Below is an at-length explanation of Pooled Income Trusts for Medicaid Home Care.
We also encourage you to download our summary on how Pooled Income Trusts help consumers get Medicaid Home Care:
What is a Medicaid Spend Down?
What is a Pooled Trust?
Who can use a pooled income trust to qualify for Medicaid?
How does one document disability in New York State?
Who administers a pooled income trust?
How is money that has been deposited into a pooled income trust used?
How often must a Medicaid beneficiary make deposits to their pooled income trust account?
Submitting a pooled income trust to Medicaid
How can I get help with a Pooled Trust?
Perhaps the most common challenge facing New Yorkers looking to qualify for Medicaid for home care is having income above the Medicaid limit. This “surplus” or “excess” income is commonly referred to as “spend-down”. By default, Medicaid requires consumers to “spend-down” their income that is above the limit towards the cost of health care before accessing Medicaid benefits – much like a deductible. This often proves extremely difficult, if not impossible.
The practical Medicaid income limits for most consumers seeking home care are $879/month for an individual ($859 plus a $20 disregard) and $1,287/month for a couple ($1,267 plus a $20 disregard). Between housing costs and paying for the basics, even consumers with income well above the Medicaid limits often find themselves with little extra money at the end of the month. As a result, many people in need of home care find themselves between a rock and a hard place. They can’t afford to “spend-down” and they certainly can’t afford to pay for care out-of-pocket. Enter the pooled income trust.
In New York State, income deposited by disabled individuals into a pooled income trust is disregarded for the purpose of determining their Medicaid budget. As such, disabled consumers seeking Medicaid coverage for home care can deposit their “surplus” or “excess” income into a pooled income trust and qualify for Medicaid without having to “spend-down”. The money they deposit into the pooled income trust remains available to them to pay their bills.
In New York State, people who have been found disabled by either the Social Security Administration or New York State may use a pooled income trust to qualify for Community Medicaid with Long-Term Care (the Medicaid level that covers home care). Most people who use pooled income trusts to qualify for Medicaid were not previously found disabled by the Social Security Administration and must provide disability documentation, together with documentation of the pooled trust itself, when submitting their pooled trust to Medicaid for approval.
Most people who require home care do not have much trouble being found disabled by New York State. Nevertheless, everyone that wishes to be evaluated to be found disabled must submit certain required paperwork for review. The following are the required items:
- LDSS-486T Medical Report (filled out by doctor)
- Medical Records for the past 12 months
- LDSS-1151 Disability Questionnaire
- LDSS-1151.1 Continuation Sheet (if necessary)
- HIPAA – OCA Official Form No.: 960
- MAP-751e Authorization to Release Medical Information – This form has been replaced by “HIPAA – OCA Official Form No.: 960”, but we have found that Medicaid will still sometimes request it. We recommend submitting both forms when requesting a disability determination.
Pooled Income Trusts are administered by non-profit organizations. An unofficial list of pooled income trusts in New York State can be found at this link.
Each member of the pooled income trust has their own account. Funds deposited into their account can be used to pay bills in the member’s name. Bills must be submitted to the trust and they are paid by an employee that works at the trust. It is often possible to set up automatic payment for recurring bills such as rent. Money cannot be withdrawn in cash form.
Money remaining in a pooled income trust upon the death of the member cannot be withdrawn. Rather, the money must stay in the trust. It is therefore advisable to use the money in the trust to pay bills on a consistent basis and not let it accumulate.
Pooled trusts generally charge fees which vary by trust.
Medicaid eligibility is determined on a month-by-month basis. Depositing surplus income into a pooled income trust eliminates the surplus for that particular month. Therefore, in order to maintain Medicaid eligibility, beneficiaries must deposit their surplus to the trust each month.
Just because someone has set up a pooled income trust, that does not make Medicaid aware of the trust. Documentation of the pooled income trust together with disability documentation must be submitted to Medicaid for review. It is not uncommon for Medicaid to take anywhere from 1 1/2 months to over six months to approve a pooled income trust.
We provide free assistance for people looking to enroll in a pooled income trust to obtain home care. If you would like assistance with a pooled income trust for yourself, a loved one, or a client, please give us a call: 718-838-3838.