In wonk talk, Ohio is switching from a 209B Medicaid state to a 1634 Medicaid state in July.
Translation for average Jane/Joe: Hundreds of thousands of Ohioans must navigate a new system to qualify for or to keep Medicaid, including many nursing home residents who will be required to set up a legal trust.
Greg Moody, who directs the state Office of Health Transformation, said the changes will streamline the system for users and make state and county services more efficient.
But others — including Community Legal Aid, which serves low income people in Akron and surrounding counties and Pro Seniors, a Cincinnati-based legal nonprofit for residents over age 60 — have doubts.
The issues are complicated and multi-layered, impacting senior citizens, the blind, the disabled and those with persistent mental illness. You can read the state’s explanation at www.tinyurl.com/abjmedicaid.
But here are some of the impacts on specific groups of Ohioans:
Nursing home retirees
Nursing home residents who depend on Medicaid must establish a Qualified Income Trust (QIT), commonly referred to as a Miller Trust, if their monthly income exceeds $2,199.
That would include many nursing home residents who receive Social Security benefits in addition to pension payments or U.S. Veterans benefits.
The average cost of a nursing home in the state is about $6,000. Once residents spend their assets — burning through savings accounts, selling their homes and other assets, often to pay for medical care — Medicaid picks up the difference between their monthly income and the nursing home bill.
The cases are reviewed yearly to re-qualify the residents for Medicaid, state officials said.
Under the new system, residents must maintain a trust to accomplish the same thing.
Any monthly income over $2,199 would be funneled into a trust to be spent on care. The idea with nursing home residents and all Medicaid recipients is to eliminate scheduled reviews of their income versus their bills.
The state has hired a contractor — Automated Health Systems — to facilitate this at no charge for those already on Medicaid, or soon to enroll.
The contractor will soon begin contacting every nursing home resident in the state who must set up a trust. Nursing home residents can opt out of accepting the contractor’s help but must still find a way to set up a Miller Trust by the end of the year or face losing Medicaid.
Banks that handle Miller Trusts will deduct fees from the trusts as a handling fee, state officials said.
Some advocates for seniors say the complicated trusts are unnecessary. Other states that have changed how they handle Medicaid, switching to a 1634 state, have accomplished the transition without relying on trusts, said Miriam Sheline, litigation director for Pro Seniors.
And, she pointed out, there are many unanswered questions, including who will administer the trusts.
Additionally, many in nursing homes have dementia and may not be able to understand the trust or what they are establishing, Sheline and other critics of the new trusts said Friday.
Disabled people
People seeking government benefits may have a simpler path to apply beginning in July, although critics say it could delay benefits.
As it stands, Ohioans must now go to a county Job and Family Services to apply for Medicaid and a state agency, Opportunities for Ohioans with Disabilities (OOD), to apply for Supplemental Security Income (SSI).
To qualify for Medicaid, a person’s assets must be $1,500 or less and their monthly income $634 or less. To qualify for SSI, a person can have $2,000 in assets and a monthly income of no more than $743.
Starting in July, applicants only need to fill out a single application at OOD. If approved, the state will automatically approve applicants for Medicaid, too.
Asset and income requirements for Medicaid will be bumped up to match SSI.
Moody said that should free up social workers in counties to help clients instead of doing paperwork. He also praised the head of the OOD for clearing a backlog of cases and speeding up the application system.
Nevertheless, Marie Curry, managing attorney for Community Legal Aid, said the change may delay benefits for applicants because, in years past, those who applied to OOD often had to wait two to three years for benefits to begin.
Amanda Garrett can be reached at 330-996-3725 or agarrett@thebeaconjournal.com.