Ohio Medicaid Qualified Income Trust

In May, when I received a letter from Ohio Medicaid, I cringed. I was afraid my eligibility might be in question. Instead, I learned myself and more than 4,000 other Ohioans were being informed that Ohio Medicaid eligibility would be changing July 1.

Since my monthly Social Security Disability Income (SSDI) income exceeds $2,199, a Qualified Income Trust (QIT/Miller trust) must be set up by August 1, or before my next Medicaid reauthorization. Qualified Income Trusts eliminate the need for individuals living in nursing homes to spend down periodically in order to maintain Medicaid income eligibility.

The QIT is irrevocable and whatever remains in it upon my death, after medical bills are paid, goes either to the nursing home or to the state of Ohio.

Online research showed Ohio had contracted with Automated Health Systems to assist individuals to set up QITs at no charge. Banks that administer the trust's checking account can charge administrative fees– not to exceed $15 a month. To cover the QIT expenses the Medicaid recipient will have his/her monthly patient liability reduced by the amount of the bank's fee. The boilerplate Miller Trust form is online. Individuals can use a private attorney, but, in Iowa, in 2011, the attorney fee for setting up a trust was $500.

In May I e-mailed Automated Health Systems to inquire about setting up a QIT. When a week passed with no reply, I called and left a message several days later, a woman called to tell me they had not yet begun setting up trusts in my area. At that time, no banks near me were willing to carry the trusts. I was asked to inquire if my bank would, but when I did my bank told me an attorney needed to inquire.

Once the trust is set up and a checking account is opened in its name, it will be used as a pass-through account and I will transfer my SSDI there and pay my monthly personal allowance which is now $50, bank fees and my fee to the nursing home.

Although this new eligibility is similar to what I have used in the past, I will not need to spend down to meet Medicaid eligibility guidelines. Medicaid recipients who receive over $2,199 monthly can now have $2,000 in cash without endangering their eligibility.

A follow-up e-mail from Automated Health Systems said there are now several banks in my area that except Miller trusts. If my nursing home is not setting up the trusts for individuals, I just need to fill out the trust form and take it to a participating bank and open the checking account. A representative of Automated Health Systems told me that an attorney is not required for each individual trust, as they are monitoring all of them.

I just have to find out if I must go to the bank personally, or if it can be done through fax or by a facility representative delivering the trust to the bank. Since this is a new process, my goal is to prevent making multiple trips to the bank to get the QIT set up.

Kathleen Mears

Kathleen Mears is a long-time blogger who has been a nursing home resident for 21 years. She is an incomplete quadriplegic and uses a power wheelchair to get around. Her computer is her “window on the world.” This blog shares her thoughts and view of life as a nursing home resident as well as ideas of how it might be improved in the future.