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Miller Trust Problems in Ohio Medicaid for Nursing Home Residents

Ohio’s new income eligibility rule for Medicaid has caused a lot of angst and complications for Ohio’s Medicaid recipients. This rule went into effect last August 1, 2016. The income standard for a nursing home resident applying for Medicaid is $2205 per month. If their gross income before deductions is one dollar over this amount they are not eligible for Medicaid. Fortunately, this can be solved by the creation of a Qualified Income Trust also known as a Miller trust. For more information see /new-developments/

One of the problems that has tripped up some persons applying for Ohio Medicaid is that the Miller trust must be created in the first month that you expect eligibility. In the past it was important to spend down all resources (i.e., accounts & other assets) by the end of a particular month and then you would have met the criteria for Medicaid eligibility. Now it is equally important that you also meet the income criteria or, if you do not, that you immediately set up a Miller trust in that same month. If you do not, you will not be eligible for Medicaid in the first month even though you have spent down below $2000. You will not be eligible until you also set up the Miller trust and transfer your income as required under the Medicaid income rules.

There is a three-month retroactivity provision under Medicaid law. For example, if a nursing home resident spends down to less than $2000 and meets all other eligibility criteria by the end of the month of August, they can wait until the month of November to submit their Medicaid application. Assuming they have met all Medicaid eligibility criteria in the prior three months back through August, they can have retroactive eligibility back through August. However, if their gross income before deductions is more than $2205 per month, they must have set up the Miller trust and make the required income transfers to the trust for August and all the months prior to the date of application. There will be no three-month retroactive provision if this was not done.

You should also be aware that under the pending proposals in Congress for the Amended American Health Care Act this three-month retroactivity will be repealed. This provision has been in the Medicaid law ever since the beginning back in 1972. Its purpose is simply to allow people some time to get their application in even though they have met the eligibility criteria in a given month. The three-month retroactivity does not give anyone additional eligibility that they are not entitled to. It simply provides them some additional time to get all their paperwork together and submit their application. The result of the proposal will simply be that persons who should have been eligible will not be because they did not promptly submit their application.