Thank you for choosing to meet with us today. We look forward to serving your

Thank youThank you

for choosing to meet with us today. for choosing to meet with us today.

We look forward to serving yourWe look forward to serving yourlong term care planning needs.long term care planning needs.

A Long Term Care Planning Firm

ServicesServices Education & Planning Education & PlanningYou indicated an interest in . . .You indicated an interest in . . .

Arizona Long Term Care System Medicare Cost-Sharing and acute care

AHCCCS Veterans Administration Legal document preparation Non-government benefit financial

planning Mortgage Debt Reduction Planning


3 Phases for today’s appointment3 Phases for today’s appointment

PHASE ONEEducation

PHASE THREESummary

&Options

PHASE TWOInterview

&Questionnaire


ALTCSALTCS

AHCCCSAHCCCS

ARIZONA’S VERSION OF ARIZONA’S VERSION OF MEDICAIDMEDICAID

AHCCCS ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

Programs for elderly, physically disabled,

children, pregnant women, and indigent families.

Programs administered through the AHCCCS

Administration and the Department of Economic

Security.


ALTCSARIZONALONGTERMCARESYSTEM

Program helps pay for long term care and acute care expenses for the

Elderly

Physically Disabled

Blind

Developmentally Disabled


ALTCSALTCSELIGIBILITY CRITERIAELIGIBILITY CRITERIA

NON-FINANCIAL

MEDICAL

FINANCIAL


AHCCCS/ALTCS AHCCCS/ALTCS Non-Financial Eligibility ChecklistNon-Financial Eligibility Checklist

Can the applicant be “linked” to the program through age or

disability?

Can the applicant verify his/her Social Security Number?

Can the applicant prove US Citizenship or a qualified alien status?

Can the applicant prove identity?

Does the applicant live in and intend to remain in Arizona?

If married, can the applicant verify marriage?

Is the applicant residing in an ALTCS-approvable setting?

Is the applicant potentially eligible for other benefits?

Does the applicant have third-party liability?

For ALTCS only—Is the applicant at risk of institutionalization? A Long Term Care Planning Firm

AHCCCS/ALTCS AHCCCS/ALTCS Medical Eligibility ChecklistMedical Eligibility Checklist

Requires nursing care by or under the supervision of a nurse on a daily basis;

Requires regular medical

monitoring;

Impaired cognitive functioning;

Impaired self care with activities of daily living;

Impaired continence;

Psychosocial deficits.


ALTCSALTCS

FinancialEligibility

INCOMELIMIT

RESOURCELIMIT

UNCOMPENSATEDTRANSFERS


ALTCS METHODALTCS METHODOF SERVICE DELIVERYOF SERVICE DELIVERY

Assigns Case ManagerProgram contractor works with Contracted Providers•NURSING FACILITIES (semi-private)•ADULT CARE HOMES (semi-private)•ASSISTED LIVING CENTERS (semi-private)•ADULT FOSTER CARE HOMES•HOME & COMMUNITY-BASED SERVICES

•Adult day care, Personal Care, •Attendant Care, Respite,•Home-delivered meals,•Home health aid & nursing,•Homemaker, Companion,•Behavioral health,•Home infusion

•DOCTORS•HOSPITALS

PROGRAM CONTRACTOR1. Mercy Care Plan or2. SCAN Long Term Care or 3. Bridgeway

ALTCS

AHCCCS


COST TO ALTCS MEMBERCOST TO ALTCS MEMBERGross Income minus the

allowable deductions:

personal needs allowance spousal allowance health insurance premiums

equal the

Share of Cost (SOC) or

Room & Board (R&B) paymentA Long Term Care Planning Firm

Medicare Medicare Cost-SharingCost-Sharing

AHCCCSAHCCCS

Qualified Medicare Beneficiary & Qualified Medicare Beneficiary & ACUTE CARE AHCCCSACUTE CARE AHCCCS

• The QMB program provides medical assistance including payment of a member’s Medicare Part B premium, annual deductibles, and co-insurance, up to and including acute care medical services. Members may qualify for this program if they meet non-financial guidelines, have Medicare Part A, and meet the income guidelines.

If total gross monthly income < $867.00, a single applicant is potentially eligible.

If total gross monthly income < $1167.00, a married couple is potentially eligible.


Specified Low-Income Specified Low-Income Medicare BeneficiaryMedicare Beneficiary

The SLMB program provides medical assistance by paying for a member’s Medicare Part B premium. Members may qualify for this program if they meet non-financial guidelines, have Medicare Part A, and meet the income guidelines.

If total gross monthly income $867.01--$1040.00, a single applicant is potentially eligible.

If total gross monthly income $1167.01--$1400.00, a married couple is potentially eligible.


Qualified Individual-1Qualified Individual-1 The QI-1 program

provides medical assistance by paying for a member’s Medicare Part B premium. Members may qualify for this program if they meet non-financial guidelines, have Medicare Part A, and meet income guidelines.

If total gross monthly income $1040.01--$1170.00, a single applicant is potentially eligible.

If total gross monthly income $1400.01—$1575.00, a married couple is potentially eligible.


AHCCCS & MCS AHCCCS & MCS RESOURCE ELIGIBILITYRESOURCE ELIGIBILITY

There are no resource (asset) guidelines for the acute AHCCCS*, QMB, SLMB, and QI-1 programs.


If not a Veteran or a widow of a If not a Veteran or a widow of a Veteran who served during Veteran who served during wartime, please skip next section.wartime, please skip next section.

Benefits through the Benefits through the Veterans AdministrationVeterans Administration

VETERANS ADMINISTRATIONVETERANS ADMINISTRATIONPOTENTIAL BENEFITSPOTENTIAL BENEFITS

If you are a Veteran or widow of a Veteran who served at least 90 days active duty with at least one day served during a war-time period, and you were discharged other than dishonorably;

AND . . .

If your assets (not necessarily including your home and automobile), are just enough to cover 12 months of expenses or less;

AND . . .

If your income each year is less than the threshold set by the Veterans Administration.

NOTE: The actual cost of unreimbursed medical care minus 5% of the MAPR can be used to offset your annual income. Medical care may include, but is not limited to monthly charges by assisted living or nursing facilities, adult care home, costs of doctor’s appointments and non-reimbursed prescription amounts, medical supplies, eye glasses, hearing aids, travel to medical appointments, etc.);

THEN . . . You may be eligible for a cash benefit from the Department of Veterans

Affairs (VA).

THOSE THAT . . .

Have a medical diagnosis by a doctor (yours and/or the VA doctor) that states that you cannot live independently and need regular assistance and care, MAY QUALIFY FOR MORE CASH!!!


VETERANS ADMINISTRATIONVETERANS ADMINISTRATIONPOTENTIAL BENEFITSPOTENTIAL BENEFITS

VA Compensation can pay the Veteran a monthly compensation if the Veteran is at least 10% disabled as a result of military service.

VA Pension can pay the Veteran a monthly pension if the Veteran served at least one day within a war-time period, has limited income, as is permanently & totally disabled OR at least 65 years old.

VA Dependency and Indemnity Compensation (DIC) can be paid to eligible survivors of service members who died on active duty, Veterans who died from service-related disabilities, and Veterans who were being paid 100% VA Disability when they passed away.

Death Pension can be paid to a surviving spouse and dependent children when the death of the war-time Veteran was not service-connected. This type of benefit is based on need.

Aid and Attendance and Housebound assistance are additional funding that can be obtained when a Veteran or widow of a Veteran requires the assistance of another person with some of their activities of daily living (ADLs) and cannot live independently OR if the Veteran or widow of the Veteran is blind. ADLs include bathing, dressing, grooming, toileting, mobility, transferring, meals, transportation, housekeeping, etc. These benefits are also needs-based; however, VA does reduce the income by the medical expenses incurred by the Veteran or widow.


VA EXCLUDED*

ASSETS

VA COUNTABLE

ASSETS

SINGLE FAMILY UNIT DWELLING

Cash

Financial Accounts

Annuities

Investments

Property

Other vehicles

Anything else of value,

not excluded

AUTO

TERM LIFE INSURANCE

BURIAL PLANS/CREMATION PLANS

BURIAL PLOT & RELATED ITEMS

HOUSEHOLD GOODS/PERSONAL EFFECTS



ESTIMATED VA CASE NET WORTH

Net worth of Countable Assets

(CMV less encumbrances)=$

Minus 12 month’s cost of living -

Remaining net worth= $

Those with a remaining net worth at or below $0.00 have a greater chance of proving need for VA pension.


ESTIMATED VA INCOME ELIGIBILITY

Gross yearly income (use both spouses income if married)= $

Minus the total yearly unreimbursed medical expenses -

Plus 5% of the maximum* rate of pension +

Sum of Income for VA purposes (remaining total)= $

Minus the maximum* rate of pension for this case -

Remaining total after last subtraction= $If remaining total is a negative number, divide it by twelve (12). If remaining total is not a negative number, you are not eligible for benefits at this time.

The quotient equals the monthly pension estimate. $For year 2009 the numbers are as follow:

MAPR Category Yearly income MAPR Category Yearly income

Veteran only 11,830 Widow only 7,933

Veteran + 1 dependent 15,493 Widow + 1 dependent 10,385

Housebound Vet only 14,457 Housebound Widow only 9,696

Housebound Vet + 1 dependent 18,120Housebound Widow + 1 dependent

12,144

Vet only A&A 19,736 Widow only A&A 12,681

Vet + 1 dependent A&A 23,396 Widow + 1 dependent A&A 15,128

Two Vets married to each other 15,493

For each addt’l child, add 2,020

Legal Document Legal Document PreparationPreparation

Getting Your Getting Your Paperwork in OrderPaperwork in Order

Legal Document PreparationLegal Document Preparation

DID YOU KNOW . . .

One out of every two Americans will suffer a period of prolonged disability in his or her lifetime.

There is a need for pre-crisis planning and for getting your legal documents signed and in place.

The alternative if you do not have your legal documents completed will be for your family to ask the court to appoint a guardian and/or conservator for you. Such procedures may be cumbersome, time-consuming and expensive.


Legal Document PreparationLegal Document Preparation

Carol Aragon-Montgomery is a certified legal document preparer and can prepare the following legal documents for you and your loved ones:

Durable Financial Power of Attorney Durable Medical Power of Attorney Mental Health Care Power of Attorney Living Will (Advanced Directives) Deeds Income-only Trust (applicable for ALTCS only) Estate Planning Portfolio (Living Trust, Wills,

Powers of Attorney, Directions letters, Duties, etc.)


Having your paperwork in order Having your paperwork in order

FINANCIAL POWER OF ATTORNEY A document that allows you to appoint someone to

handle your financial affairs Choose someone you trust Durable means that the document continues to be

legally valid even if you become incapable or unable to

handle your finances You can make this document effective immediately or

only upon your incapacitation You may want to name one or two back-up agents in

case first person not available or unable to act as your

agent Must be witnessed by someone not related to you and

notarizedA Long Term Care Planning Firm

MEDICAL POWER OF ATTORNEY

A document that allows you to appoint someone to handle

your medical care and health care decisions IF you

become incompetent or incapacitated Choose someone you trust to honor your personal wishes

with regard to your health care and health care treatments Only valid when you are incompetent or incapacitated and

unable to express your health care wishes You may want to name one or two back-up agents in case

first person not available or unable to act as your agent Must be either witnessed by two people not related to you

OR notarized



Durable Mental Health Care Power of Attorney

A document that allows you to appoint someone to handle your mental health care decisions and admit you into a psychiatric treatment facility IF you become incompetent or incapacitated

Choose someone you trust to honor your personal wishes with regard to your mental health care and mental health care treatments

Only valid when you are incompetent or incapacitated and unable to express your mental health care wishes

You may want to name one or two back-up agents in case first person not available or unable to act as your agent

Must be either witnessed by two people not related to you OR notarized



Living Will A document that allows you to express, in writing, which medical

treatments you want or don’t want at the end of your life A document that tells your family and loved ones what YOU want

and how you want to be treated at the end of your life Must be either witnessed by two people not related to you OR

notarized

Pre-hospital Medical Care Directive(DO NOT RESUSCITATE)

A document that informs emergency medical personnel and hospital emergency personnel to NOT resuscitate you

You are asking emergency personnel to NOT use equipment, drugs, or devices to restart your heart or breathing

Must be on letter-sized orange colored paper or wallet-sized orange colored paper to be valid

Must attach a picture or complete personal information with physical description

Must be signed by you in front of a witness Must be signed by your witness and health care provider



Living Trust A trust is a written agreement that sets forth who will manage

the assets place in it during your lifetime, in the event of your

incapacity, and upon your death.

Avoids the cost and delays of probate. Upon your death (and

your spouse, if married), your Successor Trustee can distribute

the assets almost immediately and with little or no additional

expense (other than typical costs such as real estate

commissions, etc.) Court supervision is not required.

Avoids conservatorship if you become incapacitated.

Keeps your estate affairs private. A Will that goes through

probate makes all aspects of your estate a matter of public

record.A Long Term Care Planning Firm


Having your paperwork NOT Having your paperwork NOT in order . . .in order . . .

Costly—in cases involving attorneys, these costs can range from $2000 on up

Guardianship Done through the court system Court decides if you can be guardian

Conservatorship Done through the court system Must have a bond Court must approve expenditures


Reducing Your Reducing Your Mortgage Pay-OffMortgage Pay-Off

Next:Next:

What would you spend your What would you spend your money on if you didn’t have a money on if you didn’t have a

mortgage payment?mortgage payment?

Take more vacations? Purchase investment

properties? Start your own

business? Retire?

Innovative program helps homeowners nationwide pay off their mortgages in a fraction of the time WITHOUT refinancing their existing mortgage and with little lifestyle changes.

Program uses innovative software with banking systems to reduce interest

With this program the only thing you have to lose is

your mortgage! Free analysis available.

PrincipalsPrincipalsGeorge L. Montgomery

Has worked in the long term care planning field since 1992 (retired AHCCCS/ALTCS employee, Montgomery & Associates principal)

Carol Aragon-Montgomery

Has worked in the long term care planning field since 1991 (at ALTCS, for largest elder law firm in valley, & founder of Montgomery & Associates)



SERVICESSERVICES Initial evaluation $90.00 an hour

ALTCS / AHCCCS / MCS Application Processes

Long Term Care Planning Consulting fee quote based on sliding fee schedule / Flat Rate

Financial Planning Services (insurance, investments, reverse mortgages, etc.)

Mortgage Debt Reduction Planning

Legal Document Preparation POAs—Financial, Medical, and Mental Health Living Will Deeds Income-only trust (for ALTCS only) Estate Planning Portfolio (Living Trust, etc.)



Questions?Questions?


Thank you for choosing to meet with us today. We look forward to serving your

Documents

Transcript of Thank you for choosing to meet with us today. We look forward to serving your