OHCA QIT Webinar June 17, 2016 Questions and Answers. Q Will current nursing home residents who have $1,500 as an asset limit be moved to $2,000?

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1 OHC IT Webinar June 17, 2016 uestions and nswers General Will current nursing home residents who have $1,500 as an asset limit be moved to $2,000? Yes, they will. What is the purpose of this document? To allow a person who has gross income of more than the special income level (currently, $2,199) and who is otherwise eligible to qualify for Medicaid. What is the reasoning for the IT? Why is it really needed, or what is its designed purpose? The IT requirement is not something anyone wants on its own. It is a federal mandate if the state goes to 1634 status and does not have a medically needy program. Ohio chose that route, and the IT came along with it. It is mandatory for Medicaid eligibility if the person is over income. What department will oversee this? We believe the surveyors and the counties will oversee this, using the PN account as an analogy. Who Needs a IT Does this apply to the Medicaid ssisted Living Waiver? Yes, it applies to all home and community-based waivers. If we admit someone who has MyCare Ohio for a short-term skilled stay, do we need to worry about IT if their income is over $2,199? This situation is not likely to happen. If a person was on MyCare Ohio in the community before being admitted, their income wouldn t be that high. The special income level of $2,199 is only used for eligibility for people in LTSS. If they were on a waiver in the community, they already should have a IT in place (or they don t need one until their 2017 redetermination date). For those residents who need to become eligible under Medicaid to stay long-term and then will transition to a MyCare plan, do they still need to meet the IT requirement so we get paid from Medicaid until the transition, and don't the redeterminations still go through Medicaid? Therefore, does not the IT have to be in place? 1

2 It depends on whether the person is receiving Medicaid eligibility under the special income level, which currently is $2,199. If they are, and their income is over that amount, they will need a IT. Otherwise, they don t. Creating the IT and IT ccount Who is the "settlor"? The person who is creating the trust (typically, the Medicaid applicant). So the primary beneficiary is the settlor and not the state of Ohio? The primary beneficiary is the person applying for Medicaid, who typically also is the settlor. What if the resident is unable to open trust due to their medical condition and they do not have a PO or guardian? The state has not provided clear guidance in this area. Can the attorney in fact ( PO ) serve as a trustee? Does the document need to be notarized? No. If a person applies for Medicaid and completes the Miller Trust but ends up not having income over $2,199, should they still open the trust? It would not hurt anything to have it set up, and if they already created it, they cannot revoke it. But it is not required, and there is no need to fund the trust if it was created. Can the facility start a IT for long term private pay admissions to position them for Medicaid eligibility down the road? Yes, but it would not be a good idea for the person to fund it. We had a family member utilize HS. They did a brief assessment, then later the family was contacted by a field representative to set up an appointment. They met, and the field representative basically only gave them the IT form and told them that they would need to get with someone at the nursing home or go to a bank and have them help set up the IT. Have you heard of this happening with others? Yes, and we communicate these issues to HS and ODM. 2

3 Funding the IT When the trust is set up, does it need to be funded? When IT document is signed, the IT does not need to be funded unless the person is applying for Medicaid eligibility on or after ugust 1, Then it needs to be funded for Medicaid eligibility to become effective. If the person is already Medicaid eligible but is waiting for their redetermination date, the trust does not need to be funded until then. In this case, the person doesn t need to have a IT at all, but they may want to have it ready, which is fine. If a person s income changes from under $2,199 to over that amount, they will need a trust right away, and they will need to fund it. Does the IT have to be a separate account from the PN? Yes, the IT account must be separate from the PN account. Does this have to be in an interest-bearing account? It isn't clear if it has to go into an interest-bearing account (assuming any money is left in the IT account after the disbursements). If we have a resident who has a pension, how is a trust to be opened if the pension will not cooperate? The company paying the pension can continue to pay the retiree, who then must move the money (if total gross income is over the SIL) into the trust. What percentage of the income is to be moved into the trust? Only the amount over the $2,199 limit or the entirety of the income? The amount over the SIL is the minimum, but more can be deposited. If the individual has a resident account and their personal needs allowance is deposited there, then they have a IT, does it just go into that same resident account? If you have a resident account and money is going into it to be paid out for personal needs, you need to have a separate account for IT if income is above $2,199 prior to the PN being paid out. The PN account cannot serve as IT account. If the income is paid first into the PN account, then anything over the SIL has to be transferred from there into the IT account. If the facility is representative payee, then would the facility deposit any excess income to the trust monthly? In Indiana I am aware of providers maintaining the excess funds for things like partial admit/discharge months or skilled months where no funds are required to be paid to the facility 3

4 for patient liability. These providers are putting the excess funds in the PN to comply with those asset limit rules and guidelines. Would we not follow suit? The Department of Medicaid says the excess income still must go into the IT account when the person is skilled, if they wish to retain Medicaid eligibility. In the case of a partial month, only the portion of the income attributable to the time when the person is Medicaid-eligible needs to be deposited (if over the SIL). If a trust is set up early, for example for someone who is pending Medicaid but not yet approved, when do they have to fund the IT? It depends if the person is pending before ugust 1, 2016, or they apply on or after that date. If the former, they would not need to fund the IT until their redetermination date in If the latter, setting up the IT would not really be early. They would need to set it up and to fund it immediately. Do we need to contact Social Security and have the direct deposit account changed to the IT account? No, you don't have to have the Social Security payment direct-deposited into the trust, but the state would like that to be done because it is cleaner. Is gross income the total of Social Security and private pension (and any other income) PRIOR to taxes or health insurance deductions? Payments Out of the IT ccount How does this work if the resident is over the SIL and they have a spouse that receives an allowance for living in the community? That is one of the permissible payments out of the trust, so the money goes into the trust, then goes out to the community spouse, the PN, and patient liability. If for some reason a Medicaid-pending resident opened a IT and then is denied Medicaid, what happens to the money in the IT? The money already should have been distributed on a monthly basis to help cover the cost of care. What happens to the personal needs allowance held by the facility if the facility is representative payee for LL of the income? There are no changes to the PN requirements. The PN is listed as a permissible payment out of the IT. If you apply for past medical, does this go through the case worker? 4

5 Yes, the process for past medical is not changing. What is different is that instead of these services being paid under retroactive Medicaid, they will have to go through past medical. t termination of the trust, who are the funds distributed to? The state of Ohio. We can no longer pay funeral expenses from what might be left in the trust? Correct. Funeral expenses are not listed in the rule as a permissible expenditure. We can pay the funeral expense out of the PN, right? Yes, the funeral expenses still can be paid out of the PN. If there is money left in the IT when the resident expires, it can't even go to a surviving spouse? No, it has to go to the state. gain, this is different from the PN account. Can the nursing facility charge the $15 administrative fee? The rule would seem to allow this as an other administrative fee, but we will need to check with the state. So will this make everyone's patient liability $2,199, and the rest of the income will remain in the IT? No, everyone's PL will be calculated the same as it has been, except the $15 for bank or other fees (if applicable) will come out of that. Typically all of the income deposited the IT account will be paid out for patient liability or other permissible expenses. Does the facility have any recourse when a trustee does not pay the facility as it should? The facility has the same recourse it would if a family member who gets the income doesn't pay. It's actually a little stronger because the trust puts the obligation to pay in writing. 5