Funding a QIT: nursing home, home care, assisted living, and PACE

Nursing home Medicaid (ICP)

In a nursing home, almost all of a person's income goes to the facility as the patient responsibility. The person keeps only a small personal needs allowance. Because the money ends up at the nursing home either way, our usual practice is to deposit all income, or at least the full patient responsibility, into the QIT, and pay the facility from the trust in one payment.

Home care through the long-term care waiver (SMMC LTC)

At home, the person still pays rent or a mortgage, groceries, and utilities from their own income. Money in a QIT can only be paid to others for the person's benefit or left in the trust. It can never come back to the person to pay the electric bill. If all income goes into the trust, the household can run short every month.

Our practice at home is to deposit the larger of two amounts: the minimum needed to bring the income left outside the trust under the limit, plus a small cushion; or the patient responsibility, rounded up. Not all income.

Assisted living through the waiver

Assisted living works like home care, with one more moving part. The facility's room and board is paid from the person's own account, not from the trust, and DCF's personal needs allowance in assisted living is built around the facility's basic room-and-board rate. If too much goes into the QIT, there may not be enough left in checking to pay room and board.

So the funding rule is the same as at home: deposit what is needed, not everything. The basic rate means a semi-private room with three meals. Private-room upcharges and add-on services are not part of it, and they are the most common reason a family's numbers do not work.

PACE

PACE follows where the person lives. A PACE participant in a nursing facility is funded like nursing home Medicaid. A participant living at home or in assisted living is funded like the waiver. Patient responsibility is paid to the PACE organization.

Why this matters

DCF's own information sheet encourages depositing more rather than less. In a nursing home that advice costs nothing. At home or in assisted living it can leave a family unable to pay the bills the waiver does not cover, while money piles up in a trust that goes to the State at death. Getting the deposit right for the care setting is a large part of what we do in a QIT Review.

Questions

Is the income limit different for assisted living?

No. The same income limit applies to nursing home Medicaid, the long-term care waiver at home or in assisted living, and PACE. What differs is the personal needs allowance, the patient responsibility, and how much should go into the QIT.

What happens if we deposit too much at home?

The extra stays in the trust or is paid out for allowed expenses. It cannot be returned to the person for living costs, and whatever remains at death goes to the State. The fix is to lower the monthly transfer.