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Wisconsin Chronic Disease Program and Estate Recovery

Wisconsin Chronic Disease Program and Estate Recovery. Matt Fanale and Jennifer Wickey Wisconsin Department of Health Services Division of Health Care Access and Accountability August 12, 2014. Wisconsin Department of Health Services. Agenda. Overview of WCDP How to apply for WCDP

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Wisconsin Chronic Disease Program and Estate Recovery

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  1. Wisconsin Chronic Disease Program and Estate Recovery Matt Fanale and Jennifer Wickey Wisconsin Department of Health Services Division of Health Care Access and Accountability August 12, 2014 Wisconsin Department of Health Services

  2. Agenda • Overview of WCDP • How to apply for WCDP • How to become a WCDP Provider • Overview of Estate Recovery Program • What governs the changes to the Estate Recovery Program • What are the changes to the Estate Recovery Program • Questions Protecting and promoting the health and safety of the people of Wisconsin

  3. What is the Wisconsin Chronic Disease Program? • WCDP is an all state tax dollar program helping pay for services for citizens with Chronic Renal Disease, Adult Cystic Fibrosis, and Hemophilia. It is a part of ForwardHealth. • WCDP is the payer of last resort over other insurance sources. Protecting and promoting the health and safety of the people of Wisconsin

  4. Who qualifiesfor WCDP? • Eligibility is based on Wisconsin residency and diagnosis of Chronic Kidney Disease, Adult Cystic Fibrosis, or Hemophilia. • You cannot be denied based on income. • Co-insurance and deductibles are based on income and family size. Protecting and promoting the health and safety of the people of Wisconsin

  5. What is covered? • Renal • Inpatient and outpatient dialysis and transplant services. • One pre-transplant dental exam. • Certain prescriptions, supplies, lab, and x-ray services. • Transplants are notcovered. Protecting and promoting the health and safety of the people of Wisconsin

  6. Renal program requirements • You must apply throughWisconsin Medicaid/BadgerCare. • To be enrolled in theWCDP renal program you must be enrolled in Medicare Parts B and D. Protecting and promoting the health and safety of the people of Wisconsin

  7. How to apply? • Applications are available on the ForwardHealth website under the Related Programs and Services section, or by calling 1-800-362-3002. • If you are not already onMedicaid, BadgerCare, or SeniorCare you canwork with your social worker to fill out the application and forms. Protecting and promoting the health and safety of the people of Wisconsin

  8. What is needed for program consideration? • The completed application, with all forms for each program, including: • Information on other insurance. • Financial information for the previous year. Protecting and promoting the health and safety of the people of Wisconsin

  9. How to determine is the application has been approved? • If the member is not already in BadgerCare they will receive a new ForwardHealth card. • If a member isn’t sure if they’re on the program they can call Member Services at 1-800-362-3002 to verify enrollment. Protecting and promoting the health and safety of the people of Wisconsin

  10. How long can an applicant stay on WCDP? • As long as you still qualify. • Reasons for Ineligibility • Move out of Wisconsin. • Failure to complete annual membership recertification. • No longer have the disease. Protecting and promoting the health and safety of the people of Wisconsin

  11. How to become a WCDP provider • Any provider that wishes to have provide WCDP services must call 1-800-947-9627 and request a certification packet. Questions regarding members or claims can be directed to this same number. • This is a separate certification from BadgerCare. Protecting and promoting the health and safety of the people of Wisconsin

  12. How Does WCDP Decide What Pharmacy is Allowed? • Any manufacturer wishing to supply pharmacy to WCDP members must sign a Manufacturer’s Rebate Agreement. This agreement is different from the BadgerCare rebate agreements. • WCDP only adds manufacturers with products relevant to the program. Protecting and promoting the health and safety of the people of Wisconsin

  13. Questions on WCDP Matt Fanale Medicaid Program and Policy Analyst 1-608-266-7415 Matthew.Fanale@dhs.wisconsin.gov Protecting and promoting the health and safety of the people of Wisconsin

  14. What is Estate Recovery The Wisconsin Medicaid Estate Recovery Program seeks repayment for the cost of certain long-term care services paid for by Medicaid and BadgerCare Plus on behalf of members and all services received by the Wisconsin Chronic Disease Program (WCDP) members. Protecting and promoting the health and safety of the people of Wisconsin

  15. How does the Department recover benefits? • Certain non-probate assets; • The estates of members; and • Liens placed on their homes. The funds recovered are returned to the Wisconsin Medicaid program, where they benefit other members. Protecting and promoting the health and safety of the people of Wisconsin

  16. Estate Recovery Authority • Authorized by Social Security Act, Title XIX, Sec. 1917 • Authorized by Wis. Stat §.49.496, 49.682 and 49.849 Protecting and promoting the health and safety of the people of Wisconsin

  17. How and when will a claim be paid? • The Department’sclaim should be paid by the attorney/personal representative of the estate in accordance with §859.25, Wis. Stats. • Higher priority claims paid before the Department are: • The cost of administering the estate. • The reasonable funeral and burial costs. • Costs of the last illness that were not paid by Medicaid (should not be any except in unusual circumstances). Protecting and promoting the health and safety of the people of Wisconsin

  18. When will the Department’s claim not be paid or delayed? • The Department’sclaim will not be paid from cash assets if there are any of the following: • A surviving spouse; • A disabled or blind child of any age; or • A child under age 21 • If there is a surviving spouse, disabled, blind or minor child, and there is ownership interest in a home in the estate, then the Department will impose a lien on the home. This lien will not be enforced while any of the above are living. Protecting and promoting the health and safety of the people of Wisconsin

  19. What if the estate is unable to repay Medicaid? • The legal process known as probate settles an individual’s solely owned property by distributing the estate to creditors, heirs, and beneficiaries. • Creditors file claims in estates to ensure payment of a debt owed them. • The Department is paid before most other creditors. Both the Department and other creditors are paid before any assets are distributed to heirs or beneficiaries whether or not there is a will. • Recovery will also be made from the member’s non-probate assets, including joint property interests, marital property interests, life estates, revocable trusts, real estate by transfer on death deed, and the proceeds of life insurance policies and annuities. • If there are insufficient assets in the estate to pay the Department’s claim, the Department is paid what is available and the recovery is ended. Protecting and promoting the health and safety of the people of Wisconsin

  20. Exemptions to Recovery (Hardships) • There are standards (DHS 108.02(12), Wis. Admin. Code) for determining whether the Department’srecovery would result in an undue hardship for an heir, beneficiary or co-owner. • An heir, beneficiary or co-owner may apply for a waiver of the Department’sclaim on their portion of the estate or property for one of the following reasons: • The heir, beneficiary, or co-owner would become or remain eligible for Supplemental Security Income (SSI), FoodShare program, Temporary Assistance for Needy Families (TANF), or Medicaid, if the state pursued its claim. • The deceased’s estate or property contains real estate used as part of the heir, beneficiary’s or co-owner’s business, which may be, but is not limited to, a working farm, and recovery by the Department would affect the property and would result in the heir or beneficiary losing his or her means of a livelihood. • The heir, beneficiary, or co-owner is receiving general relief or veterans benefits based on need under §. 45.40 (1m), Wis. Stats. Protecting and promoting the health and safety of the people of Wisconsin

  21. Hardships Cont. • The person handling the estate will be notified of these rights and how to apply for a hardship when the estate is being probated through a court or through an affidavit process. • That individual is responsible for notifying the heirs, beneficiaries, or co-owners of these rights. An heir, beneficiary or co-owner can apply to the Department for a waiver of the recovery of his or her portion of the estate or property. Protecting and promoting the health and safety of the people of Wisconsin

  22. Why the changes? • In the 2013-15 State Budget, also referred to as Act 20, made changes to the Estate Recovery Program to ensure the long-term financial sustainability of the Medicaid program. Under Act 20, the Department was given the necessary tools to collect the health care costs that were funded by taxpayers from the estates of former Medicaid beneficiaries. • In September 2013, the Wisconsin Legislature’s Joint Committee on Finance approved the implementation of most of the changes. • On December 14, 2013, Wisconsin Act 92 modified the Estate Recovery Program provisions included in Act 20 to codify the action taken by the Joint Committee on Finance. Protecting and promoting the health and safety of the people of Wisconsin

  23. Changes based on Act 20 • Recovery from life estates • Recovery from joint property • Recovery from non-probate property • Recovery from TEFRA liens • Recovery from the estate of surviving spouses • Recovery from revocable trusts (living trusts) • Recovery from life insurance policies Protecting and promoting the health and safety of the people of Wisconsin

  24. Members affected by these changes • Medicaid members of any age who live in nursing homes. • Medicaid members of any age living in an inpatient hospital and are required to contribute to their cost of care. • Medicaid members age 55 or older may have the cost recovered for only certain benefits received while they live in the community. • Medicaid members age 55 or older who reside in the community and receive services through a home and community-based waiver program, or through the Program of All-Inclusive Care for the Elderly (PACE). Protecting and promoting the health and safety of the people of Wisconsin

  25. Affected members (cont.) • Wisconsin Chronic Disease Program (WCDP) participants of any age for services that were provided on or after September 1, 1995. • Community Options Program (COP) participants who are age 55 or older for services that were provided on or after January 1, 1996, and • Non-Medicaid Family Care services provided on or after February 1, 2000, as reported to the Department for enrollees age 55 or older and living in the community; or that are any age and who live in an inpatient hospital and are required to contribute to their cost of care; or who live in a nursing home. Protecting and promoting the health and safety of the people of Wisconsin

  26. Notification to those affected • Medicaid and WCDP members, and members who were considered institutionalized were mailed a letter in late June informing them of the changes effective August 1, 2014. • The letter is available on the Estate Recovery Program website at dhs.wisconsin.gov/medicaid/erp • New members will be made aware of the program rules when they enroll in Medicaid and reach the age of 55 or become institutionalized members and will receive the Estate Recovery Program handbook. Protecting and promoting the health and safety of the people of Wisconsin

  27. What is a life estate? • A life estate is created when a property holder transfers ownership of the property to someone else (remainderer) and retains the right to reside in, and benefit from the real estate, such as receiving rent. • The life tenant’s percentage interest is determined using the life expectancy tables at the time the life estate is created. • The rest of the interest is owned by the remainderer (for example a child or children). • When the life tenant dies, the entire property interest passes to the remainderer. Protecting and promoting the health and safety of the people of Wisconsin

  28. Life Estate • Prior to August 1, 2014 • Estate Recovery did not pursue recovery from life estates. • Effective August 1, 2014 • The Department will recover only the life tenant’s interest remaining at the time of death of life estates created on or after August 1, 2014. Protecting and promoting the health and safety of the people of Wisconsin

  29. What are joint property deeds? • Joint tenancy • Under joint tenancy, if two people take title of the property as joint tenants on a deed, each person has a 100 percent ownership of that piece of property. • Regardless of the number of joint tenants on a deed, each tenant has equal ownership rights and interest. • When one joint tenant dies, the surviving tenants automatically own the property. • Joint tenancy automatically gives each tenant a “right of survivorship” where the surviving tenants receive 100% of the property. • When only one joint tenant is left alive, he or she receives the entire estate and the joint tenancy is dissolved. Protecting and promoting the health and safety of the people of Wisconsin

  30. Joint property deeds cont. • Tenancy in common • Tenancy in common provides for multiple percentages of ownership interest and inheritance rights for the heirs of each tenant. • Unlike joint tenancy, tenancy in common grants no “right of survivorship.” Thus, no other tenant in common is entitled to receive a share of the property upon a tenant in common’s death; instead, the property becomes part of the deceased’s estate. Protecting and promoting the health and safety of the people of Wisconsin

  31. Joint Property Deeds • Prior to August 1, 2014 • Only joint accounts at financial institutions were recovered. • Effective August 1, 2014 • All joint property and joint property deeds created on or after August 1, 2014 will be subject to recovery. Protecting and promoting the health and safety of the people of Wisconsin

  32. Non-probate property • Property that is held in joint tenancy or as tenants by the entirety. • Bank or brokerage accounts held in joint tenancy or with payable on death (POD) or transfer on death (TOD) beneficiaries. • Property held in a trust. Protecting and promoting the health and safety of the people of Wisconsin

  33. Non-probate property • Prior to August 1, 2014 • Only POD accounts at a financial institution were recovered. • Effective August 1, 2014 • Recovery will be made from all non-probate assets for any member who passes away on or after August 1, 2014. Protecting and promoting the health and safety of the people of Wisconsin

  34. TEFRA Liens • Estate recovery uses two types of liens: • TEFRA Liens • Must follow rules set out in the federal Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982; • Pre-death liens are imposed on the homes of living Medicaid recipients determined to be permanently institutionalized and not likely to return home to live. • Post-death liens which are often part of the probate process. Protecting and promoting the health and safety of the people of Wisconsin

  35. TEFRA Liens • Prior to August 1, 2014 • Estate Recovery did not pursue TEFRA liens on life estates. • Effective August 1, 2014 • Estate Recovery will now pursue recovery through TEFRA liens placed on life estates created on or after August 1, 2014. Protecting and promoting the health and safety of the people of Wisconsin

  36. Surviving Spouse’s Estate (Marital Property) Property acquired by either spouse during the course of a marriage is considered marital property. Protecting and promoting the health and safety of the people of Wisconsin

  37. Surviving Spouse’s Estate • Prior to August 1, 2014 • Recovery has not been sought from a surviving spouse’s estatesince 1995. • Effective August 1, 2014 • Consistent with Wis. Stat. § 766.31, recovery will now be pursued from 50% of the surviving spouse’s estate. Protecting and promoting the health and safety of the people of Wisconsin

  38. Revocable Trusts (living trusts) A revocable trust is a trust created by an individual who wants the ability to change the terms of their trust. Assets in the trust are considered the individual’s personal assets for Medicaid planning purposes. Protecting and promoting the health and safety of the people of Wisconsin

  39. Revocable Trusts (living trusts) • Prior to August 1, 2014 • The authority for Estate Recovery to recover from revocable trusts ( “living trusts”) was unclear. • Effective August 1, 2014 • Since Act 92 specifically granted this authority, Estate Recovery will now pursue recovery from only those revocable trusts created on or after August 1, 2014. • Recovery cannot be made from irrevocable trusts, with the exception of those assigned to a funeral home, SNT, and pooled trusts. Protecting and promoting the health and safety of the people of Wisconsin

  40. Life Insurance • Prior to August 1, 2014 • Recovery was made only from policies designating the estate as the beneficiary or if the beneficiary pre-deceased the insured. • Effective August 1, 2014 • Recovery will be made from all life insurance policies created on or after August 1, 2014, regardless of the beneficiary. Protecting and promoting the health and safety of the people of Wisconsin

  41. Questions on Estate Recovery Wisconsin Estate Recovery Program 1-608-264-6755 or 1-608-264-7739 Jennifer Wickey Estate Recovery Section Chief Jennifer.Wickey@wisconsin.gov 1-608-261-7831 Protecting and promoting the health and safety of the people of Wisconsin

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