Action Alert: Public Hearing 3.21 about changes to Medicaid Disability/1634 transition

A public hearing on the 1634 transition is scheduled for Friday, March 21st at 9:00 am in Conference Rooms 4 & 5 of the IN Govt. Center South.

Proposed rules to implement the 1634 Transition are found here: http://www.in.gov/legislative/iac/20140226-IR-405130533PRA.xml.pdf

Families and individuals are encouraged to provide public comment on the proposed rules. Family Voices Indiana can help you with this process and/or provide family leadership development funds to support your participation. Contact info@fvindiana.org

2014 MEDICAID DISABILITY ELIGIBILITY CHANGES

Who is affected: Current beneficiaries or future applicants for Indiana Medicaid in the aged, blind and disabled (ABD) categories.

Effective June 1, 2014, Indiana is changing the way Hoosiers will obtain Medicaid coverage in the aged, blind or disabled categories. This is called the 1634 transition. Indiana will automatically enroll individuals that the Social Security Administration determines eligible for Supplemental Security Income into Indiana Medicaid and will accept all SSA determinations of disability.

This rule will also eliminate the “spend down” provision under Medicaid. A spend down program allows individuals who have income over the eligibility threshold but otherwise meet the requirements for Medicaid under the aged, blind, or disabled (ABD) categories to receive coverage. In a spend down program, individuals with income over the limit for eligibility are assigned a ‘spend down’ or an amount of medical expenses they must incur each month prior to receiving Medicaid benefits. An individual’s ‘spend down’ is equal to the amount his or her income exceeds the eligibility limit after accounting for applicable income deductions. This will not be an option after the 1634 transition. Individuals will have to seek other insurance, including the ACA Marketplace, as appropriate. Marketplace plans do not cover non-emergency transportation costs and members interested in dental services will need to elect to add them and pay the additional premium. Marketplace plans include some service limits for physical, occupational and speech therapies and home health but have no lifetime or annual maximum dollar limits on essential benefits.

Individuals who are receiving Medicaid disability via the home and community based waivers will continue to be able to do so as long as they are eligible. Children under 18 will still be able to use Senate Bill 30 to disregard family income and assets. However, if an adult individual’s monthly income exceeds $2,163, he or she will need to take action to establish a Miller trust as soon as possible to maintain eligibility. A Miller trust is a legal arrangement for holding funds. It allows an individual with income over the Medicaid limit for institutional or home- and community-based services to qualify for Medicaid coverage. The Medicaid agency disregards income placed in the trust for the purpose of eligibility. An individual must place the portion of his or her monthly income that is greater than the current income standard of $2,163 into the trust. Individuals may apply certain deductions to these funds, and the remaining amount in the trust is paid to the institution or healthcare providers. On a monthly basis Miller trust funds will be used to pay for the cost of care, and Medicaid will pay for the care not funded by the trust. Upon the recipient’s death, any and all funds remaining in the Miller trust, up to the total cost of care, would be paid to Indiana Medicaid. A Miller trust must be established as a legal entity. Then a trust account must be set up with a financial institution to receive the funds directed into it each month.

This is a different type of trust than the ones some families establish for their child, to be funded with life insurance benefits or other money after their death.

You can find additional frequently asked questions here: www.in.gov/fssa/ddrs/4861.htm