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Special Needs, Medicaid, SSI

Tuesday, July 1, 2014

VA Improved Pension and Medicaid

 

 

Joe, an 89-year-old veteran served in WWII.  He and his wife, Mary, have been living in an assisted living facility for three years and Joe has been receiving VA Pension with Special Monthly Pension for Aid and Attendance.  Joe recently fell, and his physician has decided Joe cannot return to the assisted living facility.  Joe is now in a Nursing Home and needs to apply for Medicaid to cover the cost of his care.   

 

VA Pension Benefits can be a lifesaver for veterans or their surviving spouses who need home care or assisted living facility care.  The added money the VA awards eligible veterans or their surviving spouses when added to social security income is often just enough to help a veteran or spouse afford to stay at home with companion care or be able to move to a good assisted living facility (ALF). 

 

When a veteran, his or her spouse or surviving spouse needs skilled nursing care in a skilled nursing facility or nursing home, though, the VA Pension is often not enough to cover the cost of that level of care.  The average cost of a semi-private room in a nursing home in Georgia is about $181.00/day or about $5430.00 for a 30-day month, according to the MetLife Survey of Long-Term Care Costs published in November of 2012.    For 2014, the maximum VA Pension award for a married couple is $2085.00. *(This maximum amount includes Basic Improved Pension plus Special Monthly Pension for Aid and Attendance).  Currently, the Social Security Administration estimates that the average Social Security benefit for an aged couple when both are receiving benefits is $2,111., while the average for a single aged widow or widower is $1243 per month.   Since the combined VA Pension and Social Security rarely exceed the $5000 monthly price tag for a nursing home stay, the veteran or spouse may need to qualify for Medicaid in order to afford to live in the nursing home. 

 

Medicaid is a federal/state program available to people with low assets and income who meet the physical requirements for admission to a nursing home.  Generally, that means that the person is deficient in some of the activities of daily living.  While circumstances vary, usually a Medicaid recipient pays his or her monthly income to the nursing home, and then Medicaid pays the difference up to the amount Medicaid has contractually agreed to pay the nursing home. 

 

A single veteran who qualifies for Medicaid will have his entire VA pension benefit reduced to $90.00.  If a veteran is married and qualifies for Medicaid, whether or not he can continue to receive Improved Pension will depend on whether his spouse’s income is sufficiently reduced by unreimbursed medical expenses to make them eligible for the Improved Pension award. 

 

A married veteran can still receive the VA pension benefit and the additional part considered to be aid and attendance, so long as he would be otherwise eligible for the benefit.  If the income of the couple is less than the pension amount, the award can be apportioned to the spouse who is not in the Nursing Home and receiving Medicaid.

 

If Joe goes into the Nursing Home and begins receiving Medicaid, his Pension with Aid & Attendance can be apportioned for Mary to spend on her Assisted Living Care. 

 

 

 

 


Monday, March 18, 2013

Come hear Patti speak Tuesday, March 26th!

Come join us at the Tapestry House of Alpharetta Tuesday, March 26th at 6:30pm.

Patti will be speaking about the difference between being housebound with a  caregiver vs moving into an Assisted Living Facility. 

All are welcome!

 

 

 

 

 


Tuesday, March 12, 2013

March is Social Work Month!

Featured Article by Thom Corrigan, MSW, CMC

Each March we are asked to celebrate Social Work month. For some, this means sending a note or an e-mail to a social worker we may know. For others, it may be treating a social work colleague to lunch or bringing them a plant or some flowers to show our appreciation for them.

But this year, I invite you all to celebrate what social workers do, in addition to who they are. Social workers possess many traits and skills. These include being trained to serve as advocates and brokers for our clients. Social workers have developed skills in the areas of empowerment, resourcefulness, problem solving and helping people with transition. They help people to learn new skills while at the same time, helping them to regain confidence, self-esteem, self-determination and resilience. Social workers do this in part by modeling, teaching, empowering, counseling and developing in a person the traits and characteristics that will lead to better outcomes and create a heightened sense of accomplishment and independence.

Each year, the National Association of Social Workers (NASW) creates a theme as part of its celebration for social work. This year's theme is "Weaving Threads of Resilience and Advocacy: The Power of Social Work."   Lastly, did you know that Social Work is the only profession that has the word "WORK" in its name? I find that interesting-

Happy Social Work Month to all my professional peers and colleagues and thanks for all that you do to help people with their everyday needs and challenges!

Thom Corrigan, MSW, CMC
Certified Care Manager


Monday, February 11, 2013

Helpful News for Trustees and Beneficiaries for Special Needs Trusts

Last fall the Social Security Administration quietly released the text of changes to the Program Operations Manual System -- the POMS. Though described as "clarifications" by Social Security, they were actually far-reaching changes that would have driven up the cost of trust administration, complicated the lives of beneficiaries and provided no additional protection for anyone involved.

Lawyers, trustees and advocates raised objections, and thankfully Social Security listened. Last week another set of changes were announced and the news is entirely good for everyone.

First, a word about POMS. This not very well known set of rules has far-reaching effect. It is a manual of instructions for Social Security eligibility workers, explaining how to treat all manner of documents, transactions and information obtained in the course of eligibility applications and reviews. You can look at the POMS online, but you will quickly see that it is a complicated, detailed and tightly-written set of rules.

The POMS is not law. It is not even a set of regulations governing Social Security eligibility. It has no legal force, and so one might think it is not important. Actually, it is more important than the law, at least in day-to-day decision-making. It is the document Social Security eligibility workers look to when faced with any wrinkle, confusion or question.

The changes last fall addressed several sections of the POMS dealing with how to treat expenditures from special needs trusts. Some of the changes focused on just "self-settled" special needs trusts, others included expenditures by "third-party" special needs trusts and perhaps even payments by family members or others who try to help recipients of Supplemental Security Income (SSI).

Among the changes posted last fall:

  • When family members paid for items for a trust beneficiary -- like medical supplies, clothing, transportation or pretty much anything else -- reimbursement from a trust would be treated as income to the beneficiary, even though nothing ever went through the beneficiary's hands or account. The same would have been true for trust payments to the family member's credit card.
  • Payments for caregiving could not be made to a family member unless the family member was certified in some way. (This change actually wouldn't have made much difference in Arizona, since a variation of this rule is already in place for Arizona Medicaid -- AHCCCS/ALTCS -- recipients.)
  • Travel expenditures for third persons to visit a trust beneficiary would have been prohibited in pretty much all circumstances.

What changed? Social Security initially removed the change governing travel, and then indicated that the others were under review. Reportedly the high-level reconsideration included senior staff and even out-going Social Security Commissioner Michael J. Astrue (who had already submitted his resignation from that post, to be effective February 13, 2013). Commissioner Astrue wanted the reconsideration completed before the end of his tenure, so Social Security moved very quickly to make changes.

Last week one of the reviews got completed, and the reimbursement policy changed. Not only did it change -- it actually changed to make good sense. Now POMS section SI 01120.200 E.1.d, "Reimbursements to a third party," reads:

"Reimbursements made from the trust to a third party for funds expended on behalf of the trust beneficiary are not income.

"Existing income and resource rules apply to items a trust beneficiary receives from a third party. If a trust beneficiary receives a non-cash item (other than food or shelter), it is in-kind income if the item would not be a partially or totally excluded non-liquid resource if retained into the month after the month of receipt. If a trust beneficiary receives food or shelter, it is income in the form of in-kind support and maintenance (ISM)."

Similar changes have been made in another, related section, SI 01120.201 I.1.f.

What does it mean?

  •  It means that an arrangement used by trustees all over the country, though without any specific authorization, has now been formally blessed by Social Security.
  • It means that the trustees of special needs trusts can reimburse family members who buy clothing, bedding, diapers, supplements, medical devices, transportation services, furniture -- all manner of items -- without risking loss of benefits from Social Security.
  • It means that all of those things can be done without limiting or losing benefits from AHCCCS and ALTCS (Arizona's version of Medicaid). It means that a system that worked well, was responsible and cost-effective, is now available again to trustees, beneficiaries and family members.

Word is that the other changes are in the works for release this week. Here's hoping all the changes will be as thoughtful and responsive to practical realities.


Monday, January 21, 2013

Can A Special Needs Trust Pay for things such as Credit Card Bills or Security Deposits?

   Administering a "special needs" trust can be a challenge. The rules often seem vague, and they occasionally shift. What may seem like a simple question might actually involve layers of complexity. Sometimes expenditures might be permissible under the rules of, say, the Social Security Administration, but not acceptable to AHCCCS, the Arizona Medicaid agency -- or vice versa. Trustees work in an environment of many constantly-moving parts.

Take these two examples:

Example 1:  Being the trustee of a Self-Settled Special Needs Trust for a sister. Can you pay her credit card bills?

Maybe (don't you just love lawyers' answers?). Let's break the question down a little bit.

    First, identify the trust as "self-settled." That means the money once belonged to your sister (it might have been an inheritance, or a personal injury settlement, or her accumulated wealth before she became disabled). That also means the rules are somewhat more restrictive.

We will assume that the bills are for a credit card in her name alone. If the card belongs to someone else, the rules may be different. Not many special needs trust beneficiaries can qualify for a credit card; when they can, it can be a very useful way to get things paid for (as you will soon see).

The next question requires a look at the trust document itself. It might be that it prohibits payments like the one you would like to make. That would be uncommon, but not unheard of. We will assume that the trust does not expressly prohibit paying her credit card bills.

What benefits does your sister receive? Social Security Disability and Medicare: Not a problem.But if it is Supplemental Security Income (SSI) and AHCCCS (Medicaid) there could be a problem.

    Next, we need to know what was charged to the credit card. Was it food or shelter? If it was used for meals at restaurants, or grocery shopping, or for utility bills, you probably do not want to pay the credit card bill from the trust. If you do (and assuming the trust permits it) then you will face a reduction of any SSI she receives, and possible loss of AHCCCS benefits.

Were the credit card bills for clothes, medical supplies, gasoline for her vehicle, even car repairs? There is probably no problem with paying the credit card statement. Even home repairs should be OK in most cases (just not rent, mortgage, utilities, etc. -- and the rules might be different if anyone else lives with your sister).

As you can see, what started out as a simple question turns out to have a lot of complexity. You might want to talk with a lawyer about your sister could use the credit card. When it works, though, it can be quite beneficial.

Example 2: Can a special needs trust pay the security deposit on a new apartment?

What an interesting question. We think the answer is probably "yes."

Once again we need to look at the trust document itself. Was it funded with your own money (like a personal injury settlement), or was the trust set up by a relative or friend with their own money? Is there language prohibiting payment for anything related to your apartment?

Assuming no trust language prohibits the payment, we can turn to the effect such a payment would have on your benefits. Social Security Disability and Medicare? Once again, no problem. SSI and AHCCCS/Medicaid? Your benefits might be reduced, but the payment can probably be made.

The key question is whether a "security deposit" is "rent." Arguably, it is not, rather it is an advance payment for cleaning. A special needs trust, even a self-settled special needs trust ,can pay for cleaning. Social Security's rules treat payment of "rent" as what's called "In-Kind Support and Maintenance (ISM)." This payment, we think, should not be characterized as ISM.

If it is not ISM, then it should have no effect on your SSI or your AHCCCS benefits. If it does, it might simply reduce your SSI payment (by the amount of the deposit, but capped at about $250). So long as you still get SSI it should not have any effect on your AHCCCS benefits.

Are these rules unnecessarily complicated? Yes. Does it sometimes end up costing more in legal fees to figure out what to do than it would to just pay the bills? Yes. Welcome to the complex world of Special Needs Trust Administration. Would it be possible to write simplified rules that allowed limited use of special needs trust funds while saving a bundle on administrative expenses? Yes, but please don't hold your breath while waiting for them.

 


Friday, January 11, 2013

New Scholarships in Georgia allowing Special Needs Children to attend Private schools with better care are changing lives!

http://www.daily-tribune.com/view/full_story/8961920/article-The-Georgia-Special-Needs-Scholarship-Program-is-changing-lives


Wednesday, January 2, 2013

The start to a new life for the Mentally Disabled

   It is a new strategy for Georgia, one of several states responding to mounting pressure from the Justice Department, which in recent years has threatened legal action against states accused of violating the civil rights of thousands of developmentally disabled people by needlessly segregating them in public hospitals, nursing homes and day programs.

   For a family with a loved one who is mentally disabled, one of the hardest decisions they will have to face is determining the proper care for their loved one. Until recently, many mentally disabled persons have been placed in hospitals to live for the rest of their lie. While they are under constant care, there are social elements that are missing when living in a hospitals. These social elements, such as sense of community, friendships, and acitivies like dancing, are essential for personal growth.

  The link below is a story that exemplifies the importance of providing better living options for those who need it most.

 

 

 

http://www.nytimes.com/2012/09/30/us/ending-segregation-of-the-mentally-disabled.html?pagewanted=all&_r=0


Monday, November 26, 2012

IRS Issues Long-Term Care Premium Deductibility Limits for 2013

IRS Issues Long-Term Care Premium Deductibility Limits for 2013

The Internal Revenue Service (IRS) is increasing the amount taxpayers can deduct from their 2013 taxes as a result of buying long-term care insurance.

Premiums for “qualified” long-term care insurance policies (see explanation below) are tax deductible to the extent that they, along with other unreimbursed medical expenses (including Medicare premiums), exceed 7.5 percent of the insured’s adjusted gross income. This threshold is rising to 10 percent on January 1, 2013, although it will remain at 7.5 percent for taxpayers 65 and older through 2016.

These premiums — what the policyholder pays the insurance company to keep the policy in force — are deductible for the taxpayer, his or her spouse and other dependents. (If you are self-employed, the tax-deductibility rules are a little different: You can take the amount of the premium as a deduction as long as you made a net profit; your medical expenses do not have to exceed a certain percentage of your income.)

However, there is a limit on how large a premium can be deducted, depending on the age of the taxpayer at the end of the year. Following are the deductibility limits for 2013. Any premium amounts for the year above these limits are not considered to be a medical expense.

Attained age before the close of the taxable year Maximum deduction for year
40 or less $360
More than 40 but not more than 50 $680
More than 50 but not more than 60 $1,360
More than 60 but not more than 70 $3,640
More than 70 $4,550

Another change announced by the IRS involves benefits from per diem or indemnity policies, which pay a predetermined amount each day.  These benefits are not included in income except amounts that exceed the beneficiary’s total qualified long-term care expenses or $320 per day (for 2013), whichever is greater. (The 2012 limit was $310.)

What Is a “Qualified” Policy?

To be “qualified,” policies issued on or after January 1, 1997, must adhere to certain requirements, among them that the policy must offer the consumer the options of “inflation” and “nonforfeiture” protection, although the consumer can choose not to purchase these features. Policies purchased before January 1, 1997, will be grandfathered and treated as “qualified” as long as they have been approved by the insurance commissioner of the state in which they are sold.

The Georgetown University Long-Term Care Financing Project has a two-page fact sheet, “Tax Code Treatment of Long-Term Care and Long-Term Care Insurance.” To download it in PDF format, go to: http://ltc.georgetown.edu/pdfs/taxcode.pdf


Monday, November 12, 2012

Seniors Beware: How Much Salt are you Eating?

      Just like with most things in life, salt is best in moderation. Salt has been around for thousands of years and has served multiple purposes from being a means to preserve meats to adding flavor to a dish. But did you know that too much salt can create health problems including high blood pressure and heart disease? It is not just the french fries or the potato chips that we have to watch out for, but items that are packadged and heavy card-based.  On National Eating Healthy Day, the American Heart Association developed a list of six items that we should be mindful of consuming because of their above average levels of sodium. Please click the link to find out what are the 'Salty Six'.

 

http://seniorjournal.com/NEWS/Nutrition-Vitamins/2012/20121107-Seniors_Take_Heed.htm


Sunday, August 28, 2011

Protecting People with Special Needs: Guardianship of Young Adults


Most parents are conflicted when their children reach their 18th birthday.  For many families, that means their child will soon be leaving home for college, a new job, or the military.  For parents of children with developmental disabilities, it can be very scary when that child turns 18, because the law presumes an 18-year-old is an adult with the legal rights and responsibilities that come with adulthood.  When a child turns18, the parent no longer has the legal authority to make decisions for that child.

Joshua, a good-looking young man with a developmental disability, turned 18 six months ago.  Josh is friendly and outgoing.  They say he never met a stranger.  Josh, who functions intellectually on the level of a second grader, has been known to give his lunch money away on more than one occasion.  Josh does not tell his parents when he is feeling sick, and once cut his arm and used the wall to stop the bleeding. His parents came to me because they are conflicted about whether to seek guardianship of Josh.

Guardianship is a legal relationship created by a court. The guardian has the legal authority to make decisions about the healthcare and living arrangements of another person, called a ward.  The guardian also has the duty to look out for the welfare of the ward.  The relationship is very much like that of parent and child, where the law presumes that the ward is not able to make his or her own decisions about his or her healthcare or living arrangements.

Whether to seek a guardianship can be a difficult decision because parents want their children to gain independence, to learn to function in the world on their own and to make their own decisions.  When someone becomes a ward, they lose the legal ability to make healthcare decisions, to choose where to live, to enter into contracts, and to marry. 

Guardianship in Georgia is granted if the adult “lacks significant capacity to make or communicate significant responsible decisions” about his or her health or safety.  In order to decide whether to grant a guardianship, the court reviews a petition filed by the proposed guardian, appoints a professional to evaluate the proposed ward, and then holds a hearing in the courthouse to gather evidence about the decision-making ability of the proposed ward.

Josh’s parents ultimately decided that they need to become Josh’s guardians in order to continue to make decisions about his healthcare and where he lives, but also to ensure that he would not be enticed into signing any contracts that might bind him to spending money he doesn’t have.  Although they would like for Josh to get married some day, I explained that they can petition the court if and when Josh meets the right person and they believe he is mature enough to marry.

Please give our office a call if you have questions about whether you might need to seek guardianship of a young adult.

Next week, we’ll talk about when guardianship of minors, when that  might be necessary and how to choose guardians for your minor children.


Sunday, July 31, 2011

Caring for Children with Special Needs: Combating Autism Reauthorization Act of 2011

 Caring for Children with Special Needs

Combating Autism Reauthorization Act of 2011

You can’t turn on the television or radio without hearing about the negotiations – or lack of negotiations- in Congress regarding the looming budget crisis.  We are all concerned about whether our elected representatives in Washington can come to a compromise that will help the country out of the current debt crisis.  Of great concern to those of us who work with families who have family members with special needs is whether, and how, the few programs left to support these families will be affected.

Assuming Congress gets through these negotiations and gets back to work on other  important issues, Congress has the opportunity to address a significant issue that the United States faces today.  That issue is that the number of persons diagnosed as being on the Autism spectrum is increasing at an alarming rate.  It is estimated that 1.5 million Americans are currently on the Autism spectrum.  That number is expected to increase by 10-17% annually. 

A growing concern is that the number of autistic children entering adulthood is also increasing rapidly.   By 2023, the number of autistic children entering adulthood is estimated to be 380,000.  The cost of care for these adults is said to be around $27 million, or about the budget of the state of Tennessee. 

On August 3, 2011, the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) is scheduled to meet for hearings on the Reauthorization of the Combating Autism Act, originally passed in 2006.  The Combating Autism Act allocated $950 million dollars over the five year period for the Centers for Disease Control (CDC), National Institutes of Health (NIH), and other governmental agencies to conduct research on the autism spectrum.  The Act required the Director of NIH to develop and implement a strategic plan for autism research.  If the Act is not reauthorized by September 30, 2011, the federal commitment will disappear.

The current bill, named the Combating Autism Reauthorization Act (CARA), would allocate the federal funding of $1billion and create a National Institute of Spectrum Disorders Research within the NIH.

If CARA is not passed, research on the spectrum will likely be thrown into disorder.  We cannot afford to let this bill die.  Research into the reasons for the disorders on the spectrum, and especially research into treatment and therapies, is crucial. 

If you would like to find out more about CARA, and how you might be able to help make sure this Act is passed, see http://www.autismvotes.org/site/c.frKNI3PCImE/b.6376831/k.ACFC/CARA.htm.

 

 

 

 

 

 

 

 

 

 

 

 


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