Supplemental Security Income (SSI)

ABLE Accounts for People with Special Needs

Posted on February 9, 2017 by Jim Koewler — No Comments ↓

ABLE Accounts seem to be here to stay.

ABLE stands for Achieving a Better Life Experience. ABLE Accounts are financial accounts through which someone with special needs can spend money for many things that will enhance the person’s quality of life.

In Ohio, where I practice, they are called STABLE accounts. The ST stands for State Treasurer. (A politician can’t help but put his/her name on something.) Oddly, Ohio is one of the leaders in the U.S. in making ABLE accounts available. Ohio is the first state to make them available

These accounts are “special” accounts for people who have disabilities. They receive favorable tax treatment and will not (in most instances) impact the person’s government income (SSI) and health (Medicaid) benefits. In exchange for the tax treatment and lack of impact on government benefits, these accounts will have a number of limitations, so the politicians’ words “enhance the quality of life” and the “better life experience” are bits of puffery.

To be sure, ABLE Accounts will be useful. In fact, there is one particular use of these accounts that is quite a big step forward. Still, despite the highfalutin words of Congress, an ABLE account is not a panacea.

I’ve discussed ABLE accounts before. The February 2, 2015 installment described the federal legislation that created the ABLE account. The April 17, 2015 installment discussed how an ABLE account can be used to help qualify for SSI (Supplemental Security Income) and for Medicaid.

THE BASICS

The person who owns the ABLE account must be disabled or have been disabled before age 26. There is talk of raising the age, but nothing has happened yet.

The person can have only one ABLE account. Not one per state per person – only one per person, nationwide.

Anyone can contribute to an ABLE account. The total of ALL contributions cannot exceed $14,000 per year. This number is pegged to the amount of a gift that does not trigger the requirement to file a gift tax return. As the gift tax exclusion goes up with inflation, so will the ABLE account maximum contribution amount. Unlike the gift tax exclusion, however, the ABLE account deposit isn’t on a per person basis. The maximum is per account per year, not per donor to the account. For example, if Dad deposits $14,000 into child’s ABLE account in January 2017, no one can give anything more to the account until 2018. Deposits are NOT tax deductible, though.

If an ABLE account holds more than $100,000, SSI will be shut off until the value falls back below $100,000. Medicaid will not be shut off, though. With a maximum contribution of $14,000 (unless interest rates really jump or the stock market takes off,) it will be seven years before any ABLE account gets to that amount.

Whatever is left in the ABLE account when the person dies will go to pay Medicaid first (up to the amount that Medicaid spent on the person.) If the person relies on Medicaid for health costs, he/she should not allow the ABLE account to accumulate.

Money in a ABLE account can grow tax-free. (It’s sort of like a Roth IRA that way. The initial deposit isn’t pre-tax money, but the growth of the money in the account is tax-favored.) In fact, if the contents of the ABLE account are spent on disability-related expenses, the growth isn’t taxed. If, though, ABLE funds are used to pay some expense that is NOT disability-related, there’s a 10% penalty on that expenditure. It’s important to take great care when spending ABLE funds.

Ohio’s STABLE account can be invested in mutual funds or in a checking account. There are different mutual fund choices to allow for aggressive investors or cautious investors. (Remember that the ABLE account is a Medicaid-payback account, so these mutual fund options are attractive only to someone who is sure that he/she will NOT rely on Medicaid for care. I suspect that only a few people who are eligible to open ABLE accounts can fairly expect not to use Medicaid.) Because of the likelihood that many or even most people may come to depend on Medicaid during their lifetimes (becuase of the likelihood of people needing long term care,) I cannot stress how bad an idea it seems to allow an ABLE account to accumulate above one’s near-term needs. (Use, if possible, a Wholly Discretionary Trust if trying to allow accumulation of the money.

An ABLE Account is going to be almost as easy to use as a checking account. It can have a debit card as well. Because expenditures from the ABLE account lose their protection if not made for “disability related expenses,” avoid the debit card. The debit card is a mistake waiting to happen.

THE MOST IMPORTANT USE OF AN ABLE ACCOUNT

An ABLE account can be used to pay for housing.

That may not seem important, but it is.

Supplemental Security Income (SSI) is the source of income for a great number of people who are disabled before age 26 (the age by which someone must be disabled to qualified for an ABLE account.) An SSI recipient over age 18 can have his/her payments be reduced if the recipient receives help paying for housing. That reduction can be up to a third of the SSI payment that the person could otherwise receive.

People who are disabled as children tend to live with Mom and Dad for most or all of their lives. Mom and Dad may be well to do, living in an expensive house. The fair market rent to live in an expensive house can easily exceed one third of the maximum SSI payment, $245. (The maximum SSI payment for 2017 is $735.) For that matter, the fair market rent to live in an expensive house can easily exceed the entire SSI maximum of $735. The SSI recipient doesn’t have enough SSI income to pay fair market rent, so the SSI payment gets reduced.

Mom and Dad (or anyone else, for that matter) can place enough money into an ABLE account (as long as the total deposits during the year don’t exceed $14,000) to allow the child to pay his/her fair share of the monthly cost of the house. Then, the child/ABLE account beneficiary pays money out of the ABLE account to pay Mom and Dad for housing.

(Having the disabled person pay fair share of housing avoids tax issues while payment of “rent” runs into those tax issues. Receiving reimbursement for the fair share of housing doesn’t create income. Receiving rent creates income. That rental income can be offset by the cost of keeping up the house, but it still creates a great deal of tax recordkeeping. Collecting only the fair share of costs doesn’t create an income tax issue as long as documentation of the total cost is checked occasionally and the fair share gets adjusted when someone moves out of the house, such as a sibling moving out for college. Despite the ease of the fair share method, when calculating an SSI reduction, the Social Security Administration uses the fair market value approach.)

There are plenty of other disability-related expense that are eligible to be paid by a Wholly Discretionary. An ABLE account’s ability to pay for housing and remove the possible loss of SSI income is, in my mind, the single best use of an ABLE account.

Special Needs Trust Fairness Act

Posted on January 26, 2017 by Jim Koewler — No Comments ↓

People with special needs have a new ability to help themselves.

On December 13, 2016, President Obama signed the Special Needs Trust Fairness Act (buried within a larger law titled the 21st Century Cures Act.) The Special Needs Trust Fairness Act allows someone with special needs to create his/her own Special Needs Trust. (For background on Special Needs Trust, read the April 2, 2015 installment of this blog.)

Before adoption of the SNT Fairness Act, only a parent or grandparent of the special needs person or a court could create a SNT. As awful as it sounds, the Congress that first memorialized the concept of a Special Needs Trust must have assumed that all people with special needs lacked the ability to handle their own affairs. Of course, that was a terribly incorrect assumption. Unfortunately, the law that allows Special Needs Trusts wasn’t updated for years. Finally, that oversight is fixed.

So, what does this mean? If a person needs to create a Special Needs Trust, he/she can do it. A parent, grandparent, or court isn’t necessary. The person with special needs now has control that wasn’t available before.

Here’s an example. Some people with special needs have injury claims against someone. (Perhaps the person is the victim of medical malpractice or an industrial accident. Perhaps the injury is even the cause of the person’s disability.) The injury claim can take a long time to pursue through the court system. During the interim, the person may have started to receive Supplemental Security Income for food and housing and Medicaid for medical care. When the court award or settlement payment arrives, it can cause a break in Medicaid coverage (because the new money is “income” during the month it arrives) and long term suspension of SSI payments (because the person will have more “savings” that SSI allows.)

To avoid the loss of these benefits, the person with special needs often places the judgment/settlement award into a Special Needs Trust. Rarely was there a Special Needs Trust waiting for use. The person usually needs a Special Needs Trust set up about the time that the award is going to arrive. Before the SNT Fairness Act, the person needed a parent, grandparent, or court order to create the SNT. Now, he/she can set up the SNT directly.

Ohio Medicaid changes “Aged Blind Disabled” Eligibility

Posted on April 28, 2016 by Jim Koewler — No Comments ↓

Ohio Medicaid will change its rules on who can participate in the Medicaid Aged, Blind, and Disabled (“ABD”) program. The change will take effect in July 2016 for new applicants and will take effect with the annual renewals for existing Medicaid enrollees starting in January 2017. (The dates are subject to federal approval.) Ohio’s aim is to spend less on Medicaid. (It is a HUGE part of the state budget.)

Under federal Medicaid law, states can choose from two different ABD eligibility systems (meaning that the states can choose from two different SPENDING systems for their ABD programs.) The Ohio Department of Medicaid and the Ohio Department of Health Transformation, with a supporting change in the law by the state legislature, will change Ohio’s ABD Medicaid program from following section 209(b) of the federal Medicaid law to following section 1634 of the federal Medicaid law. Under the 209(b) system (the one that Ohio is leaving,) the states can make certain of their own choices on who is eligible for ABD coverage. Under the 1634 system (the one into which Ohio is moving,) the states must follow federal guidelines on eligibility.

The biggest differences between most states’ (including Ohio’s) 209(b) eligibility rules and the federal rules were in financial eligibility. States that followed 209(b) could have limits on income and assets that were tighter than the federal standards. That gave the appearance of keeping more people off of Medicaid ABD coverage than federal rules would have allowed.

Ohio’s rules under its 209(b) sy(tem (the old system) allowed people who had medical expenses to reduce their countable income by the amount of those medical expenses. This is called a “monthly spend down.” That spend down measurement allowed some people who had too much income “back” into Medicaid coverage. (A future installment will discuss the spend down in more detail.) The new system (under section 1634) will not allow spend downs to reduce countable income.

People with too much income won’t be left without coverage. People who have too much income to qualify for Ohio’s ABD Medicaid will be eligible for private insurance under the Affordable Care Act. Most anyone who would have qualified for ABD coverage through a spend down under Ohio’s old system will probably qualify for a highly subsidized, cost-controlled insurance policy through HealthCare.gov.

Many states followed 209(b) before the Affordable Care Act and its subsidy and cost control requirements made commercial policies affordable to more people. Many of those states have made the switch to 1634 since the Affordable Care Act has been implemented. Ohio is now following that trend.

In the installments ahead, we will discuss some of the details of this switch.

Setting aside Money for a Loved One with Special Needs

Posted on April 23, 2015 by Jim Koewler — No Comments ↓

Today’s blog post continues the series about Special Needs Law. The blog post on February 19, 2015 gave an overview of the legal issues facing people with special needs. The blog post on February 5, 2015 discussed hidden problems with the new ABLE accounts. The blog post on February 26, 2015 discussed sources of income for people with special needs. The blog post on March 5, 2015 discussed medical insurance for people with special needs. The blog post on March 12, 2015 discussed how the Social Security Administration requires people with special needs to prove a disability to qualify for Supplemental Security Income (SSI.) The blog post on March 19, 2015 discussed how the Social Security Administration requires people with special needs to prove financial eligibility to qualify for Supplemental Security Income. The blog post on March 26, 2015 gave an overview how someone with special needs can get rid of excess resources to become “poor enough” to qualify for SSI and Medicaid. The blog post on April 2, 2015 discussed how a Special Needs Trust can help shelter excess resources from SSI and Medicaid scrutiny. The blog post on April 9, 2015 discussed how a Pooled Trust can help shelter excess resources from SSI and Medicaid scrutiny. The blog post on April 17, 2015 discussed how an ABLE account (when fully implemented by the U.S. Department of Treasury and the various states) can help shelter excess resources from SSI and Medicaid scrutiny.

Today’s post discusses parents, grandparents, and other family members (and, for that matter, anyone) can make money and other assets available to someone with special needs without creating a problem with his or her Supplemental Security Income (SSI) or Medicaid eligibility.

Most parents and grandparents want to name their children and grandchildren equally in their wills. A child or grandchild who relies on SSI or Medicaid who receives assets (no matter from where the assets come) can lose SSI or Medicaid because of these new assets. The arrival of the assets can be income, causing the special needs person to fail the income eligibility test. If enough of the assets remain in the possession of person with special needs a month later, then the person may fail the asset eligibility test. When the assets are used up, then the person may get back onto SSI and/or Medicaid. (Giving the assets away to achieve eligibility will be considered an “improper transfer” or “illegal transfer,” which still creates ineligibility for the time period that the assets would have covered.)

So, how do parents and grandparents share their legacies with their loved ones who have special needs?

The most common way to leave a legacy for a loved one with special needs is through a trust. The person who wishes to make sure that money (or other assets) are available to someone with special needs will set up a trust for the benefit of that loved one. (If a trust already exists, then the person who wishes to leave money or other assets can transfer the money/assets into the already existing trust.)

First, let’s be clear about something very important. We are talking about money and other assets that never belonged to the person with special needs. Such money and assets would be considered “third-party” money/assets because they never belonged to the person with special needs (the first party) who wants government benefits (or may want benefits in the future) from Medicaid and/or SSI (the second party.)

The person who sets aside the money (Let’s call this person the “donor.”) has no legal obligation to set money aside for the person with special needs (Let’s call this person with special needs the “beneficiary” since we’re talking about trusts.) Because there is no legal obligation to give money or assets to the beneficiary, the donor’s money isn’t subject to a payback requirement like with assets placed in a stand-alone first-party Special Needs Trust or with a Pooled Trust.

So, when setting aside money for someone who needs, or will likely need, Medicaid and/or SSI, the keys are:

To avoid screwing up the beneficiary’s Medicaid or SSI eligibility, and
To avoid wasting the donated assets, like through a payback requirement after the beneficiary dies.

If the donor gives money or assets to the person with special needs, that money and those assets would then belong to the person with special needs. The money and assets must be considered in determining the eligibility (or continuing eligibility) of that person for Medicaid and SSI benefits. In other words, giving money or assets to someone on SSI or Medicaid might make that person too “rich” to get SSI or Medicaid. The person with special needs could be forced to spend the money or assets before SSI or Medicaid would be available for his or her care. The gift directly to the person with special needs makes the gifted money and assets the property of the person with special needs, and, therefore, subjects them to his or her asset and income limits. Such a direct gift reduces the costs of the government programs and increases the costs to the family.

A trust, if prepared properly, can hold the money for the person with special needs, as the lifetime beneficiary, without reducing or cutting off SSI or Medicaid benefits. The trust contents never belong to the beneficiary, so they don’t become “first-party” money. Because it isn’t first-party money, it isn’t subject to the beneficiary’s control.

The trust must also be written to avoid an obligation to pay out for things that SSI and Medicaid would normally pay. Many trusts state that they are meant for the health, maintenance, welfare, or support of the beneficiary. SSI and Medicaid pay for health, maintenance, welfare, or support. Such a trust would have to pay out for the beneficiary’s benefit before Medicaid and SSI would pay.

To avoid the perception of a payment obligation, the trust should have no payment obligation during the lifetime of the beneficiary. The best way for a trust to have no payment obligation is to have no “standard” for payment. (A “standard” for payment is an event or condition triggering a payment obligation, such as health care costs of a beneficiary when the trust says it is for the beneficiary’s health.) A Wholly Discretionary Trust, in the Ohio Revised Code, is the most often used no-standard trust for this purpose in Ohio (where I work.)

A Wholly Discretionary Trust provides that the trustee (a person other than the person with special needs) can pay out of the trust when he or she wants with complete discretion. (I wish that the name of the trust were “Completely Discretionary Trust” because people often hear “Holy Discretionary Trust” with some sort of religious meaning rather than “Wholly Discretionary Trust” is the sense of complete discretion. Unfortunately, the Ohio Revised Code uses the name “Wholly Discretionary Trust,” so that name is pretty much stuck in place.)

With a Wholly Discretionary Trust, the trustee can pay out for a beneficiary when the trustee wants, for any reason or for no reason. Likewise, the trustee can choose not to pay out of the trust for any reason or for no reason. For example, a trustee can feel pretty good about life on a sunny day and decide to use the trust contents to buy something for the beneficiary. Likewise, a Cleveland Browns fan (in a fit of frustration) could easily decide that he or she will pay no money from the trust until the Browns win the Super Bowl (meaning that the beneficiary may never get anything, if the Browns continue to play as poorly as in recent memory.)

Because a trust such as this (if set up properly) has no payback obligation, the trust can be set up to pay out to someone else after the initial lifetime beneficiary (the person with special needs) dies, acting like a will. The remaining contents of the trust (if any) can go to brothers and sisters, nieces and nephews, parents, grandchildren, or anyone else whom the grantor (the person who initially set up the trust) wishes to benefit. The remaining contents can go to a charity as well, if that is the grantor’s wish.

Some people call trusts like this “third-party special needs trusts.” I prefer not to use that label. Because first-party special needs trusts must have a payback obligation, SSI and Medicaid personnel take notice of anything that is called a “special needs trust.” I’d rather call these trusts something else to avoid having to clarify (over and over) the difference between a first-party special needs trust that has a payback obligation and a third-party special needs trust that has no payback obligation. I like to call them “supplemental services trusts.” (I don’t care if you call one “Bob” or “Stairway to Heaven.” I just suggest avoiding the words “special needs.” There’s no legal necessity to avoid those words. It’s just a suggestion to help avoid confusion.)

As mentioned above, the donor doesn’t need to set up a new trust if one already exists for a particular person with special needs. Perhaps,for example, one set of grandparents already set up a supplemental services trust for a special needs grandchild as part of the grandparents’ estate plan. Rather than creating a new trust, the other grandparents can designate that existing trust as the recipient of the money that they wish to set aside for the grandchild. (The original creators of the trust need not be grandparents. It can be anyone. I just used grandparents as an example.)

In fact (absent some serious internal family squabble,) I think it is better to have only one such supplement services trust. To work properly, a supplemental services trust should be completely separate from the people who set it up. It must be irrevocable. Because of the complete separation from a person or a married couple, the trust must pay its own taxes and have its own accounting. Two separate trusts paying for tax preparation and accounting services wastes money that could have remained in trust for the benefit of the beneficiary with special needs. To avoid duplicate trusts, the person or couple that sets up a supplemental services trust must make the trust known to other family members and to anyone else likely to wish to set aside money for the beneficiary.

To set aside money for someone with special needs, the most protective vehicle to hold that money is an irrevocable wholly discretionary trust. This allows a person with special needs to participate in the last will and testament of or a significant gift from a relative, just like the siblings and cousins who do not have special needs. At the same time, if done correctly, the gift via trust does not take away the Medicaid and SSI benefits on which the person with special needs might rely.

The ABLE Account and Qualifying for SSI and Medicaid

Posted on April 17, 2015 by Jim Koewler — No Comments ↓

Today’s post discusses how an ABLE (Achieving a Better Life Experience) account can help a person with special needs go from having too many assets to having few enough assets to qualify for (and maintain eligibility) for Supplemental Security Income (SSI) and, if necessary, for Medicaid.

I first discussed ABLE accounts in my blog post of February 4, 2015 shortly after the law creating them was passed. That blog post focused on the need to control the amount of money that goes into an ABLE account from other people, like the parents or grandparents of the person with special needs, for example (so-called “third-party money.”) Today’s blog post will focus on the usefulness of an ABLE account as a place to put first-party money (, money that belongs to the person with special needs.)

NOTE: ABLE accounts are not yet available. The necessary law has passed Congress and received President Obama’s signature. The U.S. Treasury Department must still issue implementing regulations, and the various states must approve them in each state. (The state’s do most of the work on Medicaid, so their cooperation on the interface between ABLE accounts and Medicaid is necessary.) Despite their not being available at this time, I am discussing ABLE accounts this week because, for editorial purposes, this topic fits in with the series currently underway about qualifying for SSI and Medicaid for people with special needs.

For purposes of placing “excess money” somewhere that it won’t make a person with special needs too “rich” to receive Supplemental Security Income (SSI) and/or Medicaid for long term care, an ABLE account has the same effect as a stand-alone Special Needs Trust (discussed in the blog post of April 2, 2015) and a Pooled Trust (discussed in the blog post of April 9, 2015.)

A person with special needs who has excess resources will be able to place assets into an ABLE account without being penalized by the Social Security Administration or Medicaid for giving away assets. An ABLE account can only received $14,000 in any one year. A person with special needs who has limited assets may need only to make an ABLE account deposit to remove excess resources from being counted against them for SSI and Medicaid eligibility. For someone with more assets, an ABLE account may be part of the plan but probably not the only answer. (A person can have only one ABLE account, so there’s no gaming the system to protect more money by creating multiple accounts.)

BIG LIMITATION: Under the recently passed law, ABLE accounts are available only to people with special needs whose disability started before the age of 26.

Background: To understand the importance of ABLE accounts, just like the importance of individual Special Needs Trusts and Pooled Trusts, one must remember how Social Security and Medicaid treat someone who has given away money to become financially eligible. (If you read my blogs every week, this next part will seem very repetitive because the background info is the same for individual Special Needs Trusts, Pooled Trusts, and ABLE accounts. I am repeating it here because I don’t want a first time reader or someone looking at this blog in the archive to have to go find the background reasoning in a prior installment. Also, if you read my blog every week, you must have insomnia badly.)

As we’ve discussed in prior installments, both the Supplemental Security Income program (the Social Security program for people who are disabled but don’t have sufficient work history to qualify for Social Security Disability Income) and the Medicaid program (health insurance for poor people) are “means tested.” Accordingly, people who have the financial means to pay for themselves are not eligible for SSI or Medicaid. Because, for many people. there is a very high emotional cost (and sometimes a care cost) in allowing all of their life savings to be spent away, people look for a way to protect some of their assets while still qualifying for SSI and Medicaid. Giving money (or other assets) to a relative, a trusted friend, or a trust helps protect the assets given away, but the gifts can make the applicant ineligible for SSI and Medicaid or trigger limited Medicaid coverage for a time.

That ineligibility for, or restrictions on, SSI and/or Medicaid would create a problem for many people with special needs. They often need the SSI income and the Medicaid health insurance right away. At the same time, they want the ability to get some personal items or entertainment that they wouldn’t be able to afford if all they had were SSI income and Medicaid coverage, so they would like to find a way to “keep” some of their savings.

An ABLE account, like a Special Needs Trust or a Pooled Trust can help fix the collision of the need for SSI and Medicaid and the desire to preserve some assets. Someone who needs SSI and Medicaid but who has too much money to qualify can put up to $14,000 of the excess money into an ABLE account without getting a penalty of ineligibility or restricted coverage.

The differences between an ABLE account (as I expect or hope them to be implemented) and an individual Special Needs Trust or a Pooled is the apparent ease of use of the ABLE account as compared to the trusts.

Money from an ABLE account can be used for education, and/or medical prevention and wellness services. (Expenditures from a stand-alone Special Needs Trust or a Pooled Trust for such services effectively reduce government benefits, but these expenditures from an ABLE account should not impact government benefits.) In addition, the ABLE account can pay for transportation, assistive technologies, personal support services, financial management and administration, oversight, monitoring, funeral and burial expenses, and legal fees. So, the contents in an ABLE account cannot be used for as many different types of purchases as the contents of an individual Special Needs Trust or a Pooled Trust.

Also, at least at this point, it’s possible that an ABLE account won’t need a person to act as go-between for the cash in the account and the actual expenditure. ABLE accounts may give the person with special needs more direct control over the assets in the account than the person has over the assets in a Special Needs Trust or a Pooled Trust. The limitations on the types of allowed expenditures may allow some more direct involvement by the account holder (, the person with special needs.) Of course, the implementing regulations might create a go-between mechanism to prevent the account holder’s receipt of cash which could then cause an problem with SSI eligibility for having excess income.

Like an individual Special Needs Trust and a Pooled Trust, an ABLE account has a payback requirement. When the ABLE account holder (the person with special needs) dies, the account must repay Medicaid for the costs of care that Medicaid had previously paid for the beneficiary up to the amount left in the account. (If the contents of the account are worth more, then the excess assets can be given out to remainder beneficiaries, like how a will operates. If the Medicaid “debt” is equal to or greater than the ABLE account balance, then Medicaid gets it all.) If the account holder uses the entire contents of his or her ABLE account, then Medicaid gets nothing. That’s okay. The person with special needs was were able to make maximum use of his or her SSI benefits, his or her Medicaid benefits, and his or her own assets.

As mentioned above, an ABLE account can accept up to $14,000 per year. (That amount may go up with inflation just like the gift tax exemption goes up every few years.) For the purpose of having few enough assets to qualify for SSI and Medicaid, the annual limitation isn’t an issue. Someone with special needs is trying to qualify for SSI and Medicaid right now. Once that person qualifies, annual income must be controlled to keep eligibility. That control on income probably prevents the person from accumulating enough money in any later year to make any new deposit into an ABLE account or at least from making a large deposit. Unless someone with special needs has an unexpected influx of money (like an inheritance, or an accident settlement, or a lottery win,) only the initial ABLE account deposit is likely to be important to SSI or Medicaid eligibility.

While an ABLE account can legally accept deposits from anyone (like a parent or grandparent, for example,) the payback requirement creates a disincentive for any deposits of third-party money. (Remember, money that never belonged to the person with special needs isn’t subject to a payback requirement. So, putting any third-party at risk of being paid to Medicaid upon the death of the intended beneficiary seems like a waste of money.)

Also, because the ABLE account will be a bank account or a brokerage/investment account and because of the annual $14,000 limitation on deposits, the ABLE account cannot accept real estate. This is not a place to protect a home for the person with special needs.

In conclusion, if a person with special needs must shed some assets to qualify for SSI or Medicaid, an ABLE account (at least as set up in the law) can help shield a certain amount of money from being counted. The ABLE account may be only part of the asset-protection strategy, but its apparent ease of use may prove valuable for expenditures over many years – in addition to the benefit of helping the account holder achieve SSI and Medicaid eligibility.

The Pooled Trust and Qualifying for SSI and Medicaid

Posted on April 9, 2015 by Jim Koewler — No Comments ↓

Today’s blog post continues the series about Special Needs Law. The blog post on February 19, 2015 gave an overview of the legal issues facing people with special needs. The blog post on February 5, 2015 discussed the new ABLE accounts. The blog post on February 26, 2015 discussed sources of income for people with special needs. The blog post on March 5, 2015 discussed medical insurance for people with special needs. The blog post on March 12, 2015 discussed how the Social Security Administration requires people with special needs to prove a disability to qualify for Supplemental Security Income (SSI.) The blog post on March 19, 2015 discussed how the Social Security Administration requires people with special needs to prove financial eligibility to qualify for Supplemental Security Income. The blog post on March 26, 2015 gave an overview how someone with special needs can get rid of excess resources to become “poor enough” to qualify for SSI and Medicaid. The blog post on April 2, 2015 discussed how a Special Needs Trust can help shelter excess resources from SSI and Medicaid scrutiny.

Today’s post discusses how a Pooled Trust can help a person with special needs go from having too many assets to having few enough assets to qualify for (and maintain eligibility) for Supplemental Security Income (SSI) and, if necessary, for Medicaid.

A Pooled Trust is very similar in operation to a Special Needs Trust discussed in the blog post of April 2, 2015 (last week.)

A person with special needs who has excess resources can can place assets into a Pooled Trust without being penalized by the Social Security Administration or Medicaid for giving away assets. Chapter 42, Section 1396p(d)(4)(c) of the United States Code authorizes Pooled Trusts. (Special Needs Trusts are covered by subsection (d)(4)(a) of the same section of the U.S. Code.) (As I mentioned last week, the U.S. Code is the set of laws created by Congress, the set of laws that “Bill” from School House Rock joins after he’s passed by Congress and signed by the President.) Because of the subsection of the law that allows these trusts, they often are called d4c trusts.

As a technical matter, these d4c trusts are self-settled because the assets that are going into the trust belong to the person with special needs. The are not often called “self-settled,” however, because the person with special needs is not setting up the trust (and no one is setting it up on behalf of the special needs person, like a parent, spouse, or a court.) These pooled trusts are already set up.

These Pooled Trusts are not third-party trusts because the money that is going into a pooled trust is from the special needs person. (A third party can contribute to a Pooled Trust, but that is simply a gift. A third person’s contributions to a Pooled Trust, even for the benefit of a person with special needs, has no impact on Supplemental Security Income or Medicaid eligibility for the person with special needs.) A future installment will discuss third-party trusts in more detail.

To understand the importance of the Pooled Trusts, just like the importance of individual Special Needs Trusts, one must remember how Social Security and Medicaid treat someone who has given away money to become financially eligible.

A Pooled Trust (i.e., d4c trust,) like a d4a Special Needs Trust can help fix the collision of the need for SSI and Medicaid and the desire to preserve some assets. Someone who needs SSI and Medicaid but who has too much money to qualify can put the excess money into a Pooled Trust trust without getting a penalty of ineligibility or restricted coverage. Then, the money is available, under certain restrictions, for the benefit of the person.

The difference between a Pooled Trust and an individual Special Needs Trust is a difference in the costs and in the administrative hassles of running the trust.

A Pooled Trust is kind of like a mutual fund. A mutual fund is a pool of money from many people lumped together to make investments that benefit all of the investors. The individual investors don’t have to pick the stocks in which to invest or the time to buy and sell. The individual investors don’t have to track the times of sales and purchases and dividend payouts for the stocks in the fund. The fund managers have those duties.

A Pooled Trust accepts cash from someone with special needs and puts it together with all of the other money put into the trust by other people with special needs and invests that money to benefit all of the participants. Each participant’s share of the trust assets are proportional to their cash invested in the trust. (The trust manager tracks the participants’ value in the trust.)

The trust contents that belong to a particular participant can be withdrawn from the trust (usually in small amounts) to pay for something for the person with special needs (i.e., the participant in the Pooled Trust.) Usually, the person with special needs has an intermediary or a spokesperson who communicates with the Pooled Trust managers to arrange specific purchases. (Direct contact between the person with special needs and the trust managers would look too much like the person with special needs had direct control over the trust contents. Such direct control would probably cause SSI and Medicaid to count the participant’s share of the Pooled Trust as assets available to the person with special needs, resulting in that person having too many assets to qualify for SSI and/or Medicaid.)

Like with an individual Special Needs Trust, a Pooled Trust cannot give the beneficiary cash (except for $20 per month spending money as discussed in an earlier installment ) without causing a reduction of the beneficiary’s SSI income. Similarly, the Pooled Trust can’t spend money on food or shelter for the person with special needs without causing a reduction in SSI.

Also like with the individual Special Needs Trust, a Pooled Trust has a payback provision. When the Pooled Trust participant (the person with special needs who put the assets into the trust in the first place) dies, the trust must repay Medicaid for the costs of care that Medicaid had previously paid for the beneficiary up to the amount of that beneficiaries remaining assets in the Pooled Trust. (If the contents of the trust are worth more, then the excess assets can be given out to remainder beneficiaries, like how a will operates. If the Medicaid “debt” is equal to or greater than the participant’s balance in the Pooled Trust, then the Medicaid gets it all.)

There is a twist on the repayment requirement common in Pooled Trusts. Pooled Trust contents may be given to charity rather than paid to Medicaid. Because Pooled Trusts are usually operated by charities, the Pooled Trust might encourage that its operating charity be designated as the remainder beneficiary.

Even though the family of the special needs person won’t receive the contents of the Pooled Trust, an investment in a Pooled Trust still benefits the person with special needs. By placing excess assets into a Pooled Trust, the person with special needs can get SSI and/or Medicaid. The person with special needs can also get “extra” stuff while on SSI and Medicaid. SSI and Medicaid are necessary for some people with special needs, but they provide a bare minimum of income and health insurance. They don’t provide entertainment or clothing or anything else above the bare minimum. SSI and Medicaid don’t provide any “spice” to life. They are safety net programs. They aren’t supposed to provide “spice.”

A d4c Pooled Trust can provide some spice. It can buy baseball tickets, a TV, a vacation, a magazine subscription, a computer and internet access to name just a few examples. A Pooled Trust, like a special needs trust, can provide just about anything (anything that is legal, anyway) for the beneficiary to allow the beneficiary to have something more than the bare minimum to survive.

If the beneficiary uses the entire contents of his or her share of the Pooled Trust, then Medicaid gets nothing and the charity gets nothing. That’s okay. They were able to make maximum use of their SSI benefits, their Medicaid benefits, and their own assets.

Unfortunately, in many states, the person with special needs can place assets in the trust only if he or she is younger than age 65. So, this kind of trust isn’t available for most seniors. In Ohio, where I practice, people over 65 can place assets into a Pooled Trust. (It’s one of several Ohio quirks in the public benefits programs. Those quirks might go away if a proposal by the governor is adopted.)

So, what are the differences between a Pooled Trust and an individual Special Needs Trust?

As mentioned above, in some states, a person over 65 can use a Pooled Trust.
A Pooled Trust cannot accept non-cash assets. The Pooled Trust chooses its own investments and must maintain a certain amount of ready cash to pay requests for payouts. Any incoming non-cash assets probably won’t fit with the trust’s investment strategy and also might screw up the cash on hand.
Because a Pooled Trust is investing in the stock and bond market, it can’t take real estate. An individual Special Needs Trust can own a house in which the person with special needs can live. A Pooled Trust can’t own that house because it can’t be commingled in with the trust contributions of the other participants.
A Pooled Trust has lower costs to each participant (by spreading those costs over all participants and/or getting support for administrative costs from the money left over from deceased participants who designated the operating charity as the remainder beneficiary.) An individual Special Needs Trust pays all of its own administrative costs. My rule of thumb (when the age 65 restriction isn’t a factor and a house isn’t involved) is that I recommend an individual Special Needs Trust for a pile of assets over $50,000. I recommend a Pooled Trust for lower amounts.

A d4c Pooled Trust allows someone with special needs (who has some assets) to continue to enjoy those assets during his or her lifetime and still get SSI and/or Medicaid. It allows the beneficiary to avoid the empty feeling that can come from watching his or her life savings escape while trying to qualify for SSI and Medicaid.

Wow, that was long for a blog post. Sorry.

The Special Needs Trust and Qualifying for SSI and Medicaid

Posted on April 2, 2015 by Jim Koewler — No Comments ↓

Today’s post discusses how a self-settled Special Needs Trust can help a person with special needs go from having too many assets to having few enough assets to qualify for (and maintain eligibility) for Supplemental Security Income (SSI) and, if necessary, for Medicaid.

Someone with excess resources can set up a Special Needs Trust according to the Chapter 42, Section 1396p(d)(4)(a) of the United States Code. (The United States Code is the set of laws created by Congress, , the set of laws that “Bill” from School House Rock joins after he’s passed by Congress and signed by the President.) Because of the subsection of the law that allows these trusts, they often are called d4a trusts.

These d4a trusts are self-settled. That means that the person with special needs is putting his or her own money (or other assets) into the trust. That is an important distinction with third-party trusts into which someone other than the person with special needs places assets. (A future installment will discuss third-party trusts in more detail.) To understand the importance of the first-party nature of d4a trusts, we should review how Social Security and Medicaid treat someone who has given away money to become financially eligible.

As we’ve discussed in prior installments, both the Supplement Security Income program (the Social Security program for people who are disabled but don’t have sufficient work history to qualify for Social Security Disability Income) and the Medicaid program (health insurance for poor people) are “means tested.” Accordingly, people who have the financial means to pay for themselves are not eligible for SSI or Medicaid. Because, for many people. there is a very high emotional cost (and sometimes a care cost) in allowing all of their life savings to be spent away, people look for a way to protect some of their assets while still qualifying for SSI and Medicaid. Giving money (or other assets) to a relative, a trusted friend, or a trust helps protect the assets given away, but the gifts can make the applicant ineligible for SSI and Medicaid or trigger limited Medicaid coverage for a time.

That ineligibility for, or restrictions on, SSI and/or Medicaid would create a problem for many people with special needs. They need the SSI income and the Medicaid health insurance right away. At the same time, they want the ability to get some personal items or entertainment that they wouldn’t be able to afford if all they had were SSI income and Medicaid coverage, so they would like to find a way to “keep” some of their savings.

A d4a special needs trust can help fix the collision of the need for SSI and Medicaid and the desire to preserve some assets. Someone who needs SSI and Medicaid but who has too much money to qualify can put the excess money into a d4a trust without getting a penalty of ineligibility or restricted coverage. Then, the money is available, under certain restrictions, for the benefit of the person.

The contents of the trust can be used only for the benefit of the person who put the assets into it (while that person is alive.) The trustee (the person who is the fiduciary in charge of the trust) can spend money from the trust for the benefit of the beneficiary (who MUST BE the special needs person who put the assets into it in the first place.) The trustee cannot give the beneficiary cash (except for $20 per month spending money as discussed in an earlier installment ) without causing a reduction of the beneficiary’s SSI income. Similarly, the trustee can’t spend money from the trust on food or shelter for the beneficiary without causing a reduction in SSI.

Perhaps the biggest restriction on the d4a trust is the requirement for a payback provision. When the beneficiary (the person with special needs who put the assets into the trust in the first place) dies, the trust must repay Medicaid for the costs of care that Medicaid had previously paid for the beneficiary. (If the contents of the trust are worth more, then the excess assets can be given out to remainder beneficiaries, like how a will operates. If the Medicaid “debt” is equal to or greater than the contents of the trust, then the Medicaid gets it all.

So, if Medicaid is going to get it all anyway, why put anything into a d4a trust? To get “extra” stuff while on SSI and Medicaid, that’s why. SSI and Medicaid are necessary for some people with special needs, but they provide a bare minimum of income and health insurance. They don’t provide entertainment or clothing or anything else above the bare minimum. SSI and Medicaid don’t provide any “spice” to life. They are safety net programs. They aren’t supposed to provide “spice.”

A d4a special needs trust can provide some spice. It can buy baseball tickets, a TV, a vacation, a magazine subscription, a computer and internet access to name just a few examples. A special needs trust can provide just about anything (anything that is legal, anyway) for the beneficiary to allow the beneficiary to have something more than the bare minimum to survive.

If the beneficiary uses the entire contents of the trust, then Medicaid gets nothing. That’s okay.

Unfortunately, the person with special needs can place assets in the trust only if he or she is younger than age 65. So, this kind of trust isn’t available for seniors.

Also, a trust into which other people place money for the special needs person (a third-party or d4c trust) is often called a special needs trust, but I usually call them something different. I will discuss these third-party trusts in a future installment.

A d4a trust allows someone with special needs (who has some assets) to continue to enjoy those assets during his or her lifetime and still get SSI and/or Medicaid. It allows the beneficiary to avoid the empty feeling that can come from watching his or her life savings escape while trying to qualify for SSI and Medicaid.

How can someone with Special Needs achieve Financial Eligibility for SSI

Posted on March 26, 2015 by Jim Koewler — No Comments ↓

Today’s post discusses how a person with special needs can go from having too many assets to having few enough assets to qualify for (and maintain eligibility) for Supplemental Security Income (SSI) and, if necessary, for Medicaid.

Someone with special needs who cannot qualify for SSI because he or she has assets above $2,000, needs to get rid of some of those assets. Sounds simple, right? Of course, as with anything created by Congressional politicians, it’s not as simple as it sounds.

Someone can give away assets to become poor enough for SSI, but that will create a period of ineligibility for SSI for up to 3 years. Giving away assets also makes someone ineligible for Medicaid coverage (that might be as important as the SSI income to certain people.)

Someone can also spend down the excess assets. That won’t create a penalty period of ineligibility (unless it was a thinly disguised attempt to give away assets such as buying your brother’s junk car for $10,000.) The that was bought could be useful, like new clothes, or a new refrigerator, or something specifically helpful to the disability, like an adjustable bed, or a wheelchair, or an communications assistance device. Expenditures for things that make life easier for the person with special needs are a great way to spend down excess resources. On the other hand, if there aren’t helpful things that the person needs to get, it is a waste of money to buy stuff just for the sake of spending down excess resources.

There are ways to save excess resources that can benefit someone with special needs and still allow the person to qualify for SSI and Medicaid. Depending on the amount of resources and the age of the person with special needs, a self-settled Special Needs Trust can be very useful. For someone with fewer “excess” resources (and usually under the age of 65,) a pooled trust might be the best choice. For someone who was disabled at a young age, an ABLE account (if approved in your state) should probably be used as part of the asset protection plan.

Future installments will discuss these tools in more detail.

How can someone with Special Needs become eligible for SSI – The Financial Tests

Posted on March 19, 2015 by Jim Koewler — No Comments ↓

Today’s post discusses how to meet the income test and the asset test to become eligible (and maintain eligibility) for Supplemental Security Income (SSI.)

The income test is complicated.

SSI will pay no more than $733 per month for an individual or $1,100 per month for a couple. (Those amounts get adjusted for inflation, usually annually.)
Monthly payments will be reduced by the amount of in-kind contributions (from non-governmental sources) that provide food, clothing, or shelter. (For example, if a family member provides a room rent-free, the SSI payment will be reduced by the monthly value of the room.)
If the SSI applicant has a job, the SSI payment will be reduced, but only part of the income is counted toward the SSI reduction. The first $65 doesn’t count, and one-half of the amount over $65 doesn’t count. (If the applicant works infrequently, the first $30 each quarter is not counted.)
$20 per month of non-earned income won’t reduce SSI. Any non-earned income over this $20 leads to a reduction. (If the applicant receives non-earned income but does not receive it on a monthly schedule, then the first $60 per quarter is not counted so that it comes out the same as $20 per month.)
If the SSI applicant is part of a household in which other household members are not SSI applicants or recipients, SSI uses a complicated analysis of shared income to “deem” that some of the household income belongs to the SSI applicant. The “deeming” analysis handles earned income differently than unearned income and considers the household’s children and whether some or all of the children are themselves SSI eligible. (Maybe someday when I really want to put you to sleep, I’ll blog about deeming in more detail.)

The asset test is easy. SSI is not available for an individual with assets above $2,000. It is not available for a couple with assets above $3,000. The asset test gets more complicated if an applicant needs long term care.

If the SSI applicant needs long term care (not just doctors and medicine, etc but help with bathing, dressing, grooming, etc.,) then the applicant will need Medicaid for long term care. In Ohio (where I work with people who have special needs,) the applicant must not only pass the SSI asset test of $2,000 but must also pass the Medicaid asset test of $1,500 or less. (The amount of money that a long-term-care-Medicaid applicant may have varies some from state to state, but is usually in the $1,500 to $2,000 range.)

Once someone has started to receive SSI payments, the person must maintain eligibility for SSI for the payments to continue. Accordingly, the person must continue to meet the financial eligibility tests described above as well as the disability test described in last week’s blog.

How can someone with Special Needs become eligible for SSI – The Disability Test

Posted on March 12, 2015 by Jim Koewler — No Comments ↓

Today’s post discusses how the Social Security Administration looks at a disability when considering a request for Supplemental Security Income (SSI.)

A special needs person’s eligibility for SSI creates a monthly flow of income and also gives the person Medicaid coverage for medical needs and, if necessary, for long term care needs as well. The importance of these income and care programs makes the eligibility for SSI crucial.

SSI eligibility has a three-pronged test. Applicants (1) must be unable to support themselves through work because of some disability, and (2) must have income below the SSI payment level, and (3) must have assets below certain levels determined by federal rule. This week’s blog will discuss the “unable to support themselves through work” test.

The “unable to support yourself through work” test is different for applicants of different ages.

Someone under 50 years old must show that:

the disability prevents him or her from performing any job that exists in the marketplace.
(This is, a very difficult thing to prove. It does not matter whether the job that the applicant could perform has any available openings. It matters only that the job exists.)

Someone age 50-54 must show that:

he or she cannot now perform any of the work that he or she performed in the 15 years before the SSI application,
he or she does not have transferable skills that would allow a transition to a job for which he or she has the necessary physical and mental capacity, and
he or she is not capable of performing any work more strenuous than a sit-down job (called “sedentary work.”)
(The consideration of past work and training and the acceptance that sedentary work may not be a satisfactory job makes it easier for a 50 year old to show disability than for younger applicants to show.)

Someone age 55-59 must show that:

he or she cannot now perform any of the work that he or she performed in the 15 years before the SSI application,
he or she does not have transferable skills that would allow a transition to a job for which he or she has the necessary physical and mental capacity, and
he or she is not capable of performing work for which he or she must stand for most of the work shift and must occasionally lift and carry a load of 20 pounds (called “light work.”)
(Because light work is more strenuous than sedentary work, it is easier for a 55 year old to prove a disability than for younger applicants to show.)

Someone age 60 or older must show that:

he or she cannot now perform any of the work that he or she performed in the 15 years before the SSI application,
he or she does not have transferable skills that would allow an almost seamless transition to a job for which he or she has the necessary physical and mental capacity, and
he or she is not capable of performing light work.
(Because the transferable skills test requires “an almost seamless transition” to a different job, it is easier for a 60 year old to prove a disability than for younger applicants to show.)

Once someone has started to receive SSI payments, the person must maintain eligibility for SSI for the payments to continue. Accordingly, the person must continue to meet the eligibility tests described above.

I must thank my friend Scott Kolligian, an attorney with Leiby Hanna Rasnick in Akron, Ohio, for information necessary to this article. I do not help people prove to the Social Security Administration that they are disabled. Scott does that. (My work for people with special needs or disabilities focuses on the financial eligibility, but this proof of disability piece is so closely related to what I do that I wanted to include it in the special needs series.) To find out more about Scott, visit AkronDisabilityLawyer.com.