I wanted to post this information that came from my very smart, very detail oriented Medicaid and Social Security advocate, who used to work for the state health and human services department and who knows Medicaid law far better than most attorneys, even those that work with Medicaid (typically elder law attorneys). You can see below just how complex things can get with government benefits.
"Most attorneys are familiar with the SSI deeming rules that restrict payments from a SNT for food or housing (thank goodness the restriction on food will go away on 9/30/2024).
Technically, the SSI deeming rules don't apply to RSDI/SSDI cases, UNLESS the RSDI/SSDI recipient has Medicare but doesn't have DAC Medicaid and needs to apply for a Medicare Savings Plan (MSP) to help pay for their Medicare premiums and out-of-pocket costs.
Since the deeming rules CAN apply to RSDI/SSDI recipients who have MSP plans, it is probably easier for most people who work with Special Needs Trusts to restrict SNT payments for housing and food for ALL SNT clients because it would be extremely difficult for the SNT administrators to keep up with which SSDI recipients have DAC (no deeming) versus MSP (deeming required unless the MSP recipient has a Medicaid Waiver), because DAC status and MSP status can change over time. (unlikely but can happen in certain narrow conditions).
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The 4 Medicare Savings Plans are QMB, SLMB, QI, and QDWI, and all 4 of these plans require deeming for Support and Maintenance (S/M) if the MSP applicant is not pay his/her fair share of household expenses. The income limits of these MSP programs vary, and the deeming amount also varies by program. See HHSC MEPD Handbook Sections E-7000, Q-1000, and Appendix XXXI for details.
https://www.hhs.texas.gov/handbooks/med ... ing-income
https://www.hhs.texas.gov/handbooks/med ... s-overview
https://www.hhs.texas.gov/handbooks/med ... ence-chart
A Medicare Savings Plan (MSP) can help pay for your Medicare premium and out-of-pocket costs. The MSPs use Medicaid funds to help eligible people pay for all or some of their out-of-pocket Medicare expenses, such as Part B premiums ($174.70 in 2024), co-pays, co-insurance, and deductibles. There are 4 different MSPs:
QMB: Qualified Medicare Beneficiary Program (under 100% FPL)
Benefits:
Part B premiums, deductibles, and coinsurance, and Extra Help for Part D (Rx drugs).
Individual Income Limit: < $1,255
Support & Maintenance Deeming Amoun $449
Countable Resources: $9,430
SLMB: Specified Low-Income Medicare Beneficiary Program (100% to 120% FPL)
Benefits:
Part B premium and Extra Help for Part D. May cover deductibles and coinsurance.
Individual Income Limit: $1,255.01 to <$1,506
Support & Maintenance Deeming Amount: $538
Countable Resources: $9,430
QI: Qualified Medicare Beneficiary Program (from 120% to 135% FPL)
Benefits:
Part B premium and Extra Help for Part D.
Individual Income Limi $1,506 to <$1,695
Support & Maintenance Deeming Amount: $605
Countable Resources: $9,430
QDWI: Qualified Disabled & Working Individual Program (under 200% FPL)
Benefits:
Part A premium. Does not include Extra Help for Part D.
Individual Income Limit: $2,510
Support & Maintenance Deeming Amount: $897
Countable Resources: $4,000
NOTE: If you have DAC Medicaid, you don't have to apply for an MSP to pay your Medicare premium because your Medicare premium is already paid. The DAC payment for the Medicare premium comes from the SSI program. HHSC determines eligibility for the DAC Medicaid program.
NOTE: If you have a Medicaid waiver, the MSP deeming requirement for S/M will be disregarded. This applies to ALL Medicaid waivers, including the STAR+PLUS waiver (not just the IDD waivers).
NOTE: Surprisingly, the MSP deeming requirement for S/M may also apply to SSI recipients who have high income (i.e., SSI recipients who may be using SSI work-incentive programs, including PASS, IRWE, or 1619(b). "
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My disabled adult child has RSDI DAC and DAC Medicaid and a Medicaud waiver and therfore is not subject to deeming rules that impact their only means-tested government benefit, Medicaid. Therefore, 3SNT funds CAN freely be used to pay for my child's food and shelter without impacting their Medicaid. This is huge because food and shelter are typically life's 2 biggest expenses. If a 3SNT can be used for these expenses it is a huge benefit and opens up much more comfortable housing options and makes things like paying for eating out and groceries much much easier. It also reduces the level of record keeping detail a trustee has to keep to ensure distributions were not for expenses that typically negatively impact public benefits. I have yet to come across one corporate trustee that understands this. I have only come across 1 attorney that understands this and that is only because they published a chapter that included information on the subject and it was buried in a paragraph. I've now contacted that attorney to help rewrite my 3SNT because... they get it.
My successor trustee will understand this and I will be sure to provide them with an advocate or attorney that truly understands the differences in the different public benefits programs in my state. Unfortunately these people are not easy to find.
"Most attorneys are familiar with the SSI deeming rules that restrict payments from a SNT for food or housing (thank goodness the restriction on food will go away on 9/30/2024).
Technically, the SSI deeming rules don't apply to RSDI/SSDI cases, UNLESS the RSDI/SSDI recipient has Medicare but doesn't have DAC Medicaid and needs to apply for a Medicare Savings Plan (MSP) to help pay for their Medicare premiums and out-of-pocket costs.
Since the deeming rules CAN apply to RSDI/SSDI recipients who have MSP plans, it is probably easier for most people who work with Special Needs Trusts to restrict SNT payments for housing and food for ALL SNT clients because it would be extremely difficult for the SNT administrators to keep up with which SSDI recipients have DAC (no deeming) versus MSP (deeming required unless the MSP recipient has a Medicaid Waiver), because DAC status and MSP status can change over time. (unlikely but can happen in certain narrow conditions).
------------------------------------------------------------------------
The 4 Medicare Savings Plans are QMB, SLMB, QI, and QDWI, and all 4 of these plans require deeming for Support and Maintenance (S/M) if the MSP applicant is not pay his/her fair share of household expenses. The income limits of these MSP programs vary, and the deeming amount also varies by program. See HHSC MEPD Handbook Sections E-7000, Q-1000, and Appendix XXXI for details.
https://www.hhs.texas.gov/handbooks/med ... ing-income
https://www.hhs.texas.gov/handbooks/med ... s-overview
https://www.hhs.texas.gov/handbooks/med ... ence-chart
A Medicare Savings Plan (MSP) can help pay for your Medicare premium and out-of-pocket costs. The MSPs use Medicaid funds to help eligible people pay for all or some of their out-of-pocket Medicare expenses, such as Part B premiums ($174.70 in 2024), co-pays, co-insurance, and deductibles. There are 4 different MSPs:
QMB: Qualified Medicare Beneficiary Program (under 100% FPL)
Benefits:
Part B premiums, deductibles, and coinsurance, and Extra Help for Part D (Rx drugs).
Individual Income Limit: < $1,255
Support & Maintenance Deeming Amoun $449
Countable Resources: $9,430
SLMB: Specified Low-Income Medicare Beneficiary Program (100% to 120% FPL)
Benefits:
Part B premium and Extra Help for Part D. May cover deductibles and coinsurance.
Individual Income Limit: $1,255.01 to <$1,506
Support & Maintenance Deeming Amount: $538
Countable Resources: $9,430
QI: Qualified Medicare Beneficiary Program (from 120% to 135% FPL)
Benefits:
Part B premium and Extra Help for Part D.
Individual Income Limi $1,506 to <$1,695
Support & Maintenance Deeming Amount: $605
Countable Resources: $9,430
QDWI: Qualified Disabled & Working Individual Program (under 200% FPL)
Benefits:
Part A premium. Does not include Extra Help for Part D.
Individual Income Limit: $2,510
Support & Maintenance Deeming Amount: $897
Countable Resources: $4,000
NOTE: If you have DAC Medicaid, you don't have to apply for an MSP to pay your Medicare premium because your Medicare premium is already paid. The DAC payment for the Medicare premium comes from the SSI program. HHSC determines eligibility for the DAC Medicaid program.
NOTE: If you have a Medicaid waiver, the MSP deeming requirement for S/M will be disregarded. This applies to ALL Medicaid waivers, including the STAR+PLUS waiver (not just the IDD waivers).
NOTE: Surprisingly, the MSP deeming requirement for S/M may also apply to SSI recipients who have high income (i.e., SSI recipients who may be using SSI work-incentive programs, including PASS, IRWE, or 1619(b). "
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My disabled adult child has RSDI DAC and DAC Medicaid and a Medicaud waiver and therfore is not subject to deeming rules that impact their only means-tested government benefit, Medicaid. Therefore, 3SNT funds CAN freely be used to pay for my child's food and shelter without impacting their Medicaid. This is huge because food and shelter are typically life's 2 biggest expenses. If a 3SNT can be used for these expenses it is a huge benefit and opens up much more comfortable housing options and makes things like paying for eating out and groceries much much easier. It also reduces the level of record keeping detail a trustee has to keep to ensure distributions were not for expenses that typically negatively impact public benefits. I have yet to come across one corporate trustee that understands this. I have only come across 1 attorney that understands this and that is only because they published a chapter that included information on the subject and it was buried in a paragraph. I've now contacted that attorney to help rewrite my 3SNT because... they get it.
My successor trustee will understand this and I will be sure to provide them with an advocate or attorney that truly understands the differences in the different public benefits programs in my state. Unfortunately these people are not easy to find.
Statistics: Posted by startabatha — Mon Jul 01, 2024 8:51 am — Replies 54 — Views 3477