This website is intended to provide educational materials and resources for individuals or their representatives who currently own a New York State Partnership policy. For licensed agents, the Partnership training and certification is available for those who wish to refresh their knowledge of the NYS Partnership requirements as well as gain 6 CE credits toward their licensure. Show IMPORTANT: As of January 1, 2021, there are no insurance companies currently offering new policy purchases of Partnership qualified products in New York State. This means that there are no new Partnership policies available for purchase at this time. This does not affect current, active insureds who are Partnership qualified. What is the Partnership Program? The NYS Partnership for Long-Term Care (NYSPLTC) is a unique Department of Health program combining private long-term care insurance and Medicaid Extended Coverage (MEC). Its purpose is to help New Yorkers financially prepare for the possibility of needing nursing home care, home care, or assisted living services someday. The program works by allowing an individual or couple who purchases a Partnership insurance policy and keeps in effect to hold onto all or part of their assets (depending on the type of policy purchased) under the Medicaid program if their long-term care needs extend beyond the period covered by their policy. Partnership policyholders who use the benefits according to the conditions of the program can apply for MEC, which may assist in paying for on-going care long-term care needs. Unlike regular Medicaid, MEC allows you to protect some or all of your assets, depending on whether the policies is qualified as a Dollar for Dollar Asset Protection plan or a Total Asset Protection plan. However, MEC does require that you contribute your income to the cost of your care according to Medicaid income rules. NYSPLTC helps New Yorkers pay for their long-term care without having to “spend down” their assets, as they would have to do if they relied totally on Medicaid to pay for their long-term care. By allowing New Yorkers to keep what they've worked hard to acquire, and reducing Medicaid costs for the State, NYSPLTC provides a win-win scenario for everyone. FOR RATE INCREASE INQUIRIES: Long term care insurance premium rate increases are filed with and approved by the New York State Department of Financial Services. New York State regulations require insurance carriers to support requests for rate increases with actuarial justification. Insurers have the responsibility of pricing and determining the rates that need to be charged in order to meet future claim obligations. For rate increase questions, please contact the Consumer Assistance Bureau at the New York State Department of Financial Services at 1-800-342-3736. Copyright © 1998-2022 New York State Partnership for Long-Term Care. All rights reserved.
Florida’s Long-term Care Partnership Program is a partnership program between Medicaid and private long-term care insurers designed to encourage individuals to purchase private long-term care insurance. Long-Term Care Partnership policies are tax qualified (a portion of premiums paid may be claimed as a tax deduction) under federal law; provide policyholders with inflation protection; and most importantly, provide dollar-for-dollar asset protection in the event the policyholder needs to apply for long-term care Medicaid assistance. For every dollar that a partnership policy pays out in benefits, a dollar of assets can be protected from Medicaid spend-down requirements. LegislationThe authorizing language for the establishment of the Florida Long-Term Care Partnership (LTCP) Program by the Agency for Health Care Administration, in consultation with the Office of Insurance Regulation and the Department of Children and Family Services, is located in s. 409.9102, Florida Statutes, and Rule Chapter 69O-157.201 of the Florida Administrative Code. This language may be accessed using the links below. Florida StatutesFlorida Administrative Code
Chapter 69O-157.201 Standards For Approved Long-Term Care Partnership Program Policies Chapter 69O-157.1155 Producer Training Chapter 65A-1.712 SSI-Related Medicaid Resource Eligibility Criteria Florida Medicaid State Plan Amendment
2.6–A Supplement 8c, Eligibility Conditions and Requirements Office of Program Policy Analysis & Government Accountability (OPPAGA) Report No. 09-08 [106KB] FAQsResources and LinksDisclaimer: References to products, services or other companies does not constitute an endorsement or recommendation by the State of Florida Agency for Health Care Administration. Purchase of a partnership policy does not guarantee eligibility for Medicaid.
The long-term care insurance (LTCI) partnership program was developed in the 1980s to encourage people who might otherwise turn to Medicaid to finance their long-term care (LTC) to purchase LTCI. If people who purchase qualifying policies deplete their insurance benefits, they may then retain a specified amount of assets and still qualify for Medicaid, provided they meet all other Medicaid eligibility criteria. Currently, these programs operate in four states: California, Connecticut, Indiana, and New York. Table 1 illustrates the current number of policies in force and the number of people receiving partnership policy benefits in the participating states. Table 1
Source: Government Accountability Office, 2005. Demographics of PurchasersAlthough the partnership program was intended to attract lower- to middle-income Americans (the cohort most likely to spend down to Medicaid), state policyholder surveys indicate that most purchasers have substantial assets. The majority of purchasers in California, Connecticut, and Indiana had assets in excess of $350,000. In contrast, the average person age 55 or over has less than $50,000 in assets. The New York program, unique in that it allows unlimited asset protection for purchasers, has primarily attracted higher-income purchasers, because of this feature and its resulting higher premium costs. ExpansionThe Deficit Reduction Act of 2005 (DRA 05) now allows all states the option to enact partnership policies. Policies in these new programs must meet specified criteria, including federal tax-qualification, identified consumer protections, and inflation protection provisions. Compound annual inflation protection will be required for purchasers below age 61, although states can determine the percentage rate (e.g. 3 percent, 5 percent, etc.). “Some level of inflation protection” (not defined) will be required for purchasers between the ages of 61 and 75. Also, DRA 05 requires the U.S. Department of Health and Human Services to develop a reciprocity agreement, enabling purchasers to use their benefits in other partnership states; however, states may opt out of this reciprocity. At least 21 states, anticipating a change in federal law, already have enacted authorizing legislation. These states are listed in Table 2. Table 2
Source: National Association of Health Impact of Partnership Programs on Medicaid SpendingWhether the partnership programs will help save the Medicaid program money is a major policy question. Proponents argue that, by deferring the use of Medicaid for those who otherwise would spend down their assets and qualify for benefits, people who purchase partnership policies will reduce Medicaid’s spending on LTC. Others argue that partnership programs will qualify people for Medicaid who otherwise would never have used the program: their own assets would have paid for their LTC costs. Moreover, some argue that, if Medicaid is intended to be a safety net for people with few assets and limited incomes, partnership programs could deplete Medicaid resources by qualifying people for benefits who can, and should, finance their own services. Partnership policies have the potential to save Medicaid dollars if they are purchased by people who would not have bought other (non-partnership) policies. If, instead, these policies replace LTCI policies that do not include Medicaid asset protection, then they may result in higher Medicaid spending. So far, the data are inconclusive because the programs are still relatively new and few purchasers have begun to use benefits. Issues and ConcernsWith the likely expansion of LTCI partnership programs into additional states, consumer education is critical. The addition of a partnership option in a growing number of states will add a layer of complexity to the already-difficult process of deciding whether to buy LTCI and, if so, which policy to purchase. While partnership programs allow purchasers to protect a certain level of assets if they deplete their insurance benefits and qualify for Medicaid, many consumers do not understand that Medicaid eligibility is not automatic. To qualify for Medicaid, individuals must meet the state’s income and functional eligibility criteria, which may change by the time they apply for Medicaid. Regarding income, the GAO reported that about half or more of the purchasers in three states had average monthly incomes of $5,000 or more. To meet Medicaid’s income eligibility, most states require that monthly income not exceed 300 percent of the federal Supplemental Security Income (SSI) amount (300 percent of SSI is $1,809 per month in 2006) or the monthly cost that Medicaid pays for nursing home care (which averaged $3,540 in 2002). While married individuals can protect additional income for a community spouse and qualify for Medicaid, only about 15 percent of nursing home residents are married. As a result, many who have purchased partnership policies may never qualify for Medicaid because their incomes are too high. Another issue is functional eligibility. To receive LTCI benefits from a partnership policy, one generally must be cognitively impaired or need assistance with two or more activities of daily living (such as bathing or dressing). To meet Medicaid’s functional eligibility criteria for LTC, most states have more restrictive disability criteria, often including medical needs. This may prove to be a problem for purchasers who deplete their partnership benefits and then cannot qualify for Medicaid. Finally, the ability to remain at home is a potential issue for consumers. While consumers express an overwhelming preference to receive LTC services in their homes or in community-based settings, Medicaid beneficiaries have no entitlement to receive these benefits. A partnership purchaser who qualifies for Medicaid after depleting his or her insurance benefits may be able to receive services only in a nursing home, depending on the state’s eligibility criteria for HCBS and whether there is a waiting list for services. BibliographyAhlstrom, Alexis, Clements, Emily, Tumlinson, Anne and Jeanne Lambrew. The Long-Term Care Partnership Program: Issues and Options, Washington, D.C.: The Brookings Institution and The George Washington University, December 2004. Government Accountability Office. GAO-05-1021R. Washington, D.C.: GAO, September 9, 2005. Stone-Axelrad, Julie. Long-Term Care Insurance Partnership Program. CRS Report for Congress, Washington, D.C.: CRS, September 27, 2004. Footnotes
Written by Enid Kassner, AARP Public Policy Institute March 2006 ©2006 AARP All rights are reserved and content may be reproduced, downloaded, disseminated, or transferred, for single use, or by nonprofit organizations for educational purposes, if correct attribution is made to AARP. Public Policy Institute, AARP, 601 E Street, NW, Washington, DC 20049 |
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