What is Medicaid Extended Coverage (MEC)?
Medicaid that is available to a qualified Partnership policyholder (QPP) who has met the minimum duration requirement under his/her policy is called Medicaid Extended Coverage (MEC). The Total Asset Protection Plans allow for the disregard of all of the QPP's resources (assets) in determining eligibility for MEC. The Dollar-for-Dollar Asset Protection Plans allow for the disregard of the QPP's resources (assets) under MEC up to the total amount of benefits paid out by the participating insurer on behalf of the QPP. For both plans, income and the cost of care are considered in determining Medicaid eligibility.
The goal of the Partnership program is financial independence for consumers through shared responsibility. This means New York State will share with participating consumers in planning for their long-term care expenses. If an individual/couple purchases a Partnership insurance policy and keeps it in effect, the State will protect them, if otherwise eligible, against the costs of extended care situations through the Medicaid program.
Notice of Eligibility: The 90-day Notice Letter
At least 90 days prior to meeting the durational requirement for receiving Medicaid Extended Coverage, the participating insurance company is required to notify a Partnership policyholder via a 90-day notice letter. This notice shall inform the policyholder of their eligibility to apply for Medicaid Extended Coverage. The letter should also identify the approximate date of satisfying the durational requirement for Medicaid Extended Coverage. Lastly, the letter should also offer an approximate number of benefit days available before the policy benefits are exhausted. For example, an individual who purchased a Total Asset “3/6/50” policy will need to exhaust 3 years of nursing home coverage (i.e., 36 months of nursing home coverage or its equivalent) before they are eligible to receive Medicaid Extended Coverage.
The table below shows 2023 Medicaid resource and income allowances. The resource allowances do not apply to the Total Asset Protection Plan QPP. In the case of the Dollar-for-Dollar Asset Protection Plan QPP, the resource allowances in the table would be in addition to the dollar amount paid by the Partnership policy on behalf of the QPP.
|Resource Allowance||Income Allowance (monthly)|
|Community spouse||$148,620 (maximum)||$3,715.50|
|Home care (community-based long-term care services)|
Increased to $1,857.75 for QPP's
|Applicant with spouse||$40,821||$2,268
Increased to $3,715.50 for QPP's
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