Month: March 2015

How can someone with Special Needs achieve Financial Eligibility for SSI

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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.

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

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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.)

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

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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.

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.

 

Medical Insurance for People with Special Needs

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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.

Today’s post discusses Medical Insurance for People with Special Needs.

The medical insurance coverage to people with special needs is linked to their source(s) of income.

SUPPLEMENTAL SECURITY INCOME (the Social Security disability system for people who do not have enough of a work history to qualify for Social Security Disability Income.)

Medicaid Medical Coverage – People who receive Supplemental Security Income automatically qualify for Medicaid medical coverage.  Medicaid medical coverage insures doctor visits, hospital stays, prescriptions, and other “traditionally insured” health costs.  For people who are “high functioning” despite their special need, this Medicaid medical coverage may be the only Medicaid coverage necessary.

Medicaid Long Term Care Coverage – SSI recipients who need help with Activities of Daily Living (bathing, toileting, grooming, dressing, walking, eating, and getting in our out of bed or a chair) may need Medicaid coverage for long term care (from an arm of Medicaid called the Aged, Blind and Disabled.)  Because SSI recipients can have no more than $2,000 in assets, they usually qualify for Medicaid long term care coverage automatically.  (Some states, including Ohio, where I practice, have a Medicaid asset limit below $2,000, so, as a practical matter, SSI recipients in these states may have an asset limit lower than the federal rules say.)  Long term care coverage insurance for nursing home costs, assisted living costs, or the cost of in-home help with Activities of Daily Living in addition to the coverage for traditional medical costs such as doctor visits and hospital stays.  For people whose special needs create a need for help with Activities of Daily Living, this Medicaid coverage of long term care may be the most important government benefit they receive.

SOCIAL SECURITY DISABILITY INCOME (the Social Security income program for disable people who have qualifying work history.)

Medicare – People who receive Social Security Disability Income can get Medicare coverage two years (the rules use the language “24 months” probably because SSDI comes as a monthly payment) after the disability income starts.  The Medicare available to people with special needs who receive disability income is the same as Medicare for seniors.  It covers 80% of costs, and the insured person can pay the 20% themselves or can buy additional insurance (an Advantage Plan or a Medicare Supplement) to cover it.

Affordable Care Act – Until Medicare starts (and the 24 month count doesn’t start unless the disabled person is receiving Social Security Disability Income,)  the Affordable Care Act is the source of health insurance for people with special needs (just like it is for everyone else.)

Medicaid for Long Term Care – Medicare and the Affordable Care Act provide insurance coverage for “traditional” medical costs such as doctor visits, prescriptions, hospital stays, etc.  They do NOT provide coverage for long term care costs such as nursing homes, assisted living, or in-home help with Activities of Daily Living (bathing, toileting, dressing, grooming, eating, walking, or getting in and out of bed or a chair.)  Further, a person receiving SSDI does NOT automatically qualify for Medicaid for long term care.  SSDI recipients who need Medicaid coverage for long term care must qualify for that coverage under Medicaid’s separate rules in their state.

NEITHER SSI NOR SSDI

Someone with special needs who does not, for whatever reason, qualify for Supplemental Security Income or for Social Security Disability Income must rely on the Affordable Care Act for health insurance and on the Medicaid Aged, Blind and Disabled program for long term care.