Ohio Medicaid is Changing August 1st

• July 12, 2016

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• By Mary Day

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• News

The Ohio Medicaid program is changing effective August 1^st, 2016, as Ohio converts from a § 209(b) to a § 1634 type of Medicaid program.  Under the Social Security Act, states have an option to run their Medicaid program as one of two types.  Ohio has been a § 209(b) state since Medicaid began in 1968.  As of August first it will convert to a § 1634 Medicaid program.

This conversion means big changes in both Community and Institutional Medicaid programs.  Institutional Medicaid pays for nursing home care and long-term care services in the community such as assisted living and home care under the PASSPORT program.  This aged, blind or disabled (ABD) category of Medicaid coverage had 437,000 Ohioans enrolled in 2014, including over half of long-term care nursing facility residents.  The biggest changes for these Institutional Medicaid program recipients are:

• Spend-down income eligibility is replaced with an income cap: Medical expenses can no longer be used as a deduction from income to lower gross income to Medicaid eligibility levels.  As of August 1^st, there will only be a gross income eligibility test.  To qualify for Medicaid, one’s gross monthly income must be at or below 300% of the federal benefit rate, the monthly SSI benefit of $733, which is $2,199.  Many current nursing facility residents on Medicaid have monthly gross income over $2,199 and will no longer qualify for Medicaid as of August 1^st.  However, the Ohio Department of Medicaid (ODM) is giving those NF residents a grace period until January first, or even later, to lower their gross monthly income via a Qualified Income Trust (QIT), a.k.a. a Miller Trust, to remain Medicaid eligible.

• Creating a Qualified Income Trust (QIT) to Remain Medicaid Eligible: ODM has created a QIT fill-in-the-blank form available on its website.  The Medicaid recipient must complete it, including naming a trustee.  Next take the completed trust form to a bank to open a QIT Trust account.  Note that not every bank will set up a QIT account.  Then set up an electronic fund transfer (EFT) of the portion of your monthly income that exceeds $2,199 into the trust account and an EFT out of the trust account to the nursing facility to pay your personal liability amount as determined by Medicaid.  ODM has hired Automated Health Systems, OhioQIT@automated-health.com, 1-844-265-4722, to help current Medicaid recipients with this process.  Note that a guardianship may be necessary for incompetent Medicaid recipients without a financial power of attorney with the authority to complete the QIT document.  All financial powers of attorney should grant the attorney-in-fact the power to create a QIT for Medicaid purposes.

• Increased Resource Limits: A Medicaid recipient may now have $2,000 in resources, up from $1,500 previously.

• Some Spousal Retirement Funds Are Now Exempt: Previously spousal pension funds were countable assets for Medicaid eligibility purposes.  Now some are no longer included in countable assets, though which spousal pension funds are excluded is unclear.

• One automobile is excluded regardless of value: Previously, this exclusion was available only when the Medicaid applicant had a community spouse.  Now this exclusion is available to all Medicaid applicants, including single individuals, so long as the car is being used for transportation.

• The individual’s Home is Now Excluded if: The individual in the nursing facility intends to return home or any dependent relative is living in the home.

As always, Pro Seniors Legal Hotline is available to answer your Medicaid questions and any other legal questions you may have.  Call us Monday through Friday, 8:30 a.m. to 4:30 p.m. to schedule a telephone appointment if you or the person you are calling for is at least 60 years of age and an Ohio resident.