Important October BEM Changes

DHHS released new BEM language to take effect October 1, 2015. Click here to read them. Of particular note are the new provisions for long term care partnership insurance payments and care contracts.

As to the long term care insurance partnership, this concept has been addressed in prior blogs. What we learn from the new language is that the protection will only apply to payments actually made to or for the benefit of the insured. Meaning that the supplemental asset protections accrue only as the benefit is received (as opposed to simply allowing for a supplemental asset protection in the amount of the total benefit purchased).

The new long term care insurance language expressly precludes assets protected by the partnership policy payments from estate recovery.

The language regarding care contracts is more troubling. These changes arise out of the Jensen Court of Appeals decision, also discussed in prior blog posts here.

The new care contract provisions segregate contracts for personal care and home maintenance.

The presumption of gratuitous care only applies to relatives. However, and importantly, the requirements of having a Medicaid compliant contract applies to relatives and non-relatives equally.

The new provisions preclude any payments after the person receiving care is in a nursing home or “adult foster care home (licensed or unlicensed)” [I think they mean “assisted living facility”] = a big problem for professional care providers hired to supplement care particularly in ALFs.

For clients applying for Medicaid who have received personal care assistance, even through a professional agency, the new policy will require providing the contract to DHHS for review.