1634 Program Overview. Birdi Schwamberger ODM-TA December 11, 2015

Transcription

1 1634 Prgram Overview Birdi Schwamberger ODM-TA December 11, 2015

2 Ohi Department f Medicaid Agenda Intrductin Overview f 1634 Plicy Changes Qualified Incme Trust (QIT) Overview High Level QIT Trust Prcess Flw Next Steps Q&A 2

3 Ohi Department f Medicaid Intrductin Under Sectin 1634 f the Scial Security Act, states can enter int an agreement with the federal gvernment t use the Scial Security Administratin (SSA) t determine Medicaid eligibility fr its aged, blind and disabled ppulatin. Under 1634, individuals fund eligible fr Supplemental Security Incme (SSI) are autmatically enrlled int Medicaid and d nt have t separately apply fr Medicaid benefits. Currently in Ohi, Medicaid eligibility fr aged, blind and disabled individuals is determined by the Ohi Department f Medicaid. Individuals applying fr SSI and Medicaid must apply separately fr each prgram. Ohi is wrking t transitin t This transitin simplifies the Medicaid eligibility determinatin prcess by eliminating the need t apply separately fr SSI and Medicaid benefits. The transitin als makes cverage available t mre lw-incme Ohians. 3

4 Ohi Department f Medicaid Histry f 209(b) In 1972, Cngress expanded the Medicaid prgram t cver individuals wh are aged, blind, r disabled In the law that cntained this change, sectin 209 says that states must prvide Medicaid t anyne wh receives Supplemental Security Incme Paragraph (b) f sectin 209 says that states culd chse t be mre restrictive t have lwer incme r resurce limits States that chse this 209(b) ptin are required t allw individuals t Spend Dwn t the mre restrictive incme limit The law als put in place sme restrictins arund incurred expenses fr Spend Dwn 4

5 Tday in 209(b) wrld Ohi Department f Medicaid 50,000 Ohi residents with disabilities qualify fr Medicaid Sme have incme, but must spend dwn their incme t 64% FPL t qualify fr Medicaid Can have hme and vehicle, but n resurces ver $1500 Must prve disability TWICE Via CDJFS fr Medicaid eligibility Via Opprtunities fr Ohians with Disabilities (OOD) fr SSI eligibility 5

6 Ohi Department f Medicaid Sectin 209(b) and Spend Dwn Individuals can meet the Spend Dwn in varius ways: Recurring Persn has established mnthly csts r unpaid past medical bills that meet the Spend Dwn. Persn gets their Medicaid card mnthly withut Pay in Spend Dwn is cnsidered met as f the first f the mnth, even if the payment was made n the 15th Delayed The persn incurs csts in the amunt f the Spend Dwn. The cst is incurred whether the persn pays up frnt r receives an itemized additinal actin n bill fr services Individuals can grup expenses int certain mnths s that they meet their part the Spend Dwn in thse mnths 6 6

7 The Other Optins Ohi Department f Medicaid States wh chse nt t g the 209(b) rute had tw ptins: SSI Criteria 1634 The State cvers everyne wh meets the criteria fr Supplemental Security Incme (SSI) The state makes its wn decisin whether the persn meets the criteria fr SSI The State accepts Scial Security Administratin s decisin In Ohi, OOD s decisin that the persn is eligible fr SSI SSI beneficiaries are autmatically enrlled n Medicaid The State des nt recnsider the determinatin OOD - Opprtunities fr Ohians with Disabilities 7

8 Ohi Department f Medicaid Why Switch? Fairness in the 209(b) and MAGI (Mdified Adjusted Grss Incme) adult wrld: A persn under 65 withut Medicare can get MAGI adult cverage with incme up t 138% FPL (Federal Pverty Level*). A persn 65 r lder, r with Medicare, has t Spend Dwn t 64% FPL Tw peple with the same Spend Dwn amunt may have very different results based n what treatment they need frm what prvider in ne case, the prvider never actually attempts t cllect n the incurred bill. In anther case, the persn has t pay up frnt t get services Administrative simplificatin: N mre Spend Dwn calculatin r cllectin *Federal Pverty Level is the set minimum amunt f grss incme that a family needs fr fd, clthing, transprtatin, shelter and ther necessities 8

9 Ohi Department f Medicaid What Are We Prpsing t Build? We will still have MAGI grups, and anyne wh gets SSI will be autmatically enrlled n Medicaid We will have a lkalike categry fr individuals wh are 65+, blind, r disabled, but wh d nt have SSI. The FPL will be raised t 75% and resurce limit will be raised t $2000. Medicaid Buy-In fr Wrkers with Disabilities (MBIWD)will still be an ptin fr flks wh are wrking with disabilities Individuals wh need NF/ICF (Nursing Facility/ Intermediate Care Facility) care r services under an existing waiver will have an incme limit f 300% FBR (Federal Benefit Rate) 300% FBR is abut 225% FPL (fr 2015, this amunt is $2199) N ne will be able t Spend Individuals with Severe and Dwn their incme, but Persistent Mental Illness (SPMI) individuals seeking LTC can depsit will be cvered under a new excess incme int a Qualified state plan ptin with an incme Incme Trust t becme eligible fr cap f 300% FBR 9

10 Ohi Department f Medicaid Wh needs a Qualified Incme Trust? If an individual s incme is ver the Medicaid incme limit fr Lng term Care (LTC) services, he/she can depsit their excess incme int a Qualified Incme Trust in rder t be eligible fr LTC Medicaid services Lng-term care services are given t Medicaid beneficiaries wh: live in a nursing facility (NF); r live in an intermediate care facility fr individuals with intellectual disabilities (ICF-IID); r receive hme and cmmunity-based services (HCBS), like PASSPORT, Assisted Living, Ohi Hme Care, Individual Optins, MyCare Ohi, etc. 10

11 Ohi Department f Medicaid What Is a Qualified Incme Trust? A Qualified Incme Trust (QIT) r Miller Trust, is a special legal arrangement t disregard an individual s incme ver certain threshlds An individual, their legal guardian r their pwer f attrney may pen a Qualified Incme Trust Cannt cntain spusal r family resurces Is irrevcable Can cntain nly the individual s incme Must be used fr incme nly and cannt shield ther assets Qualified Incme Trust key characteristics that make it different frm ther types f trusts Must be prperly executed and name the State as a beneficiary Allws fr resurces t be recvered by the State* *The Trust shuld cntain language such as: Upn the death f the beneficiary, the trust assets shall be paid t the Medicaid agency f the State f Ohi up t the ttal amunt f the Medicaid payments made t r n behalf f the 11

12 Hw Des a QIT Trust Wrk? Ohi Department f Medicaid Individual must place the prtin f his r her mnthly incme that is greater than the current incme standard int the trust Individual may apply certain deductins t these funds, and the remaining amunt in the trust is paid t the institutin r health care prviders On a mnthly basis, the QIT trust funds pay fr the cst f care, and Medicaid pays fr the care nt funded by the trust Upn a recipient s death, if he/she is subject t estate recvery, any and all funds remaining in the QIT Trust (up t the ttal cst f care) are paid t Medicaid 12

13 Ohi Department f Medicaid What can the mney be used fr? Mney put in the Qualified Incme Trust accunt can be used t pay fr: Incurred medical expenses f the primary beneficiary The cst f medical assistance prvided t the primary beneficiary, including patient liability t the LTC prvider A mnthly persnal r maintenance needs allwance fr the primary beneficiary Maintenance allwance fr individual s spuse r family dependents 13

14 Intrductin t the Vendr Ohi Department f Medicaid ODM will prcure the services f a vendr t help peple affected by this change set up a Qualified Incme Trust A vendr has nt yet been annunced stay tuned! Individuals culd als use their wn resurces t set up a Qualified Incme Trust rather than use the services f ODM s vendr Legal guidance is recmmended when a Qualified Incme Trust is created 14

15 Ohi Department f Medicaid High Level Qualified Incme Trust Prcess Flw 1. State identifies impacted individuals and sends ntificatin 2. Vendr prvides educatin and assistance t these individuals 3. Vendr helps these individuals pen a bank accunt fr Trust depsits 4.Trust infrmatin is prvided t cunty ffice fr eligibility prcessing 5. Individuals make a mnthly depsit int their Trust accunt 6. State mnitrs Trust transactins

16 Ohi Department f Medicaid 1. State identifies impacted individuals and sends ntificatin Ntificatins sent t the individual: Explain the 1634 change and the individual s ptin t pen a Qualified Incme Trust Prvide implementatin timelines and when actin needs t be taken Refer the individual t a vendr fr additinal guidance Individuals impacted by this change include: Individuals residing in a Nursing Facility r an Intermediate Care Facility Individuals participating in a Hme and Cmmunity Based Service waiver Multiple ntificatins may be sent t individuals t infrm them f 1634 changes and remind them t take actin 16

17 Ohi Department f Medicaid 2. Vendr prvides educatin and assistance t these individuals Vendr cntacts individual and determines if they need a Qualified Incme Trust The Vendr educates individuals abut Qualified Incme Trust, including: Qualified Incme Trust Requirements Implementatin timeline and when actin must be taken State apprved Qualified Incme Trust frm Vendr prvides assistance with establishing a Qualified Incme Trust, including help filling ut the Qualified Incme Trust frm 17

18 Ohi Department f Medicaid 3. Vendr helps these Individuals pen a bank accunt fr Trust depsits Individual must create a bank accunt used exclusively fr Qualified Incme Trust depsits Vendr assists individual in wrking with financial institutins t pen an accunt fr Qualified Incme Trust depsits The accunt can be pened in any bank that prvides this service Banks may charge a fee t administer the Qualified Incme Trust accunt 18

19 Ohi Department f Medicaid 4.Trust infrmatin is prvided t Cunty ffice fr eligibility prcessing Individuals must prvide: Prf that a Qualified Incme Trust has been established The CDJFS ffice is respnsible fr dcumenting infrmatin and prcessing eligibility fr the individual 19

20 Ohi Department f Medicaid 5. Individuals make a mnthly depsit int their Trust accunt The individual is respnsible fr making mnthly depsits int the Qualified Incme Trust accunt The mnthly depsit amunt is dependent n the individual s incme and changes when incme changes 20

21 Ohi Department f Medicaid 6. State mnitrs Trust transactins The State will establish a prcess t mnitr mnthly Qualified Incme Trust transactins 21

22 Next Steps Release RFP t prcure vendr Cntinue t wrk thrugh utstanding plicy decisins Begin develpment f educatinal and legal dcuments fr all stakehlders Develp n-ging cmmunicatin plan Ohi Department f Medicaid 22

23 Ohi Department f Medicaid Q&A 23