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Changes to the Partnership for Long Term Care (PLTC) Insurance Program

This year brings some of the most sweeping improvements to the PLTC. These changes are designed to modernize the program.

The four major changes to the program are as follows:

A new plan option will be available offering a Total Asset Protection Plan with two years of nursing home coverage; four years of home care or residential care (at half the nursing home rate). A Medicaid State Plan Amendment to include this option has already been approved by CMS. This offering (2-4-50) will be available upon final publication of a new Regulation #144 by the Department of Financial Services. These regulations are now in a 45 day comment period and a final rule is expected by June 1, 2012.

The second change is the decision by NYS to participate in Reciprocity as offered in the Federal Deficit Reduction Act of 2005. This change will allow New Yorkers who relocate to one of the forty other participating states to take advantage of both asset protection and Medicaid Extended Coverage in those states at a dollar-for-dollar level based on the amount of LTC insurance paid on their behalf. This provision will also allow PLTC participants from the other forty states who relocate to New York to achieve the same benefit. A Medicaid State Plan Amendment to include this option has already been approved by CMS. Reciprocity will be available upon final publication of a new Regulation #144 by the Department of Financial Services. As noted above, a final rule is expected by June 1, 2012. A new disclosure statement explaining Reciprocity in detail will be attached to any new PLTC policy.

The third change relates to required inflation protections. Every PLTC policy sold must cover a minimum daily benefit amount, and this amount is increased annually by an inflation factor. Historically, this factor has been 5%, but research shows that a more accurate amount would be 3.5%. This new level will now be available, subject to the choice of the policyholder, upon final publication of a new Regulation #144 by the Department of Financial Services. As noted above, a final rule is expected by June 1, 2012.

The final change relates to the way insurance agents are trained and certified to sell PLTC policies. In the past, DOH staff has traveled around the state and agents have spent valuable time sitting in classrooms to receive this training. DOH has opened an all on-line training and certification program.

These changes are designed to make the PLTC policies more attractive as a benefit to policyholders and a savings to the Medicaid Program. This program is one of the "win-win" activities that result when public-private partnerships are carefully planned and implemented for the benefit of all.