State Long Term Care Partnerhip Program


State Long-Term Care Partnership Program: State Reciprocity Standards


State Long-Term Care (LTC) Partnership Programs are joint Medicaid/private ventures designed to encourage individuals to purchase long-term care insurance saving both state, and federal dollars by substituting private insurance for Medicaid.The program allows for the application of special Medicaid eligibility rules for these individuals once private benefits have been exhausted and additional coverage is required. It began as a demonstration project in five states, but was expanded by the Deficit Reduction Act of 2005 (DRA) which contained provisions allowing states with an approved plan amendment (SPA) to participate. According to the Centers for Medicare and Medicaid Services (CMS), as of August 2008 18 states--California, Colorado, Connecticut, Florida, Idaho, Indiana, Missouri, Minnesota, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, and Virginia--have implemented State Long-term Care Partnership Programs and a number of states have programs in process. The DRA also required that reciprocity standards be developed allowing states with Partnership Programs to form reciprocal agreements. This would permit a participating state to employ the use of specific diregards when determining eligibility of applicants who purchased plans in other participating states. These standards were published in the Federal Register September 2, 2008.


Reciprocity Standards

States participating in a reciprocal agreements must agree to the following:

  1. Medicaid applicants who purchased a LTC policy in a state participating in the reciprocal agreement and who has received benefits under their private LTC policy will receive an asset disregard in an amount equal to the benefits received (dollar for dollar).
  2. The asset disregard procedure and calculations must be uniform among the states participating in the reciprocal agreement.
  3. Amounts equal to the benefits received under the LTC policy will be exempt from Medicaid estate recovery.
  4. If a person moves from the state in which his or her partnership policy was issued amd later applies for Medicaid in another state participating in the agreement where they are determined to be eligible for Medicaid using the asset disregard, the asset disregard may not be revoked upon eligibility redetermination if the state subsequently withdraws from the reciprocal agreement.

The reciprocity standards may only apply to the asset disregard, which will become effective January 1, 2009.  Individuals may only be considered for asset disregard eligibility if both the state in which they purchased their LTC policy and the state where they are applying for Medicaid are participating with the reciprocal standards.

State Participation Status

All qualified states participating in the program will be deemed as participating in the reciprocal agreement unless they elect to be exempt from the standards by notifying the Department of Health and Human Services in writing. States must provide notification of an election to remain exempt through a new SPA prior to the effective date of the standards. States who implemented programs prior to May 1993 may also adopt the reciprocity standards and participate in the agreement, but they must submit a new SPA in order to do so. States opting for an exempt status may choose to form agreements on a state-by-state basis outside the agreement. HHS will create a communication mechanism for informing states and the public regarding the participation status of each state.

CMS Summary of the LTC Partnership Program

Additional Information on LTC Partnership Programs in the States (the latest information available on the HHS Long-term Care National Clearinghouse)

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