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Statewide Medicaid Managed Care (SMMC) – Managed Medical Assistance Program

By Asset Protection Planning, Government Benefits, Long-Term Care, Medicaid PlanningNo Comments

Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services.

There are two different parts that make up the SMMC program:

  • The Managed Medical Assistance (MMA) Program
  • The Long-term Care (LTC) Program

Medicaid recipients who qualify and become enrolled in MMA will receive all health care services (other than long-term care) from a managed care plan. Medicaid recipients who qualify and become enrolled in LTC will receive long-term care services from a Long-term Care managed care plan.

What does the Statewide Medicaid Managed Care program provide?

Medicaid members receive their health care services through a managed care plan. MMA plans cover services such as prescriptions, doctors’ visits and hospital stays.

All MMA plans offer the following health care services:

  • Advanced Registered Nurse Practitioner
  • Ambulatory Surgical Center Services
  • Assistive Care Services
  • Behavioral Health Services
  • Birth Center and Licensed Midwife Services
  • Chiropractic Services
  • Dental Services
  • Child Health Check Up
  • Immunizations
  • Emergency Services
  • Emergency Behavioral Health Services
  • Family Planning Services and Supplies
  • Healthy Start Services
  • Hearing Services
  • Home Health Services and Nursing Care
  • Hospice Services
  • Hospital Services
  • Laboratory and Imaging Services
  • Medical Supplies, Equipment, Prostheses and Orthoses
  • Optometric and Vision Services
  • Therapy Services
  • Physician Assistant Services
  • Physician Services
  • Podiatric Services
  • Prescribed Drug Services
  • Renal Dialysis Services
  • Clinic Services
  • Transportation Services

Medicaid applicants will receive a letter once you are approved for Medicaid informing them of the MMA plan the state has enrolled them with. Applicants are allowed to switch to an alternate plan in the first 120 days.

If you have specific questions regarding your Medicaid eligibility, the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

June 23, 2020
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Statewide Medicaid Managed Care (SMMC) – Long-term Care Program

By Asset Protection Planning, Government Benefits, Long-Term Care, Medicaid PlanningNo Comments

In 2011, the Florida Legislature created a new program called the Statewide Medicaid Managed Care (SMMC) program.

There are two different programs that make up the Statewide Medicaid Managed Care:

  • The Long-term Care (LTC) Managed Care Program
  • The Managed Medical Assistance (MMA) Program

Medicaid recipients who qualify and become enrolled in the Statewide Medicaid Managed Care – Long-term Care program will receive long-term care services from a long-term care managed care plan. Medicaid recipients who qualify and become enrolled in the Statewide Medicaid Managed Care – Managed Medical Assistance program will receive all health care services other than long-term care from a managed care plan.

What does the Statewide Medicaid Managed Care program do?

Medicaid recipients will receive their long-term care services from a managed care plan. These managed care plans will cover long-term care services only and do not cover medications, doctor’s visits or other healthcare related services.

All long-term care managed care plans offer the following services:

  • Adult Companion
  • Adult Day Care (Adult Day Health Care)
  • Assistive Care Services
  • Assisted Living Facility Services
  • Attendant Care
  • Behavior Management
  • Caregiver Training
  • Case Management
  • Home Accessibility Adaptation
  • Home Delivered Meals
  • Homemaker
  • Hospice
  • Intermittent and Skilled Nursing
  • Medical Equipment & Supplies
  • Medication Administration
  • Medication Management
  • Nursing Facility Care
  • Nutritional Assessment and Risk Reduction
  • Occupational Therapy
  • Personal Care
  • Personal Emergency Response System
  • Physical Therapy
  • Respiratory Therapy
  • Respite Care
  • Speech Therapy
  • Transportation

The state will send Medicaid recipients a letter notifying them as to whether or not they are required to enroll in Florida’s Statewide Medicaid Managed Care – Long-term Care program and provide a list of plans for their specific region.

If you have specific questions regarding your Medicaid eligibility, the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

June 22, 2020
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How to Get on the Florida Medicaid Waiver Wait List

By Asset Protection Planning, Elder Law, Government Benefits, Long-Term Care, Medicaid PlanningNo Comments

In Florida, the Medicaid program that helps pay for long-term care in an assisted living facility or at home is called the Long-Term Care Diversion Waiver. There is a waitlist for this program. In order to get on the waitlist, you will need to do the following:

  1. Call your local Area Agency on Aging and request a “screening for home and community-based services.” Each county in Florida is assigned to an Area Agency on Aging. Your local agency can be found here.

The representative will collect some preliminary information and will schedule a time for the phone screening with the individual requiring assistance, primary caregiver ,or closest family member.

  1. Complete the screening interview. The interview usually lasts about 30 to 40 minutes. The interview covers basic demographic information for the applicant, as well as information regarding the applicant’s income and assets. The interviewer will also ask about the applicant’s needs for care, including the applicant’s ability to perform Activities of Daily Living. It is important to be honest and provide the interviewer with all health and care issues no matter the extent of the issue.
  2. Following the interview, you should receive a prioritization decision. This letter indicates the applicant’s priority score, which determines their place on the waitlist. The higher the score, the higher the priority the applicant receives on the waitlist.
  3. At this point, you do not actually need to submit a Medicaid application, so you do not need to be technically asset or income qualified for Medicaid. However, it is important to have a plan in place to become income and asset qualified for Medicaid, so that you are ready to apply when the applicant receives a spot off the waitlist. If the applicants’ condition deteriorates while on the waitlist, you can request a re-assessment to move higher up on the waitlist.
  4. Once you receive notification that the applicant has received a spot off the waitlist, you will be provided with a deadline to submit the Medicaid application.

If you have specific questions regarding preserving your Medicaid eligibility, the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

June 19, 2020
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How Can I Spend Funds in A Qualified Income Trust?

By Asset Protection Planning, Medicaid PlanningNo Comments

There are very specific rules regarding how the funds in a Qualified Income Trust (QIT) may be spent. It is very important that the Trustee ensures that only allowable expenses are paid out of the QIT account because if funds in the QIT are spent improperly, it could jeopardize the recipient’s Medicaid eligibility.

Only the following expenses can be paid out of a QIT account:

  1. The Patient Responsibility due to the nursing home (as determined by the Department of Children and Families)
  2. Health insurance premiums
  3. The Community Spouse Allowance (as determined by the Department of Children and Families)
  4. Medical expenses not covered by insurance (i.e. medical durable supplies, additional home health care agency hours, therapies not covered by Medicaid)
  5. Uncovered portions of an assisted living bills

If you have specific questions regarding managing a Qualified Income Trust account or your duties as the Trustee of a Qualified Income Trust, the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

June 2, 2020
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Does the Qualified Income Trust Need a Taxpayer Identification Number?

By Asset Protection Planning, Medicaid PlanningNo Comments

Some banks may request that you obtain a Taxpayer Identification Number for the Qualified Income Trust (QIT, also referred to as a Miller Trust).  However, In Part 21, Chapter 7, Section 13 of “Assigning Employer Identification Numbers (EINs),” the IRS specifically provides that “If the trust is a Miller type of trust, do not assign an EIN. Instead, inform the trustee that he/she must …Use the SSN of the beneficiary or trustee to report trust activities.” A Qualified Income Trust (QIT) is a “grantor trust”, which means that for tax reporting purposes, the trust’s finances are the same as the Settlor’s finances.  Therefore, the bank must use the Social Security Number of the Settlor (the Medicaid recipient) when setting up the QIT checking account.

If you have specific questions regarding establishing a Qualified Income Trust,  the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

June 1, 2020
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How much of my income should be deposited into the Qualified Income Trust?

By Asset Protection Planning, Medicaid PlanningNo Comments

The Trustee must deposit the amount of the Medicaid recipient’s income that exceeds the income cap into Qualified Income Trust (QIT) each and every month.  In 2020, the gross monthly income cap is $2,349.00. So, for example, if the Medicaid recipient’s gross monthly income was $4,000.00, the Trustee would need to deposit a minimum of $1,651.00 into the QIT each month.  If the Medicaid recipient’s gross monthly income was $4,500.00, the Trustee would need to deposit a minimum of $2,151.00 into the QIT each month.  In order to account for any discrepancies or fluctuations that may arise in monthly income, we always advise our clients to deposit more than the minimum amount each month.

Properly managing and funding a QIT is very important for maintaining Medicaid Eligibility.  If you have specific questions regarding funding a Qualified Income Trust account or your duties as the Trustee of a Qualified Income Trust, the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

May 29, 2020
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What Items Must Be Included in a Qualified Income Trust Agreement?

By Asset Protection Planning, Medicaid PlanningNo Comments

A Qualified Income Trust (QIT) agreement is a complex document that must meet specific requirements to be approved by the Florida Department of Children and Families. According to the applicable Florida regulations, a QIT agreement must:

  1. Be irrevocable,
  2. Require that all funds remaining in the QIT at the time of the death of the Medicaid beneficiary be paid to the State of Florida (up to the amount of Medicaid benefits paid on behalf of the Medicaid beneficiary),
  3. Consist of only the Medicaid applicant’s income, and
  4. Be signed and dated by the Medicaid applicant, the Medicaid applicant’s spouse, or someone who has the legal authority to act on the Medicaid applicant’s behalf.

If you think you may need to establish a Qualified Income Trust, the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

May 28, 2020
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How do I Establish A Qualified Income Trust?

By Asset Protection Planning, Medicaid PlanningNo Comments

A Qualified Income Trust (QIT) agreement is a complex document that must meet specific requirements to be approved by the Florida Department of Children and Families. The Florida Supreme Court has ruled that the preparation and execution of QIT is the “practice of law” and as a result, you cannot hire someone other than a Florida attorney to assist you with the planning and preparation of a QIT.

If you think you may need to establish a Qualified Income Trust, the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

 

 

May 27, 2020
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Opening the Qualified Income Trust Bank Account

By Asset Protection Planning, Elder Law, Medicaid PlanningNo Comments

Opening the Qualified Income Trust Bank Account

Once a Qualified Income Trust (QIT) has been prepared and signed, the Trustee must establish and maintain a separate bank account in the name of the QIT. The account can be established at any banking institution. Prior to going the bank to open the account, it is a good idea to call your bank and make an appointment. It helps to explain the situation before you arrive for the appointment, so that the bank representative will know what your purpose is and will be better equipped to help you.  When you call to make the appointment, explain that you, as Trustee of a Trust, will be setting up a checking account and making a deposit. Explain that it is not a trust account, but just a regular checking account that happens to be in the name of a trust.  Make sure that the bank can offer you a checking account that is non-interest bearing, and that you do not need to keep any minimum amount in the account at any given time.

The QIT account should be titled in the name of the Trust, for example, “Jane Doe Qualified Income Trust Dated __________, 2020” or “John Smith, Trustee of the Jane Doe Qualified Income Trust Dated ________, 2020.” A QIT is a “grantor trust”, which means that for tax reporting purposes, the trust’s finances are the same as the Settlor’s finances. Therefore, the bank should use the Social Security Number of the Settlor (the Medicaid recipient).

Make sure you bring the original Trust Agreement and your Driver’s License or other government issued photo identification with you to the bank to open the checking account. The bank can make a copy of the Trust, but you should not relinquish possession of the original Trust.

If you have specific questions regarding setting up a Qualified Income Trust account or your duties as the Trustee of a Qualified Income Trust, the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

May 26, 2020
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What is a “Qualified Income Trust”?

By Asset Protection Planning, Government Benefits, Medicaid PlanningNo Comments

As of January 1, 2020, in Florida, in order to qualify for Medicaid benefits, the applicant’s gross income must be less than $2,349.00 per month. In general, if the Medicaid applicant’s monthly gross income exceeds this amount, the applicant will be denied Medicaid benefits. The only current exemption to this barrier is the establishment of a “Qualified Income Trust” (QIT). A QIT is an irrevocable trust that can be established to receive the Medicaid applicant’s excess income.  Once the trust is established, a checking account is opened in the name of the trust. Simply put, establishing a QIT allows the applicant’s income to be exempt from the “income cap” by flowing the applicant’s excess income through a special checking account each month.

The QIT is irrevocable and cannot be changed after it is signed. Only the applicant’s income can be deposited into the checking account and only certain payments may be made out of the account. After the Medicaid recipient dies, the balance of the QIT will be paid to the State of Florida up to the total amount of Medicaid payments made on the recipient’s behalf.

If you have specific questions regarding asset protection planning and Medicaid eligibility, the experienced elder law attorneys of Bach, Jacobs & Byrne, P.A. are here to assist you. Call us at (941)906-1231 to set up a consultation.

 

 

May 25, 2020
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