Qualified Income Trust (Miller Trust) 02/14/2018

Angie Claywell Intake Coordinator Life Center for Independent Living

Why is Medicaid Important? offers nursing home care, long-term care services, and home health care services beyond what is offered by Medicare. offers helps to those who need assistance with activities of daily living. single largest source of health coverage in the United States The most common form is aged, blind, and disabled Medicaid

What is a Qualified Income Trust (QIT)? In simple terms, a trust is a legal entity to hold assets to achieve a certain goal The Qualified Income Trust, also known as the Miller Trust, diverts a portion of monthly income, allowing a person to meet Medicaid income requirements. Income above the state maximum of $1348.00 has to be diverted into the trust account, which lowers the individuals income to the Home and Community Based Services Program (HCB) standard. Applicable Medicaid programs include: Home and Community Based Services and Missouri Children with Developmental Disabilities Waiver Services (MOCDD)

LIFE Center’s Introduction to the QIT Over the years, LIFE Center has encountered many individuals who desperately needed services, but didn’t qualify for Medicaid. Two of my colleagues, Patty Fitzgerald and Theresa Scherer, started looking for alternative solutions and stumbled upon the Miller Trust. Patty contacted Charles Bentley, former Deputy Director of Family Support Division (FSD), for more information. QITs were available for use in the state of Missouri since 1993, although they had not be utilized for the HCB waiver program.

How L.I.F.E. got started with the Q.I.T. cont. My colleague, Patty, met a lot of resistance with FSD while attempting to create the QIT to access Medicaid. LIFE’s first QITs were developed by a local elder law attorney After a year of hard work, the first Qualified Income Trust used to access HCB Medicaid was approved in April of 2015. Sadly, the grantor died before he could benefit from the trust. The first QITs to provide the expected benefits were approved in July of 2015.

What is a Qualified Income Trust? The Qualified Income Trust, also known as the Miller Trust, diverts a portion of monthly income, allowing a person to meet Medicaid income requirements. Income above the state maximum of $1348.00 has to be diverted into the trust account, which lowers the individuals income to the Home and Community Based Services Program (HCB) standard. Applicable Medicaid programs include: Home and Community Based Services and Missouri Children with Developmental Disabilities Waiver Services (MOCDD)

Important Terms Trust – refers to the trust documents that must be completed and approved by the state. Trust account – refers to the actual bank account. Grantor – whoever is creating the trust. This will either be the person in need, power of attorney, legal guardian, conservator, public administrator, or authorized representative. Lifetime Beneficiary – the person in need of services. Trustee – the person named by the grantor who will manage the funds in the trust account.

How does this effect other programs? Each FSD program has specific rules to follow. The QIT may effect an individual’s eligibility for other programs. The income deposited into the trust each month will be excluded in the determination of eligibility, but only for the QIT programs (HCB and MOCDD). The balance in the trust account will not be considered as an available resource for any of the Mo HealthNet for the Aged, Blind, and Disabled (MHABD) programs.

Requirements To qualify for HCB Medicaid using the Qualified Income Trust three requirements must be met: Must be 63 or older Monthly income in excess of $1348 Must qualify for a waivered service (to be determined by DSDS)

Obtaining the Trust Once it has been determined that an individual is 63 or older and has income exceeding $1348, complete a Qualified Income Trust Referral form and send to the HCB Processing Unit The HCB Processing Unit will send you a completed Schedule A form which breaks down the gross monthly income and trust diversion amount, along with the trust template, if requested. The grantor must complete the trust document, either by using the template created by the Family Support Division or by obtaining one using a licensed attorney. The completed trust must then be sent to the HCB Processing Unit. Once approved, a trust account must be obtained at a participating financial institution. Medicaid will be backdated to the first day the waivered service began (if the lifetime beneficiary already had services) or the date the trust account was opened, whichever is applicable.

Funds in the Trust Account In order to qualify for the Qualified Income Trust the grantor must assign a trustee to spend the money on his or her behalf. Deposited funds can be setup as an automatic transfer from the individual’s personal account to the trust account or as regular cash deposits. For documentation purposes, checks should be used for all transactions. The funds in the trust account can accumulate and carry over from month to month if there are no allowable expenses to be paid. Upon termination of trust or the death of the lifetime beneficiary, any funds remaining in the trust account would be issued to the state in an amount up to or equal to the amount of Mo HealthNet benefits paid by the state.

How can the funds be used? Funds can be used to pay for anything medically necessary, including but not limited to: Prescription medications Doctor bills Mileage to and from a doctor appointment Mileage to and from a pharmacy Durable Medical Equipment that is not covered by Medicaid Reimbursement for Part B Medicare Physician approved needs, such as a medically necessary diet or incontinence supplies

Maintaining the Trust: documents required for annual review Trust transactions must be documented and verified annually by FSD. All of the following documents should be kept in a safe place: Doctor bills Bank statements Approval from doctor for nonprescription items Mileage reimbursement chart Trust account reporting worksheet

Additional Questions? Angie Claywell HCB Processing Center Intake Coordinator, L.I.F.E., INC Ph: 573-756-4314 ext. 125 Email: angiec@lifecilmo.org HCB Processing Center Ph: 1-877-304-7393 Email: ssd.hcbinformation@dss.mo.gov