RHODE ISLAND

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Senate approves Long-Term Care Insurance Partnership

May, 2007 STATE HOUSE – Legislation approved by the Rhode Island Senate will establish a new Long-Term Care Insurance Partnership in Rhode Island, offering more peace of mind and more consumer protections for individuals who may need long-term health care services.

Under current laws, Rhode Islanders who have more money than the state permits when they need long-term health care services are disqualified from having Medicaid pay for those services. To get the care they need, Rhode Islanders must first spend their own money, even if it means using up any assets (a home, etc.) they may have. In effect, Rhode Islanders must pay out of their own pocket until they are poor enough to qualify for Medicaid.

The bill approved by the Senate (2007 – S0638A), sponsored by Sen. William A. Walaska (D-Dist. 30, Warwick), addresses that issue by creating the kind of insurance program already in place in California, Connecticut, Indiana and New York.

“Establishing this program means you can qualify for Medicaid without having to spend yourself into poverty,” said Senator Walaska. “Through this program, which is functioning quite well already in several other states, you can apply for Medicaid benefits even though you haven’t sold and used your assets.”

Under the program proposed by the Walaska bill, which incorporates much of the model legislation recommended by the National Association of Insurance Commissioners, a Rhode Island consumer would be allowed to buy a long-term care insurance policy, live in the state while receiving long-term care services and receive and exhaust the benefits under the program for long-term care services. Once those private policy benefits are exhausted, the policy holder will become eligible for the state government-administered Medicaid.

“The benefit of this program is that you can eventually qualify for Medicaid without using up all your assets,” said Senator Walaska. “It is true an individual who participates in this new program and purchases a private long-term care policy may have to use part of his or her income to cover some health care costs, but that same person will not have to drain the savings account or, possibly, be forced to sell a home to afford the proper care.”

“Each dollar paid by the insurance company is a dollar of personal assets that can be saved,” he said.

The Walaska legislation incorporates many of the consumer protections contained in the model law as well as in the federal HIPAA (Health Insurance Portability and Accountability Act). It sets restrictions on the requirement for institutionalization prior to receipt of benefits; it sets standards for premium refunds, rescinding policies and claims denials; it sets requirements for a premium non-payment grace-period for a policyholder who is cognitively or functionally impaired, and it establishes long-term care insurance issue training requirements for brokers and producers.

SOURCE:  Rhode Island Division of Insurance Regulation

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