Step 1 – Request Information

The first step in the initial determination process is to request a copy of the LTC insurance policy (or certificate of coverage) from the client, using an MHCP Request for Information (DHS-3271) (PDF). Along with this request you must also send the Permission to Share LTC Insurance Information

The DHS-5426A is a permission form which allows DHS to discuss the LTC insurance policy with the insurance company.

(DHS-5426A).

The client has 10 working days to return the copy of the policy and the signed DHS-5426A. Be sure to enter a case note of the request and to set a DAIL/WRIT to remind yourself of the due date.

Using the information on the LTCP Process – Initial Determination (PDF) handouts, what do you do if requested items are not returned?

Link to the following: If the client does not provide the insurance information and/or the DHS-5426A, proceed in determining eligibility for MA-LTC without the benefit of protected assets. Send the client a SPEC/MEMO indicating that the items were not returned (See LTCP Notice handout)

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LTCP Processes - LTCP Initial Determination

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