528           PROCESSING CASES WITH TRUSTS
 

528 A.      INITIAL CASE PROCESSING

The following process must be followed for all initial applications where a Medicaid Qualifying Trust (MQTMedicaid Qualifying Trust) is being used to establish Medicaid eligibility. This includes individuals that are reapplying immediately after case closure.  

The trust should not be sent to policy for review until the interview has been completed and the application is ready to be approved.

1. Request and obtain a complete copy of the trust document.
2. Email hss.dpa.policy@alaska.gov with the PI's client ID, the name of the individual that the trust belongs to, and what type of trust needs to be reviewed.  Policy will find the trust document in ILINX with this information.  Only one trust will be reviewed per email so if an individual has more than one trust to be reviewed, each trust needs a separate email. 

Note:

Policy will enter a case note on the existing Medicaid case number if the trust is approved.

Policy will send the trust approval document or an explanation of what changes need to be made before the trust can be approved via email to the specific LTCLong Term Care office caseworker who submitted the trust for review. If the trust was submitted by any other office, Policy will send this to the general office email address.

If other unrelated documents are attached with the trust in ILINX, the email will be returned and the caseworker will be required to resubmit it without the additional pages.

3. Request and obtain a copy of the trust bank account showing when the account was established and the monies being deposited into the account.

Note:

Although the state cannot require it, it is best practice and highly encouraged that the client deposit all of their countable income directly into the trust bank account. The trustee can then transfer the allowable monthly amount into the client's personal bank account. This helps avoid accidental under-funding of the trust. 

4. Request and obtain a copy of the court document showing that the trust has been registered with the court or use the CourtView Search website to verify registration of the trust.  The CourtView Search website is available at: www.courtrecords.alaska.gov.

Follow these instructions to determine if a trust has been registered with an Alaskan court:   

• Type in the first and last name of the trustee and click the search button.
• When the search results are displayed, choose the appropriate court record and click on the case number.
• The summary screen is displayed that provides the name of the trust, the trustee(s), the case number and the date the trust was registered with the court.

5. After receiving trust approval, copies of bank statements, and the court document showing the recording of the trust; the Medicaid case can be opened.

6. If the Medicaid Qualifying Trust is used to establish or maintain Medicaid eligibility, email the following information to the DHCSDivision of Health Care Services TPLThird Party Liability Unit at: dmatpl@alaska.gov:

1. Complete copy of the trust document;
2. Completed Trust Reporting form that contains the name of the client, the trustee, trustee contact information, bank, and bank account number (The Trust Reporting form is located under e-forms); and
3. Copy of the trust approval form showing approval from Policy.

528 B.      PROCESSING APAAdult Public Assistance-RELATED MEDICAID CASES WITH TRUSTS

1. When opening a Medicaid case with a Qualifying Income Trust (QITQualifying Income Trust ), send the following notices:

M140 - APAAdult Public Assistance Medicaid - Qualified Income Trust

M144 - Miller Trust Information - APAAdult Public Assistance

2. When opening an APAAdult Public Assistance-Medicaid case with a Special Needs or Pooled Trust, send the following notices:

M141 - Medicaid - Special Needs or Pooled Trust

M143 - Special Needs or Pooled Trust Information

3. Mail the appropriate brochure to the trustee and client:

MED 21 - Trustee Information     

MED 22 - Special Needs or Pooled Trusts

MED 23 - Qualifying Income Trusts

528 C.      PROCESSING LONG TERM CARE APPLICATIONS WITH TRUSTS

1. When opening a Waiver case with a Qualifying Income Trust (QITQualifying Income Trust ), send the following notices:

M112 - Medicaid Approval - Waiver Services

M130 - Cost of Care / Waiver

M142 - Medicaid Trust Information - LTCLong Term Care

2. When opening a Nursing Home Medicaid Case with a QITQualifying Income Trust , send the following notices:

M120 - Cost of Care / LTCLong Term Care Facility

M121 - Medicaid Approved - LTCLong Term Care Facility

M142 - Medicaid Trust Information - LTCLong Term Care

3. When opening a case with a Special Needs or Pooled Trust, send the following notices:

M141 - Medicaid  - Special Needs or Pooled Trust

M143 - Special Needs or Pooled Trust Information

4. Mail the appropriate brochure to the trustee and the client:

MED 21 - Trustee Information     

MED 22 - Special Needs or Pooled Trusts

MED 23 - Qualifying Income Trusts

528 D.    PROCESSING RENEWALS WITH TRUSTS

1. Review file for the following:
   1. Complete signed copy of the trust document;
   2. Trust approval;
   3. Name and contact of trustee; and
   4. Bank statement of trust account.

2. Contact the trustee, confirm he or she remains the trustee, and get current contact information.  

3. If the trustee is no longer acting in this capacity:
   1. Request a copy of the addendum naming the new trustee;  
   2. Get current contact information of new trustee; and
   3. Complete a new Trust Reporting form with new trustee information and email the new updated trustee information to the DHCSDivision of Health Care Services TPLThird Party Liability Unit at: dmatpl@alaska.gov.

4. Request current bank statement, review for discrepancies by:
   1. Review balance;
   2. Compare current balance with balance from previous year renewal to ensure that cost of care has been paid and that trust funds have been used appropriately;
   3. Review deposit information to ensure money is being deposited into trust account; and  
   4. Compare balance and monthly activity with any cost of care obligation, etc.

Note:

Although the State cannot require it, it is best practice and highly encouraged that the client deposit all of their countable income directly into the trust account. The trustee can then transfer the allowable monthly amount into the client's personal bank account. This helps avoid accidental under-funding of the trust.

5. If there are any discrepancies:
   1. Request statements from past 12 months; and
   2. Discuss use of the trust with trustee and clarify appropriate use of trust.
   3. If, after being advised of the proper use of the trust, the trustee continues to misuse the trust, the caseworker may declare the trust an invalid Medicaid Qualifying Trust. If declared invalid, the trust shall be treated as an irrevocable trust under the general trust provisions in manual sections 525(B) and 525(C).
   4. The caseworker may declare the trust to be valid again if the trustee provides adequate evidence that the trust is being used appropriately.

6. At every renewal send the following:

MED 21 - Trustee Information;     

MED 22 - Special Needs or Pooled Trusts or MED 23 - Qualifying Income Trusts; and

Notice: M143; or M142; or M144 and M140.

528 E.      DOCUMENTATION

Initial Case Note: When opening a Medicaid case that has an approved Medicaid trust, a separate CANOCase Notes must be recorded with the following information:

1. CANO Title: Trust Established 

2. Body of text:
   • Name and contact information of Trustee
   • Type of trust
   • Name of bank and trust bank account number
   • Beginning trust bank account balance
   • Cost of care obligation for QIT’s (if applicable)

All documentation about the trust must be created in a separate CANOCase Notes titled Trust Information.  Trust information must be identifiable to ensure information is sufficiently passed on to other caseworkers.  

Note:

The Policy & Program Development Unit will create a trust approval case note when review of the trust has been completed and it is found to meet the requirements of a Medicaid Qualifying Trust.

The trust approval case note will be entered on the existing Medicaid case number, if a stand-alone case number has not yet been registered.  If this occurs, the Eligibility Technician processing the application will be required to copy the trust approval case note into the stand-alone case number that is created when the Medicaid is authorized.

Renewal Case Note: When renewing a case that has an approved Medicaid trust, a separate CANOCase Notes must be recorded with the following information:

1. CANO Title: Medicaid Trust

2. Body of text:
   • Name and contact information of Trustee
   • Name of bank and trust bank account number
   • Balance in trust bank account balance at time of renewal
   • Cost of care obligation for QITQualifying Income Trust cases (if applicable)

528 F.      CLOSING A CASE WITH A MEDICAID TRUST

1. Determine the reason for closure.

2. If the closure is because of death, enter the date of death on the MEREMedical Reference screen.

3. Close out the TPRThird Party Resource and MCRMedicare segments on the MERIMedical Resource Information screen.  Close all TPRThird Party Resource segments with the actual date of death, and close out the MCRMedicare segment with the last day of the month in which they deceased.

4. Send a closure notice and email a copy to the DHCSDivision of Health Care Services TPLThird Party Liability Unit at: dmatpl@alaska.gov.

528 G.   TRUST CHANGES

When a trust is amended, such as when a new trustee is assigned, the amended trust document and court paperwork confirming that they have approved the change must be sent to policy for approval.