Ohio Admin. Code 5160:1-6-03.2 - Medicaid: use of qualified income trusts (QIT)
(A) This rule sets forth the requirements
that must be met in order to establish and use a qualified income trust (QIT)
(also referred to as a Miller trust) to become eligible for medicaid payment of
long-term care services.
(B)
Definitions
(1) "Beneficiary" is defined in
rule 5160:1-3-05.2 of the
Administrative Code.
(2) "Grantor"
is defined in rule
5160:1-3-05.2 of the
Administrative Code.
(3)
"Individual" is defined in rule
5160:1-6-01.1 of the
Administrative Code.
(4)
"Irrevocable trust" is defined in rule
5160:1-3-05.2 of the
Administrative Code.
(5) "Primary
beneficiary" means the "individual" as defined in paragraph (B)(3) of this
rule.
(6) "Qualified Income Trust"
(QIT) means a trust that allows an individual whose income is over the special
income level (SIL), as described in rule
5160:1-6-03.1 of the
Administrative Code, to have some or all of his or her income not be counted
when determining medicaid eligibility by placing income in the trust.
(7) "QIT account" means the account that
holds the income placed into a QIT.
(8) "Trustee" is defined in rule
5160:1-3-05.2 of the
Administrative Code.
(C)
A QIT can only be used to establish medicaid eligibility by an individual whose
income is above the SIL, who is eligible for long-term
care (LTC)
LTC services covered by the
Ohio medicaid program, and who is subject to the calculation of patient
liability under rules
5160:1-6-07
and 5160:1-6-07.1 of the
Administrative Code.
(D) A QIT must
be a valid trust under the law of Ohio or another state and meet the following
requirements:
(1) The trust must be
irrevocable.
(2) Only the
individual's income can be placed into the QIT.
(3) The source(s) of income placed into the
QIT must be identified.
(4) The
individual cannot transfer or assign to the trust his or her right to receive
income.
(5) No other property or
resources, except for any interest earned on the trust corpus, can be placed
into the QIT.
(6) The trust
document must provide that the trust shall terminate upon the death of the
primary beneficiary, at which point the remaining trust property shall be
distributed to the Ohio department of medicaid or its successor up to an amount
equal to the total medical assistance paid on behalf of the primary
beneficiary; the trustee is prohibited from repaying other persons or creditors
prior to this distribution.
(E) Distributions from the trust shall be in
amounts and for the purposes necessary to maintain the individual's income
eligibility for medicaid. In accordance with rules
5160:1-6-07
and 5160:1-6-07.1 of the
Administrative Code, distributions from the trust shall be made in the
following order, no later than the last day of the calendar month in which the
income is placed in the QIT account:
(1) A
monthly personal or maintenance needs allowance for the primary
beneficiary;
(2) A maintenance
allowance for the spouse, if any, of the primary beneficiary and, if
applicable, a maintenance allowance for family dependents;
(3)
Health care
costs
Incurred medical expenses of the primary
beneficiary.
in
In accordance with rules
rule
5160:1-6-07 and 5160:1-6- 07.1 of the
Administrative Code.
,
When
when income is used to help pay for LTC services or
other medical care provided to the individual, the individual is considered to
have received fair market value for the income placed in the trust, up to the
amount actually paid for other medical care provided to the individual and to
the extent that the payments purchased are
care at fair market value;
(4) The trustee may make payments in an
amount up to fifteen dollars per month from the QIT account for bank fees,
attorney fees, and other expenses required to establish and administer the
trust. If fifteen dollars is insufficient to cover the cost to administer the
trust, the individual can request that the payment amount be increased.
Requests for an increased payment amount must be approved by the Ohio
department of medicaid (ODM).
(F) The trust corpus is not counted as a
resource available to the individual in determining his or her eligibility for
medicaid.
(G) The establishment of
the QIT must be documented, including the location of the QIT account, the QIT
account number, and details regarding
about who has access to the QIT account. The title
of the QIT account must clearly identify it as a QIT account in the name of the
individual.
(H) If the individual's
income cannot be automatically transferred or deposited into the QIT account
each month, then the individual must provide ODM with documentation showing
that the individual's income is being transferred or deposited into the QIT
account on a monthly basis. Every effort should be made to have the
individual's excess income transferred or deposited directly into the QIT
account on a monthly basis.
(I) The
properly executed QIT document, proof of the establishment of the QIT account,
documentation of the required monthly deposit amount, and verification of
monthly deposits from an income source or sources into the QIT account,
including efforts to have income deposited directly into the QIT account, must
be submitted along with the application for medicaid for an individual needing
LTC services.
(J) Documentation of
monthly deposits into the QIT must be presented at the individual's annual
eligibility renewal
review or at the request of the administrative
agency. If such documentation is not presented, any income that should have
been placed into the QIT but was not will be considered available for purposes
of determining the individual's medicaid eligibility for that month. Any
medicaid payments made by the administrative agency during a period of
ineligibility are subject to recovery under rule
5160:1-2-04
of the Administrative Code.
(K) The
individual can elect to have all, or only a portion, of his or her income
placed into the QIT account. Any income not placed into the QIT account will be
counted as available to the individual when determining eligibility for
medicaid.
(L) Income placed into
the QIT is subject to the patient liability requirements as set forth in rules
5160:1-6-07
and 5160:1-6-07.1 of the
Administrative Code. All income placed into a QIT is combined with any
countable income not placed into the QIT to arrive at a base income figure to
be used in the patient liability calculation. The base income figure is used
for post-eligibility distributions.
(M) Distributions or payments from the QIT,
other than as authorized by this rule, may be considered a transfer of assets
for less than fair market value and subject to a penalty in accordance with
rule 5160:1-6-06.5 of the
Administrative Code. When income placed into the QIT exceeds the amount paid
out of the QIT in accordance with paragraph (E) of this rule, the excess income
may be subject to penalties under the transfer of assets provisions as set
forth in rule
5160:1-6-06.5 of the
Administrative Code.
(N) In
accordance with rule
5160:1-3-03.1 of the
Administrative Code, payments made from the QIT directly to the individual that
are not authorized by paragraph (E) of this rule are counted as income to the
individual in the month they are received.
(O) In accordance with rule
5160:1-3-03.8 of the
Administrative Code, payments made from the QIT to a third-party to purchase
something in-kind for the individual will be counted as unearned income to the
individual in the month received. Payments to a third-party for something other
than in-kind support and maintenance that are not authorized under paragraph
(E) of this rule, are subject to the transfer of asset penalties as set forth
in rule
5160:1-6-06.5 of the
Administrative Code.
Notes
Promulgated Under: 111.15
Statutory Authority: 5160.02, 5163.02
Rule Amplifies: 5160.02, 5163.02
Prior Effective Dates: 08/01/2016, 09/01/2017
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