*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: September 1, 2008 |
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19.25.45 - Continuing Care Retirement Community (CCRC) Entrance Fee |
Archived: June 1, 2016 (Previous Versions) |
Part or all of an entrance fee paid to a CCRC may be considered a countable asset when determining eligibility for MA and MinnesotaCare.
This section provides information on CCRCs and steps to follow when determining if all or part of the entrance fee must be counted in a client’s asset total.
Determining the Availability of a CCRC Entrance Fee.
Steps in Evaluating a Possible CCRC Entrance Fee.
A CCRC provides housing, services and nursing care, usually all in one location. This enables people to remain in a familiar setting as they grow older. Types of services provided by a CCRC include but are not limited to:
l Board.
l Lodging.
l Nursing services.
l Medical services.
l Home health care.
l Other health-related services.
Example:
Lola contracts with the Happy Homes CCRC. The contract entitles Lola to live in the community and to receive services as needed.
Initially Lola moves into a townhouse located on the Happy Homes campus and receives help each day with her insulin shot. Being a member of the community, Lola enjoys attending recreational activities, shopping at the community’s gift shop and using the on-site hair dresser.
Three years after signing the contract Lola needs a bit more help with her daily tasks and moves into the assisted living facility on the same campus. She continues to have access to the same activities and services as she did while she lived in the townhouse.
Lola falls and breaks a hip a year later, resulting in a move to the nursing home facility on the same campus. Again, she continues to have access to the same activities and services she did while in her other two living accommodations.
A CCRC must be registered with the county recorder in the county in which it is located. A CCRC must meet the following criteria to be registered:
l Have a written contract with clients to provide services for the life of the individual or a period in excess of one year. Services and lodging provided by a CCRC do not need to be provided at the same location.
l Requires an entrance fee of $100 or more.
l Requires the client to pay regular periodic charges for the care provided.
The following are not considered to be a CCRC for MA and MinnesotaCare purposes:
l A facility operating solely as a nursing facility.
l A facility that delivers housing without services.
l A program or organization that provides services but not housing.
l Services received by a client which are provided by an individual related by blood or marriage.
See Minnesota Continuing Care Retirement Communities for a list of known registered CCRCs in the State of Minnesota.
Count the available portion of an entrance fee paid to a CCRC toward a client's total countable assets at application or renewal for the following programs:
l Medical Assistance (MA):
n Method A.
n Method B.
n MA waiver programs.
n MA payment of long-term care services.
n MA for Employed Persons with Disabilities (MA-EPD).
l Medicare Savings Programs.
l MinnesotaCare.
Determining the Availability of a CCRC Entrance Fee
Determine the availability of the entrance fee by reviewing the specifications in the contract signed by the client.
To be considered available to the client, the entrance fee paid to a CCRC must meet all of the following conditions:
1. All or a portion of the entrance fee can be refunded or used to pay for needed services if the client does not have other sufficient resources to pay for those services.
Needed services may include but are not limited to:
n Medical care, both inpatient and outpatient.
n Home health care.
n Skilled nursing care.
2. The entire fee amount or the remaining portion of the fee can be refunded if the client either:
n Dies.
n Ends the contract and leaves the CCRC.
3. The entrance fee does not purchase ownership interest in the CCRC.
Verify the amount of the entrance fee available to a client. Verification can be:
l A copy of the contract.
l An accounting of the contract information from the CCRC.
Note: The client must either provide the information needed from the CCRC or sign a General Authorization for Release of Information (DHS-2243A) giving permission to contact the CCRC to obtain the information.
Verify the availability of the entrance fee at renewal:
l If it was not previously verified at application.
l If the entrance fee availability has changed and the available amount cannot be determined with the verification on file.
Note: The contract between an individual and the CCRC may allow for a change in the availability of an entrance fee. Check the contract at renewal to see whether there are circumstances when the availability of the entrance fee might change.
Follow program provisions in Verification of Assets in addition to the information above.
Steps in Evaluating a Possible CCRC Entrance Fee
Follow these steps at application, at renewal or when a contract is reported between renewals:
1. Determine if the client belongs to a CCRC by comparing the client’s address to the addresses listed in Minnesota Continuing Care Retirement Communities. If the client’s address:
n Is the address of a listed CCRC, continue to Step 3.
n Is not the address of a listed CCRC, and the client reports a contract with a CCRC, continue to Step 2.
n Is not the address of a listed CCRC, and the client does not report a CCRC contract, the client does not have an entrance fee available. Continue processing other eligibility criteria.
2. Determine if the CCRC is registered. Contact the county recorder in the county in which the CCRC is located to determine if the CCRC is registered.
n If registered, continue to Step 3.
n If not registered, and it appears the client is reporting information on a CCRC, submit a HealthQuest requesting further instructions.
3. Request verification of the entrance fee and contract information.
Request additional information at renewal if the entrance fee availability has changed from what was verified at application and the available amount cannot be determined with the verification on file. Continue to Step 4 if no additional verification is needed.
If the verification is:
n Received, continue to Step 4.
n Not received,
m For applicants: Deny eligibility at the end of the processing period.
m For enrollees: Close eligibility as an incomplete renewal, or if reported at a time other than renewal, close giving 10-day notice.
4. Determine if the entrance fee is available and, if available, the amount that can be refunded.
5. Count the available amount toward the counted assets total.
n For MA eligibility:
a. Update MAXIS STAT/OTHR with the available amount.
b. Use FIAT to FAIL the asset test creating ineligible results if the client’s total countable assets are over the asset limit due in part to counting the refundable entrance fee amount.
Reminder: Allow clients with excess assets to properly reduce those assets to within program limits following policy provided in Excess Assets.
n For MinnesotaCare eligibility:
Close or deny eligibility using status reason code ’70’ (failing the asset test) if the client’s total countable assets are over the asset limit due in part to counting the refundable entrance fee amount.
Reminder: Allow clients with excess assets to properly reduce those assets to within program limits following policy provided in Excess Assets.
6. Case note information about the CCRC entrance fee, including the name, location, the amount of the entrance fee paid, the amount available and any other important information. Title the case note **CCRC Entrance Fee**.
John and his family are applying for MinnesotaCare. He lives with his wife and 17-year-old son. On his application he reports he has been a member of the Twilight CCRC for the past five years.
Action:
Contact the county recorder’s office to confirm that the Twilight CCRC is registered as a CCRC. Request verification of the contract from John.
John sends a copy of his contract. According to the terms of the contract, he paid an entrance fee of $100,000 and did not purchase ownership rights to the CCRC. The contract indicates 90 percent of the entrance fee is available. John can either receive a refund of 90 percent of the entrance fee if he were to leave the CCRC, or he can use up to 90 percent of the funds to pay for services provided by the CCRC.
Action:
Count $90,000 ($100,000 X .90) of the entrance fee toward the family's total countable assets. John and his wife are ineligible for MinnesotaCare due to excess assets.
Marion is applying for MA. She has been a member of the Happy Life CCRC for the past ten years and has been receiving nursing home care through the CCRC for the past three years. Marion provides a copy of her contract with the CCRC, and the worker confirms it is registered with the county recorder’s office. The contract contains the following:
l Marion did not purchase ownership interest in the CCRC.
l She paid a $150,000 entrance fee.
l One hundred percent of her entrance fee can be either refunded when she leaves the CCRC, or applied to her cost of care while at the CCRC.
Action:
Request verification of the amount of the entrance fee that has been used toward Marion’s cost of care.
Marion signs a consent for release of information to allow her worker to talk to the CCRC directly. The CCRC provides documentation that $75,000 of her entrance fee has been used toward her cost of care over the past three years.
Action:
Apply $75,000 ($150,000 - $75,000) toward Marion’s total countable assets. Marion is ineligible for MA due to excess assets unless she is able to reduce assets properly.
Marta is applying for MA because her health has deteriorated and she has used most of her available assets to pay for her cost of home and community-based services. She is a member of a CCRC, which has been registered with the county recorder’s office. Marta has been living at the CCRC for 73 months.
Marta provides a copy of the CCRC contract which contains the following information:
l Marta did not purchase a percentage of ownership of the CCRC.
l She paid a $300,000 entrance fee.
l The CCRC retains two percent of her entrance fee for each month she lives at the CCRC, which is not available for refund.
l Any amount not retained is available for refund when Marta leaves the CCRC.
Action:
Because Marta has lived at the CCRC for 73 months and two percent of the entrance fee is retained for each month she lives at the CCRC, no portion of the entrance fee is available. If Marta’s other total countable assets are less than the asset limit and she meets all other eligibility criteria, Marta is eligible for MA.
Calculation:
Month 1 |
$300,000 x .02 = $6,000 |
$300,000 - $6,000 = $294,000 |
Month 2 |
$300,000 x .02 = $6,000 |
$294,000 - $6,000 = $288,000 |
Month 3 |
$300,000 x .02 = $6,000 |
$288,000 - $6,000 = $282,000 |
Months 4 - 73 continue to be calculated in the same manner. |
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