07/15/2016

What You Need to Know about QITs To-Date

What You Need to Know about QITs To-Date

Ohio’s Disability Determination Redesign (1634 conversion) for Long-Term Services and Supports (LTSS):

• With the elimination of spend down, an individual (LTSS recipient) whose gross income is greater than $2,199 per month must create a Qualified Income Trust (QIT) or Miller Trust to stay or to become eligible for Medicaid LTSS.

• The individual must deposit at least the amount of their income that exceeds the $2,199 (called the special income limit or SIL) into the QIT account each month.

• A QIT is a legal entity.

• All recipients of LTSS services including SNF, HCBS waivers (PASSPORT, Assisted Living, MyCare Ohio, Ohio Home Care etc.) ICD/IID and Department of Developmental Disabilities waivers must meet the QIT requirements.

• The QIT requirement takes effect on August 1, 2016. All new (on or after August 1) Medicaid applicants will need a QIT immediately in order to be eligible for Medicaid LTSS. The establishment of the QIT and the depositing of income into the QIT “create” eligibility and cannot go back any earlier than the beginning of the month in which the QIT was established.  However,
  
  • Current, Medicaid-eligible recipients have until their next redetermination in 2017 to meet the requirement. These recipients will have full Medicaid until their next redetermination.
  • Pending Medicaid-eligible recipients (those who apply prior to August 1, but receive approval after August 1) will also have until their next redetermination to establish the QIT.
  • Exception: If a person has a significant change in income (e.g. lump sum) that causes their income to go above the SIL, then that individual will need to establish a QIT immediately in order to maintain eligibility. 

• Medicaid redetermination dates are available to authorized representatives, individuals or their family. If the provider is the authorized representative (not representative payee) for the individual, the provider can obtain the Medicaid redetermination date from the county caseworker.

Qualified Income Trusts (QITs)

• Ohio Department of Medicaid (ODM) has contracted with Automated Health Systems (AHS) to assist in the creation of the QITs. However, individuals and providers have the option to use AHS or not.

• If an individual or provider is not working through AHS, consider approaching the retail division of the bank, not the trust division, because the QIT/Miller Trust is not a traditional trust, but rather, functions like a checking account.

• ODM’s draft rule on QITs does not specify who may be a trustee. The individual could be their own trustee.  A family member or friend who is willing to assume the responsibility could be the trustee.  A nursing facility may also serve as the trustee for a QIT.  Anyone, including a facility, considering being the trustee for a QIT needs to understand the duties of a trustee under the QIT rule.

• A nursing home serving as the trustee can enact the trust through a pooled trust account and account for it through the resident bank system. A facility must create an account for the QIT that is distinct from the individual’s personal needs account.

• ODM does not prohibit a trustee from signing a blanket authorization allowing a nursing facility to withdraw the patient liability from the QIT account each month without a new authorization each time.

• ODM has provided a State endorsed trust template, however, any trust instrument that meets the legal requirements for the QIT is acceptable.

• The QIT follows the beneficiary, as it does not terminate until the individual’s death. The trust template allows the trustee to appoint a successor trustee. If the trustee is the nursing facility, the facility should appoint someone else at the time of the individual’s transfer.

• If an individual has a guardian, the guardian can sign the QIT. If an individual has a power of attorney (POA) that includes language that permits the attorney-in-fact to enter into a trust on behalf of the individual, the POA can sign the QIT.  If the person does not have a guardian or a POA and has not been declared incompetent by a court, ODM considers them to be competent. For these individuals, family members, facility staff, and AHS personnel can help explain the QIT so the individual can feel comfortable signing it.  NOTE:  Unless a lawyer is assisting in the execution of the QIT, it is important that the individual/family is notified that the facility representative is not a lawyer and that the facility cannot give legal advice, but that the QIT is required for Medicaid eligibility for individuals with income over the SIL and what a QIT is in general terms.  Beneficiaries who want legal assistance can obtain it from AHS or their own attorney.

• Requirements of the QIT account:
  • Include only an individual’s own income (no assets or income from other persons)
    • The minimum monthly deposit is the amount by which the beneficiary’s income exceeds the SIL, but they can deposit more than that amount, up to all of their income.
  • Be irrevocable (only terminates on an individual’s death)
  • Name the State of Ohio as the beneficiary. Any monies left is the account, must be paid to State up to the total amount of Medicaid payments made on an individual’s behalf. 
    • Funeral costs or other expenses cannot be paid out of the QIT account.
  • Include the:
    • Location of the QIT account
    • Account number
    • Who has access to the account
    • Title of the account, which must clearly identify it as a QIT account in the name of the individual
    • Monthly deposit amount
    • Actual monthly deposits
    • If applicable, the reason income cannot be deposited directly into the account

• Money put in the QIT can be used to pay for the following expenses, but is not limited to this list:
  • Incurred medical expenses;
  • Monthly personal or maintenance needs allowance;
  • Bank fees associated with the maintenance of the Trust up to $15 (an individual can request ODM to approve a higher fee)
  • Patient liability, if applicable.

• Payments out of the QIT must be approved in the Post Eligibility Treatment of Income (PETI) patient liability calculation.

• Individuals or providers will need to provide documentation to the county caseworker at redetermination to support compliance, compliance with the QIT requirements can be documented by means of the ODM QIT Verification form. ODM is still determining whether this form will be mandatory or not.

Special Circumstances

• If an individual who is on Medicaid has a skilled stay and their income is above the SIL ($2,199), the individual must deposit the excess income into a QIT account even if they do not have patient liability that month.

• Individuals within a Restricted Medicaid Coverage Period (RMCP), with income above the SIL must also establish a QIT even though Medicaid is not paying for their LTSS as the SIL is used to determine their base Medicaid eligibility.

• A deceased individual whose pro-rated patient liability exceeds the SIL, must have the excess go into the QIT and the remainder can go estate.

• ABLE/STABLE accounts do not exempt the excess income for Medicaid eligibility determinations. The individual’s own income above the SIL must go into the QIT.  The ABLE/STABLE Accounts are an exempt resource.