Presenting a live 90-minute webinar with interactive Q&A Coordinating Medicare, Medicaid and Disability Benefits for Elder and Special Needs Clients WEDNESDAY, NOVEMBER 29, 2017 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific Today’s faculty features: Christine A. Alsop, Elder Law Practice Group Leader, TuckerAllen , St. Louis David Pollan, Partner, The Pollan Law Firm , Atlanta Lori J. Parker, Esq., Parker Law Office , Rochester, N.Y . The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10 .
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INTERPLAY OF MEDICAID AND SSI MEDICARE SAVINGS PROGRAMS DAVID PAUL POLLAN, ESQ. david@pollanlawfirm.com
FINDING THE LAWS AND NAVIGATING THE MEDICAID SYSTEM Medicaid was designed to meet the healthcare needs of low-income Americans and was enacted into law in 1965 through Title XIX of the Social Security Act, 42 U.S.C § 1396 et seq . Medicaid is a partnership between the federal government and individual states with financial contributions from each to provide medical care, supportive services, and prescription drugs for those individuals who meet income and/or resource testing limits. Although states are not mandated to participate, all 50 states have a Medicaid program. 6
THE BASICS OF SUPPLEMENTAL SECURITY INCOME (SSI) SSI provides a monthly cash benefit to a disabled individual or to a representative payee appointed by the Social Security Administration to manage the benefit on behalf of the disabled beneficiary. Like Medicaid, eligibility for SSI is contingent on the individual being “aged”, “blind”, or “disabled” and meeting income and assets eligibility criteria. 7
KEY MEDICAID RELATED LAWS The federal government requires each participating state to cover certain Medicaid services (called “mandatory”) and then permits the state to add additional services if the state chooses (“non - mandatory” services). The states also have some flexibility in determining who will be eligible for Medicaid in he state. Because of this flexibility, each state’s Medicaid program is different. 8
SSI & MEDICAID ELIGIBILITY 1634(a) States Refers to the majority of states under the Social Security Act that have a contract with the Social Security Administration to determine eligibility for Medicaid at the same time a determination of eligibility is made for SSI benefits. These States also use the SSI eligibility criteria for Medicaid eligibility for their aged, blind and disabled SSI recipients. 9
SSI CRITERIA STATES Refers to those states that use the same Medicaid eligibility criteria that is used by social security for SSI eligibility, but require individuals to apply separately for Medicaid. 10
209(b) STATES Refers to those states that use more restrictive eligibility criteria for Medicaid eligibility that is used by Social Security for SSI eligibility. 11
WHAT DOES “MEANS -TESTING MEAN? “Means” or “needs” tested refers to financial eligibility requirements for the respective benefit government program. In the State of Georgia, there are more than 23 classes of medical assistance or Medicaid. SSI and Medicaid have both income and asset testing requirements for eligibility. Depending on the class of Medicaid, there may only be income, but not asset testing. 12
MEDICAID QUALIFICATIONS – THE BASIC RULES There are two main steps to qualifying for Aged, Blind or Disabled Medicaid. The individual must be: Aged, or be totally disabled, or be blind. ● Aged is defined as 65 years or older. ● Disabled is defined as “the inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment. ● Blind is defined as “a central visual acuity of 20/200 or less in the better eye with the use of correcting lens, or limitation in the fields of vision such as the widest diameter of the visual field. 13
CLASSES OF MEDICAL ASSISTANCE A person must fall within at least one class of assistance. In Georgia, there are over 20 different coverage categories of Medicaid, known as classes of assistance, each with it’s own eligibility criteria. The class of assistance that an individual is eligible for is determined by a person’s living arrangement, types and amounts of income, marital income, marital status and prior Medicaid coverage, among other factors. 14
MEDICAID WAIVER PROGRAMS ● Community Care Services Program (CCSP) ● Services Options Using Resources in a Community (SOURCE) ● Independent Care Waiver Program (ICWP) ● New Options Waiver Program (NOW) and Comprehensive Supports Waive Program (COMP) 15
FINANCIAL CONSIDERATIONS AND GOVERNMENT BENEFITS The Basics of Nursing Home Medicaid and Medicaid Waivers (excluding SOURCE ). For 2017, the income “cap” for institutional classes of Medicaid and most of the Medicaid Waivers is $2,205/month in gross income ( i.e., before deductions for the Medicare Part B and D premiums). Only the income of the Medicaid eligible is considered for eligibility purposes; the income of a community spouse is disregarded. 16
THE FOSTER CARE INDEPENDENCE ACT OF 1999 AND SSI ELIGIBILITY ISSUES The “Foster Care Independence Active of 1999 ” radically altered how assets may be preserved for purposes of SSI eligibility. The law included new SSI “anti - fraud” provisions to pay for the increased foster care spending. The major SSI changes included reinstatement of the SSI transfer of assets penalty which was abolished in 1988, and changes to the SSI rules regarding the treatment of trusts as a resource for eligibility purposes. SSI and Medicaid rules governing third-party trusts, such as testamentary trusts or inter vivos trusts established with a third party’s assets for the benefit of a disabled individual remain unchanged. 17
SSI TRANSFER OF ASSETS PENALTY Section 206 of the Act reinstates the transfer of assets penalty which was eliminated by Congress in 1988. The SSI rules provide for a maximum 36 month penalty period for asset transfers for the purpose of qualifying for SSI. The penalty is calculated based upon the value of the asset transferred divided by the SSI benefit rate. 18
Family The Interplay of Medicaid and SSDI Christine A. Alsop, TuckerAllen calsop@tuckerallen.com November 29, 2017 20
The main federal government benefits programs for the disabled Family • Supplemental Security Income (SSI) • Medicaid • Medicaid Waiver Programs • Social Security Disability (SSD) • Medicare • Federally Assisted Housing through HUD (Department of Housing and Urban Development) • Food Stamps 21
A Primer on Public Benefits Benefits based on Needs Based Benefits Entitlement SSD (Social Security Supplemental Disability) Cash Security Assistance CDB Income (Childhood Disability Benefits) Medical Medicaid Medicare Assistance 22
Social Security Disability Insurance (SSDI) Family Social Security Disability insurance is a national program for injured workers that have paid the requisite number of work credits into the Social Security System. 23
Social Security Disability Insurance (SSDI) Family To meet the definition of disability benefits, recipient must not be able to engage in any substantial gainful activity (SGA) because of a medically-determinable physical or mental impairment(s) that is expected to last longer than a year or end in death. 24
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