2014 Medicaid Eligibility and Spend Down Changes

The Indiana Family and Social Services Administration (FSSA) has announced that effective June 1, 2014 Indiana Medicaid will change the way individuals who are aged, blind or disabled will qualify for Medicaid coverage.  The changes will result in a new process that nursing facility residents and nursing facility operators will need to learn and use in order to obtain Medicaid coverage.
On June 1, 2014 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 will eliminate the requirement that these applicants also complete a second application and go through a second medical review process to become eligible for Indiana Medicaid with disability coverage. The transition also eliminates the spend down program, which has caused administrative burdens for providers and members, and creates alternative options for those members.

FSSA has established a website with numerous resources for current and future Medicaid recipients, as well as for providers (see http://www.in.gov/fssa/ddrs/4859.htm).  Last week, on January 30th, FSSA held an all stakeholders meeting to begin explaining this new process (click here for the presentation).  In addition, FSSA has posted a general notice that will go to all current Aged, Blind or Disabled Medicaid members, and FAQs on its website.

A must read for Nursing Facility Residents and Operators
Of critical importance to individuals whose income may exceed the eligibility limit and who want to continue receiving Medicaid, or who want to obtain Medicaid for the first time is the use of a Qualified Income Trust (also known as a Miller Trust).   Establishing a QIT allows a recipient, or potential recipient, to place that part of their income that exceeds the income limit into the QIT and have that amount of income disregarded from eligibility determinations.  FSSA has released an instructional packet about QITs and how to establish one on its website (click here).

For those residents that exceed the current income standards and are a nursing facility who are on Medicaid, or persons that are receiving home and community based services from Medicaid, a QIT must be established and in use by June 1, 2014 in order for Medicaid eligibility to be continued.  In addition to the QIT webpage linked above, FAQs 46 to 55 at http://www.in.gov/fssa/ddrs/4861.htm#Transition_Beneficiaries also discuss the  QIT process.