What can a Florida QIT pay for?

How DCF treats money leaving the trust

Under DCF's income trust policy, payments from the trust to third parties are not income to the Medicaid recipient, and interest the account earns and keeps is not income either. Payments made directly to the recipient are counted as their income. That one rule explains most of what a trustee should and should not do.

Money paid from the trust for the recipient's medical care counts as fair compensation for the income placed in the trust, so it does not create a transfer penalty. When the patient responsibility is less than the Medicaid rate, DCF does not need to examine the trust's payments at all, unless money was paid to the recipient.

The patient responsibility

After eligibility, DCF figures how much of the person's monthly income goes toward the cost of care. It counts all income, inside and outside the trust, then subtracts, in order: the personal needs allowance; any allowance for a spouse at home or a dependent family member; income protected in the month of admission or discharge, when it applies; and uncovered medical expenses. What remains is the patient responsibility, and paying it to the provider each month is the QIT's main job.

Health insurance and other medical costs

DCF allows a deduction for health insurance premiums, deductibles, and co-insurance paid from the person's income, and for other medically necessary care that Medicaid does not cover, within limits. The expense must be the person's own, paid with the person's funds by them or someone acting for them, and paid to the provider. DCF averages recurring expenses, projects them forward, and reconciles every six months.

Because these costs reduce the patient responsibility, they are a natural use of the trust. Keep every premium notice and bill; DCF has to see them to allow the deduction.

The spouse at home

When the Medicaid recipient is married and the spouse lives at home with income below the State's standard, part of the recipient's income can be set aside for the spouse each month as the community spouse income allowance. That allowance is subtracted before the patient responsibility is figured, and it can be paid to the spouse from the trust. Our guide for married couples explains how the allowance is calculated.

What not to pay

Do not pay the Medicaid recipient, and do not move the trust's balance back into the recipient's checking account; either one counts as the recipient's income. Do not make gifts from the trust or pay family members for anything that is not for the recipient's benefit. And do not let a balance pile up: whatever is left at death goes to the State, up to what Medicaid paid.

Questions

Can the QIT pay assisted living room and board?

In assisted living, the facility's room and board is usually paid from the person's own account, not from the trust, and DCF builds the personal needs allowance in assisted living around the facility's basic rate. Putting too much into the QIT can leave too little in checking for room and board. Our guide to funding by care setting explains the balance.

Can money in the QIT be given back to my parent for spending money?

Not without consequence. Anything the trust pays directly to the Medicaid recipient counts as their income. The personal needs allowance is part of the person's income that DCF leaves for them; it is not something to draw back out of the trust.