By Diane B. Weinberg

As a business owner, one book that has been recommended to me time and time again is Who Moved My Cheese?  by Spencer Johnson and Kenneth Blanchard.  The premise of the book is that business needs change and that, as business owners, we need to be able to address these changes and move forward effectively.  Last week, Medicaid moved the cheese, and it still has not provided us with its new rules.

 When a client comes to our office seeking assistance with long-term care planning, we evaluate her particular circumstances.  We look to her housing situation:  Where does she live? Does it meet her needs?  How long can she safely live there in light of her medical condition and other needs?   We look to see how she can pay for her housing needs and for how long:  What is her monthly income?  How much does she have in her bank account?  Does she have a home or other property that she can liquidate?  Does she have long-term care insurance?   If we believe that this individual is going to need nursing home care, we then look to the Medicaid regulations to determine how or whether this person will qualify for Medicaid.  Effective July 1, 2014, the rules governing Medicaid income eligibility changed.  How this will impact our clients remains to be seen.

Before July 1, 2004, Georgia was a “spend-down” (or medically needy) state that allowed an applicant to offset her income on his own care until he reached the state’s income standard for eligibility.  Thus, for example, an applicant who earned $4,000 a month would still be eligible for Medicaid if her nursing home care cost $6,000 each month.   On July 1, 2004, Georgia became an “income cap” state in which an applicant could not qualify for Medicaid if her income was over a specific amount.   In 2014, that amount was $2,163.  If an applicant earned more than $2,163, then she could place the excess income into a Qualified Income Trust (also known as a “QIT” or Miller Trust), and Medicaid would treat that excess income as if it didn’t exist.

The QITs made income planning for Medicaid relatively easy.  Do you have income above the cap limit?  If so, fill out this Medicaid form and create a QIT.  Unfortunately, QITs are very fussy, and clients had a difficult time managing these accounts.  I can only imagine that the employees at the Department of Family & Children Services had an equally difficult time trying to determine whether the QITs were being properly maintained; I’m sure most of them were not.

On June 12, 2014, the Commissioner of the Georgia Department of Community Health released a public notice explaining that, pursuant to House Bill 744 and effective July 1, 2014, the department would submit an amendment to the Centers for Medicare and Medicaid Services (“CMS”).  The amendment eliminates QITs and changes Georgia from an income-cap state back to a spend-down state.

So, what does this mean for the future?  Unfortunately, we don’t know.  There is a public hearing July 10 to discuss the new rules.  There is no other information about how CMS will implement the new rule or what it means for people who already have Medicaid or have begun the application process by July 1.  We suspect Medicaid doesn’t quite know what it’s going to do, either. With the recent controversies revolving around DFCS caseworkers, and considering how underfunded and understaffed these programs are, it will be interesting to see how DCH handles this change while maintaining qualification for current Medicaid recipients.  Until then, we will have to be prepared for CMS’ change – and be ready to change with it.

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