Washington Elder Law Practice Report (#10) / Washington exchange enrolls about 250,000 by end of 2013

January 22, 2014

Washington State LawThis is installment #10 in a continuing series of Washington Elder Law Practice Reports.

The Washington State Health Exchange is beginning to have a major impact on Elder Law practices.

As of the end of 2013, the Exchange (at www.wahealthplanfinder.org) had enrolled almost 250,000 individuals.

Of this total, about 71,000 enrolled in private health plans and about 177,000 in the Medicaid program (now called Washington Apple Health).

Of the total Medicaid increase, about 121,000 enrolled under the new “adult” category, while about 56,000 were previously eligible for Medicaid but not enrolled.

As noted by the Health Care Authority (HCA), individuals with previous Medicaid coverage are now being “converted, redetermined, or renewed under the new modified adjusted gross income (MAGI) standard and…are not considered ‘new to

Medicaid’”. Those without previous eligibility are being evaluated under the new MAGI standard.

It is important to note that individuals who require long-term care (LTC) assistance may no longer use the “Application for Benefits” form that has been in place for decades.

Rather, applications and renewals for LTC are to be based on completing the general “Application for Health Care Coverage” that is used for all Exchange applications (based on MAGI eligibility), then adding on the new “Washington Apple Health Supplemental Form” that requires much more financial information for LTC coverage.

The supplemental form requires detailed information about all sources of income and all resources, as well as information about any transfers of resources during the previous five years.

Forms may be completed online or mailed to the Department of Social and Health Services (DSHS). The general DSHS rules for LTC eligibility have remained unchanged, so far.

The State is still authorized to seek recovery from estates after the death of both spouses, for individuals age 55 or older who receive Medicaid services.

Recovery may also be sought from all estates for individuals who receive services that are fully funded by the State.

Washington attorneys thus have to adopt new procedures to help clients apply for LTC assistance, while generally making use of established regulations and directives.

The mechanisms now in place for LTC applications are quite different from those of the past, and are linked more strongly to the broader Medicaid program.

There are many ways in which the new DSHS forms may be interpreted, and in how the required information may be provided. Legal practice expectations built up over a period of many years may now have to be evaluated and revised, placing more demands on attorney time.

It will often be difficult to provide needed and appropriate information that fits into the design of the forms now in use. It may not be feasible to consider online submissions, since extensive attachments and explanations are often required.

In general, all LTC financial information must be backed up by attached copies of documentation such as account statements, contracts, and policies. A typical LTC application often includes a thick stack of attachments, and requires some flexibility in completing the basic forms.

It is yet to be seen whether the new procedures will slow down or speed up the application process, and whether attorneys will find the new procedures to require less or more time.

Elder law practice in Washington is discussed by Cheryl and Ferd Mitchell in volumes 26 and 26A of Washington Practice (Washington Elder Law and Practice and the associated Elder Law Handbook). Probate practice is covered in volume 26B.