Initial Determination Activity

Read the scenario on the handout LTCP Process – Initial Determination Activity (PDF).

Using your handouts, answer the questions. Return to this page to check your answers.

Question 1.

Send Catherine the DHS-3271 (MHCP Request for Information) requesting Catherine to complete, sign and return the DHS-5426A and provide a copy of the insurance policy or certificate of coverage.

Question 2.

Catherine has 10 working days to return the DHS-5426A and the copy of the insurance policy or certificate of coverage.

Question 3.

No, you cannot determine MA-LTC eligibility for Catherine because she currently has excess assets. Both the cabin property and the savings account are counted assets and the $192,600 total value of these is well in excess of her $3,000 asset limit.

Question 4.

If Catherine does not return the DHS-5426A and/or the copy of the insurance policy or certificate of coverage, deny MA-LTC eligibility at the end of the processing period, because Catherine is over assets. Do allow Catherine an opportunity to reduce assets following MA policy requirements.

Question 5.

Enter Catherine’s LTC insurance policy information into the TPL Subsystem when Catherine is approved eligible for MA. She will either have to reduce assets following MA policy requirements or wait until it is determined whether she can protect assets.

Question 6.

Include the following when you submit a HealthQuest submission:

Title the submission “LTCP.”

A statement asking to have the policy reviewed for the LTCP.

Catherine requested MA-LTC for September 8.

Her eligibility is pending because she has excess assets.

No retroactive coverage was requested.

Question 7.

Provide the insurance policy or certificate of coverage and the signed DHS-5426A to HealthQuest.

Page 7

LTCP Processes - LTCP Initial Determination

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