Medical Assistance for Long-Term Care Services

2.4.1 Eligibility Requirements

This subchapter provides general policy information that applies to Medical Assistance for Long-Term Care Services (MA-LTC).

If an enrollee is no longer eligible for MA under their current basis, they must be redetermined for all health care programs they are potentially eligible for, without interruption in their coverage. See EPM 1.3.2.1 Change in Circumstances for more information.

LTC Eligibility Factors

People requesting MA-LTC must meet all of the following eligibility factors to be eligible:

Must be eligible for MA
Requires a nursing facility level-of-care as determined through a Long-Term Care Consultation (LTCC)
Must have home equity at or below the home equity limit
Must not be subject to a period of ineligibility under the uncompensated transfer rules
Must name the state the remainder beneficiary of certain annuities

Eligibility for MA

People who request MA-LTC are required to meet all of the eligibility requirements for MA before determining if the person meets the LTC Eligibility Factors. MA eligibility is determined under MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD), MA for Employed Persons with Disabilities (MA-EPD) or MA with Families with Children and Adults (FCA).

Bases of Eligibility

People enrolled in MA are eligible to receive MA-LTC if they meet the LTC Eligiblity Factors.

People enrolled in MA who meet the LTC Eligibility Factors are eligible to receive MA-LTC in a long-term care facility (LTCF) only. People eligible for MA-FCA are not eligible to receive services through a home and community-based services (HCBS) waiver. If a person with an FCA basis of eligibility needs services through an HCBS waiver, the person must be determined eligible under MA-ABD.

People enrolled in MA for Employed Persons with Disabilities (MA-EPD) who meet the LTC Eligibility Factors are eligible to receive MA-LTC. People who are enrolled in MA-EPD and meet the LTC Eligibility Factors use the MA-ABD income methodology and are subject to MA-EPD asset limits. See EPM 2.3.5.3.1 MA-EPD Assets.

Minnesota Health Care Programs Applications

MA applicants who are requesting MA-LTC should use one of the following forms:

Application for Payment of Long-Term Care Services (DHS-3531)

MA enrollees who are requesting LTC services should use one of the following forms:

Minnesota Health Care Programs Request for Payment of Long-Term Care Services (DHS-3543)
Minnesota Health Care Programs Payment of Long-Term Care Services for MA for Families with Children and Adults (DHS-3543A)

MA enrollees who are requesting MA-LTC coverage of HCBS waiver services should submit one of the following forms:

MA-ABD enrollees: Minnesota Health Care Programs Request for Payment of Long-Term Care Services (DHS-3543)
MA-FCA enrollees (to be determined for MA-ABD): Supplement to MNsure Application for Health Coverage and Help Paying for (DHS-6696A)

Claims for MA-LTC services cannot be paid until the enrollee is determined eligible for MA-LTC.

If the enrollee is requesting services because of a move to an LTCF, eligibility can begin the date the enrollee moved into the LTCF or the date that all eligibility requirements for MA-LTC are met, whichever is later.
If the enrollee is requesting services through an HCBS waiver, eligibility can begin no earlier than the date of the LTCC or the date the enrollee meets all eligibility requirements for MA-LTC, whichever is later.

Notification

People who request MA-LTC are notified of the results of the eligibility determination through either a system generated or a manual notice. ”Notice of Action for Medical Assistance (MA) Payment of Long-Term Care Services” (DHS-4915).

The lead agency assessor or case manager, or the LTCF, is notified when the person becomes eligible so that LTC services can begin.

Legal Citations

Minnesota Statutes, section 256B.056, subdivision 2a

Minnesota Statutes, section 256B.056, subdivision 11

Minnesota Statutes, section 256B.057

Minnesota Statutes, section 256B.0595

Minnesota Statutes, section 256B.0911

Code of Federal Regulations, title 42, section 435.916

United States Code, title 42, section 1396p