Help for Applying for Medical Assistance

Help Sheet for Applying for Medical Assistance

January 2017

Please note that I am writing this to you as a guide. I have had many family members voice frustration with me as to the “how’s” of navigating through the medical assistance application process. I am not an attorney, and this is not legal advice but rather, things I have learned over the past 25 years of helping families through the medical assistance process.

We accept the GRH, Group Residential Housing rent rate, which the State of MN determines every summer, for a shared companion room. This means that you can only remain in a private room while on medical assistance, if someone other than the person applying for medical assistance chooses to pay the private room differential for the resident.

  1. When should you apply for Medical Assistance, which is generally titled elderly waiver (EW) in assisted living settings?
    1. A good rule of thumb is to call the county phone numbers in the county which you reside 60 days before your assets reach $3,000 as a total balance.
    2. If you do not have care needs as determined by the state, you may be denied access to assisted living if your needs could be met in another independent setting. The nurse who determines your level of care needs determines this on the LTCC Consultation or MN Choice Assessment. The State of MN wants to make sure seniors are placed in settings which meet their needs.
    3. You can access the medical assistance application on the Diamond Willow and Keystone Bluffs websites.

 

  1. There are two very important steps to take: (1) Apply for financial assistance and fill out the medical assistance application and call the county financial worker (2) Call for a LTCC or MN Choices level of care assessment with the county.
    1. The financial eligibility is one aspect of the process, which determines financial need after the county reviews the application completed by the resident/family member. Once the financial eligibility process is started, the case has to be opened in 60 days. Otherwise, if paperwork is not completed, the case will go back to day zero and the process for opening medical assistance may be delayed and the resident may have no payer source to pay their bills for care in a setting such as an assisted living.
    2. The level of care assessment is something that is a second aspect of the process, and this is done by a separate agency in the county. This level of care assessment determines medical need and is called a LTCC assessment or MN Choices assessment. Once the nurses from the county do the level of care assessment, this is good for only 60 days. This means that the financial team must have all the paperwork they need in a timely manner, to assure the case is opened for the senior applying for medical assistance.
    3. Once the financial team opens the case, and the nurse determines level of care need to support assisted living need, then the provider can bill the State of MN for the service portion of the cares. It is important to know that the state does not allow back billing, therefore the resident is considered private pay until the county opens the medical assistance case.
    4. Important phone numbers to call for the county you reside in:
      1. For Diamond Willow Residents who reside in Lester Park, Proctor, Mountain Iron and Keystone Bluffs Residents, call 218-733-2725 to apply for financial assistance. Please call 218-726-2366 for a LTCC/MN Choices level of care assessment.
      2. For Diamond Willow Residents who reside in Little Falls, call Morrison County at 320-631-3577 and ask for the long term care team to assist them with the financial application. Then they should call 320-632-6664 which is public health for the MN Choices application.
      3. For Diamond Willow residents who reside in Alexandria, call Douglas County at 320-762-2302, and this is the number to call to apply for medical assistance. Then call 320-763-6018 and this is the public health nurse line to request a level of care assessment which is known as a LTCC consultation or MN Choices.
      4. For Diamond Willow residents who reside in Detroit Lakes, call Becker County at 218-847-5628, and press zero and ask for: The adult service intake team who processes the LTCC Long Term Care Consultation which is known as MN Choices and this determines level of care need. Then you will need to call back the same number at 218-847-5628, and press zero and ask for the financial team to apply for medical assistance in assisted living.
      5. For Diamond Willow residents in Baxter, call Crow Wing County at 218-824-1250, and when they answer it will say Crow Wing County Economic Assistance line. Then there will be a menu of seven choices. Press 0 to speak to a county representative. Then it will list to four more choices, then press 4 to speak to a county representative. Please let them know you need to apply for medical assistance and you currently reside in an assisted living. Then call 218-824-1140 to schedule a LTCC screen/MN choice assessment which determines the level of care need.
      6. For Diamond Willow residents in Grand Rapids, call Itasca County at 218-327-6706 or 218-327-6146 and let them know you need to apply for financial assistance and you currently reside in an assisted living. You also need to let them know you need a LTCC/MN Choices screen from a nurse to determine the level of care need of the person who is applying.
      7. For Diamond Willow residents in Park Rapids, call Hubbard County at 218-732-2453 and let them know you need to apply for financial assistance and you currently reside in an assisted living. You also need to let them know you need a LTCC/MN Choices screen from a nurse to determine the level of care need of the person who is applying.

 

  1. Other things to be aware of:
    1. It is important to know that your monthly income is a completely separate thing from your total assets when applying for medical assistance. Therefore, assets can be a variety of items such as savings, checking, stocks, bonds, commercial or residential property, land, etc. as just a list of some common examples.
    2. If you are a married couple, the county will do an assessment to determine your eligibility and sometimes one person remains in their home and one person needs a higher level of care. Sometimes both people need a higher level of care and the county has a formula for this which the state has set forth.
    3. The look-back period is 60 months before the date of applying for medical assistance (elderly waiver), therefore if assets are transferred inside of this time period there may be a disqualification period to match the amount of money transferred. This is something the county would determine when doing the application for medical assistance.
    4. Have you had a Long term Care Consultation? This is what is also referred to as MN Choices which determines that the applicant has care needs which the assisted living provider offers.
    5. If the county determines you have a high monthly income as defined by the State of Minnesota, you may have what is called a “Spenddown or waiver obligation.” What this really means is that in addition to the amount you pay for your rent, which is currently $891 per month for a shared room on medical assistance, then you are personally responsible to pay an additional amount of money from your monthly income to the provider each month. This is what “spenddown or waiver obligation means”. If you have a spenddown or waiver obligation, the state reduces the amount they pay the provider for the services, because the resident has a high monthly income and can afford to pay a higher portion.
    6. During the time you are applying for medical assistance, the resident is responsible to continue paying the provider monthly to avoid an eviction notice. All residents are considered private pay until they are opened on medical assistance.

 

  1. Some items to gather early for records the state will want to review:
    1. Recent bank statements of balances
    2. Real estate property tax statements, and documents showing amount owed against property
    3. Burial contracts and the name of the company or funeral home that holds the contract
    4. Other assets such as bonds, trusts, stock ownership, annuities, etc. and you must have the current statement with any balance owing against asset.

 


Full Circle Senior Living Corporate Office
Assisted Living With Memory,
Medical and Physical Care
1411 London Road
Duluth, Minnesota 55805
1-877-247-1205