This week’s blog continues the discussion of the changes to Ohio Medicaid’s Aged, Blind and Disabled (ABD) program coming in 2016-2017. The initial installment (April 28, 2016) provided an overview of the transition from the old system (following section 209(b) of the federal Medicaid law) to the new system (that will follow section 1634 of the federal Medicaid law.) The May 5, 2016 installment discussed the new income rules that will go into effect with the new eligibility system. The May 12, 2016 installment discussed setting up a Qualified Income Trust (aka Miller Trust) that will be necessary for people who need ABD Medicaid to help pay for long term care. The June 16, 2016 installment discussed the Ohio rules that describe how to use the Miller Trust each month. The June 23, 2016 installment discussed the difficulty in understanding the need for a Miller Trust. The July 1, 2016 installment discussed the need to empty the Miller Trust account every month. The July 7, 2016 installment discussed the need to balance the Miller Trust with the desire to have health insurance. The July 15, 2016 installment discussed the confusing deposit rules for Miller Trusts. The July 21, 2016 installment discussed the changes that the Ohio Department of Medicaid made to the form Miller Trust document. Today’s installment will discuss whether income is supposed to go directly into the Miller Trust.
The Ohio Department of Medicaid has finalized its new rule on Miller Trusts (aka Qualified Income Trusts or QITs.) A copy of the final rule is available here. The first form Miller Trust from the Ohio Department of Medicaid can be found here. The new version of the form Miller Trust from the Ohio Department of Medicaid can be found here.
Because the rule calls them QITs and today’s installment makes a number of references to the new rule, for this installment, I’ve started usually to call them QITs.
The Ohio Department of Medicaid had originally announced that the new rules would take effect on July 1, 2016. As that date approached, and the enormity of the changeover became more apparent, the effective date was delayed until August 1, 2016. I recently heard a rumor (and it is just that, only a rumor) that the implementation will be delayed again.
While the delays may seem frustrating, it is very hard to overstate the enormity of the changes that Ohio’s Department of Medicaid is trying to make. Not only are there the rule changes for people who need long term care that I have been discussing (and will continue to discuss) in my blog and newsletter. There are bigger changes (affecting tens of thousands more people) in the eligibility rules for Medicaid for people who are disabled but do not need long term care. In addition, to oversee the new requirements for all affected people, the state and county Medicaid offices have to move to a new software system to manage the Medicaid program.
As discussed previously, someone in Ohio who needs Medicaid support to pay for long term care whose gross monthly income exceeds the Special Income Level ($2,199.00 at this time) must use a QIT to make the income over the Special Income Level not “income” anymore in the eyes of Medicaid. (Yes, the process is as hard to follow in real life as it is to follow in that sentence.) In order to get the benefits of the QIT, the amount of income over the $2,199 (or more than just that excess income) must be placed into the QIT each month so that the remaining “countable” income is $2,199 or less each month. (It’s not getting any more understandable, is it?)
Despite what I wrote two weeks ago, it is not entirely clear whether income should be placed directly into the QIT upon the income’s arrival from the payer. Section H seems to conflict (at least partially) with the language of Section D(4) (discussed two weeks ago) on this point. The second sentence of Section H states, “Every effort should be made to have the individual’s excess income deposited directly into the QIT account on a monthly basis.” Section D(4), however, states states that the person cannot “cannot transfer or assign to the trust his or her right to receive income.” Arranging a deposit directly into the QIT (what Section H seems to require) sure sounds like assigning the right to receive income (what Section D(4) prohibits.)
Now, perhaps (as discussed two weeks ago) the arrival of income into the person’s hands must first be into a non-QIT account. The, money could be “transferred” into the QIT. Unfortunately, it’s not clear that Section H refers to “transfers” of income from one account to another or “deposits” of income upon its first arrival. Section H uses both “transfer” and “deposit,” and it’s not clear that these terms mean different things in the QIT rule. The first clause of the first sentence of Section H refers to income being “transferred” into the QIT account, and the second clause of the same sentence refers to income being “deposited” into the QIT account. The second sentence also uses the word “deposited,” adding to the confusion. In fact, Section H uses “transfer” once and “deposit” five times.
I believe that the rule means to have all income arrive into non-QIT account(s) and then get transferred into the QIT, but whoever wrote the rule did not make its intent clear. Perhaps, Ohio Department of Medicaid means “transfers” in Section H but used “deposits” because of sloppy writing or sloppy proofreading. Unfortunately, approximately $5,000 – $6,000 in Medicaid benefits for long term care costs is at stake each month for people who must comply with this rule. Is it too much to ask for clarity?