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Aged, Blind and Disabled Manual Section: Institutional Medicaid Policy Manual Number: 125.020 Chapter: Post-Eligibility Treatment of Income

July 1, 2026 Division of TennCare 5 vi. QIT Fees A QIT is a trust established for individuals seeking LTSS who are ineligible for TennCare Medicaid due to excess income. See the Qualified Income Trust (QIT) or Miller Trust section in the ABD Trusts policy. Individuals who establish a QIT for the purpose of becoming TennCare Medicaid eligible in Institutional Medicaid are allowed a QIT allowance. The purpose of the QIT allowance is to cover any bank fees associated with maintaining the QIT. Subtract a $20 QIT Allowance, or other verified amount, from total income for individuals who establish a QIT for TennCare Medicaid eligibility purposes, if applicable. d. CSIMA When determining an institutionalized individual’s patient liability, an allowance is deducted from his or her income for the needs of the community spouse. The CSIMA is allowed unless specifically refused by the institutionalized spouse. Funds must actually be transferred to the community spouse to be deducted. i. When to Allow a CSIMA 1. The CSIMA is allowed unless specifically refused by the institutionalized spouse. 2. Funds must actually be transferred to the community spouse in order to be deducted. 3. A CSIMA is not allowed if both spouses are institutionalized. 4. A CSIMA is allowed when one spouse is institutionalized in a nursing facility and the other is eligible for HCBS in the community. 5. If the community spouse applies for TennCare Medicaid, the CSIMA will be counted as unearned income. 6. A community spouse receiving SSI, Families First (FF), Veteran’s Affairs (VA) Pension, TennCare Medicaid or means-tested benefits does not have to accept the total or any of the income allocation if it will result in the termination or decrease of those benefits. 7. If a couple is married but living separately, and consider themselves to be separated, the CSIMA may be allowed if both individuals agree to the allocation and the community spouse is not institutionalized. 8. If the community spouse lives out of state, the CSIMA is allowed if the community spouse can be located and the couple is still married.