a Long-Term Care Partnership Program
policy before the date the program is discontinued remains eligible to receive
the dollar-for-dollar resource exclusion.
