Government Benefits Flashcards
(35 cards)
What do “incapacity” and “incompetence” refer to for purposes of Special Needs Trusts?
These refer to the inability of a trustee to manage the trust.
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 4]
Generally, what does “disability” mean for government benefits eligibility?
For most purposes involving special needs trust, “disability” is “the inability to perform any SUBSTANTIAL GAINFUL EMPLOYMENT,” which is the standard used to determine eligibility for Social Security Disability Insurance and Supplemental Security Income benefits.
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 4]
When are SSDI/SSD benefits available?
Social Security Disability Insurance is available to individuals with a disability who either (1) have sufficient work history prior to becoming disabled or (2) are entitled to receive benefits by virtue of being a dependent or survivor of a disabled, retired, or deceased insured worker.
- NOTE: For SSDI, “disability” is “the inability to perform any SUBSTANTIAL GAINFUL EMPLOYMENT.”
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 5]
What is the “means” test for SSDI eligibility? What significance does this have for Special Needs Trust planning?
There is no “means” test for SSDI eligibility. Thus, SNTs may not be necessary for some beneficiaries (they can qualify for entitlements like SSDI and Medicare even though they receive income or have available resources.
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 5]
When are SSI benefits available?
The Supplemental Security Income program provides benefits to low-income individuals who are disabled, blind, or elderly and have limited income and few assets.
- NOTE: For SSI, “disability” is “the inability to perform any SUBSTANTIAL GAINFUL EMPLOYMENT.”
- NOTE: SSI eligibility rules form the basis for many other government program rules, so they are important in SNT planning and administration.
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 5]
What is Medicare?
Medicare is the federal HEALTH INSURANCE program for people who paid into the social security system while working and are either (1) over 65 or (2) under 65 and determined to be disabled by the social security administration (have been entitled to SSDI benefits for the last 24 months).
- ELEMENTS (me): [1] Paid into Social Security (internet says usually requirement is paying in for 10 years); [2] While working; [3] over 65 OR under 65 + have been entitled to SSDI benefits for the last 24 months.
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-2]
Who is entitled to receive Medicare?
Medicare benefits are available to (1) all those age 65 and over, provided that they would be entitled to receive Social Security benefits if they chose to retire (whether or not they are actually retired) and (2) those under 65 who have been receiving SSDI for at least two years.
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 5]
When (requirements) and to what degree does Medicare pay for nursing home costs?
WHEN: (1) The resident is getting physical or occupational therapy at least 5 days per week or skilled nursing care for 7 days per week (“Therapeutic skilled nursing care”) and (2) The resident has been hospitalized for at least 3 days within the 30 days prior to admission to the nursing home.
HOW MUCH: If the above requirements are met, Medicare will pay all nursing home care costs for the first 20 days. After this, the insured will be required to pay co-insurance (Medicare pays 80% and the insured pays 20%).
Who runs Medicare and who runs Medicaid (Federal vs. State)?
Medicare is operated and funded by the federal government. Medicaid is run by state governments but is partially funded by the federal government.
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 5]
What does CMS stand for? What department is it under?
The Centers for Medicare and Medicaid Services. It is under the federal department: the Dep’t of Health and Human Services (HHS).
What is Medicaid?
Medicaid is a medical assistance program for people who have income and assets below a certain amount (a welfare program).
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-2]
Regarding Medicaid, what limits are placed on how strict states can be when determining eligibility?
States are generally prohibited from using eligibility standards that are more restrictive than those used by the Supplemental Security Income (SSI) program.
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-3]
What nursing home care will MEDICAID pay for?
What timeline (number of days) limits apply?
Medicaid’s nursing home program will pay for custodial nursing home care (non-medical care that helps people with daily activities). Medicaid provides coverage for most medical expenses such as physician bills and durable medical equipment.
There is no limit to days of coverage.
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-3]
When does Medicaid pay relative to Medicare and private insurance?
Medicaid is the payer of last resort, so it will only pay after Medicare or private insurance has paid its required share.
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-3]
What is COPES? What services does it provide?
Community Options Program Entry System (COPES) is a Medicaid program designed to help persons avoid institutionalization.
It covers long-term care delivered at home, in adult family homes, and in assisted living facilities.
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-3]
What are the requirements for COPES?
COPES has different limits than other Medicaid services. It has the same financial eligibility rules as the Medicaid nursing home program, but in addition, applicants must either (1) currently be in a nursing home OR (2) establish that they are likely to be institutionalized without COPES but can safely reside at home (or in a non-institutional residential facility) with COPES services.
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PGs: 1-3 & 1-4]
What retroactive coverage does COPES offer?
There is no retroactive COPES coverage.
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-4]
What are the Medicaid rules for INCOME for a SINGLE PERSON applying for NURSING HOME benefits?
What result if the applicant’s income is above the Medicaid rate but below the private pay rate?
In a nursing home, a single individual’s income must be less than the PRIVATE PAY RATE in the facility plus the APPLICANT’S REGULARLY RECURRING MONTHLY MEDICAL EXPENSES.
If an applicant’s income is above the Medicaid rate and below the private pay rate, the applicant will be certified as eligible for Medicaid and will only have to pay the Medicaid rate. In this case, however, the applicant must spend down excess income over the Medicaid rate on medical costs before they will be eligible for Medicaid coverage for other medical expenses.
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-5]
What are the Medicaid rules for INCOME for a SINGLE PERSON applying for COPES benefits?
There is a fixed income cap for the Medicaid COPES program. In 2024, it’s $11,584(?).
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-5]
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How does payment work regarding Medicaid and nursing homes?
Medicaid pays nursing homes at its own reimbursement rate for that particular nursing home.
[SOURCE: “Medicaid and Special Needs Planning: Practice Tips When a Client is Elderly or Disabled”; PG: 1-3]
What is the most common source of funds for special needs trusts?
Lawsuit proceeds (often a lawsuit over the injury that caused the disability).
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 5]
What is the key element for determining whether a SNT is “self-settled?”
The key test in determining whether a trust is self-settled is to determine whether the beneficiary had the right to outright possession of the proceeds prior to the act establishing the trust.
- If so, public benefits eligibility rules will treat the beneficiary as having set up the trust even though the actual implementation may have been undertaken by someone else acting on their behalf.
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 5]
What are “Sole Benefit” trusts?
Trusts in which, via gifting in trust, a grantor secures Medicaid benefits for both themselves and the grantee.
[SOURCE: “Administering a Special Needs Trust: A Handbook for Trustees (2021 Edition)”; PG: 6]
