Governmental and Private Resources for Persons with Brain Injuries and their Families

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1 Governmental and Private Resources for Persons with Brain Injuries and their Families Bill Levis BIAC Past President and Family Member April 23, 2014

2 Resources When A Loved One Suffers A Brain Injury County Specific Single Entry Point for BI Coordination SSI/SSDI Social Security Administration CO/MD Medicaid County Human/ Social Services Approved if SSI/SSDI BI Waiver CoDHCPF Apply in Hospital Nursing Home Ineligible Family Obligations Clock Ticking Court Approved Guardian Conservator Colorado Brain Injury Program Case Management Insurance Private Health Settlement Workers Comp Custodial, Disability, Special Needs Trusts April 23,

3 When to Apply for Services Work with social worker at hospital or long term acute care facility on available government services. Critical to get Medicaid and possible Brain Injury Waiver money approved before patient leaves hospital. April 23,

4 Social Security Apply with Social Security Administration for Supplemental Security Income Program (SSI), and Disability Income Program (SSDI) for those with qualifying work history, Once SSI or SSDI approved, Medicaid should be approved as well but need to apply for Medicaid with county. April 23,

5 Benefits Comparison SSI SSA SSDI Supplemental Security Income Social Security Social Security Disability Income Disability Retirement Disability No work history required Work history required Work history required Income Cap - $721/month (2014) Income Cap Depends on work record Income Cap Depends on work record Resource Cap - $2,000 No Resource Cap No Resource Cap Always Medicaid Typically Medicare Typically Medicare

6 Medicaid Apply for Medicaid with County Department of Human/Social Services If services not going to be provided in timely manner, contact county commissioner in charge of Human/Social Services, CDHCPF is Colorado Department of Health Care Policy and Financing, If all else fails, contact State senator and representative, ory?openframeset, and U.S. Senators, _cfm.cfm and representative, April 23,

7 Medicaid/Medicare Comparison Medicaid Medicare Health Care Health Insurance Individual State Administration Federal Administration Financial & Disability Qualification Age or Disability Qualification Covers in-home care programs, skilled nursing care, long term care, prescriptions Funding: reimbursement required Covers hospitalization, 100 days max rehabilitation, prescriptions Funding: premiums and co-pay Estate Recovery: YES Estate Recovery: NO

8 Brain Injury Waiver Possible additional funding providing home or community based alternative to hospital or specialized nursing facility care for those between 16 and 64 VER_for_PERSONS_with_BRAIN_INJURY Adult day services Specialized Medical Equipment & Supplies Behavioral management Day treatment Home modifications Mental health counseling Non-medical transportation Personal care Respite care Substance Abuse Counseling Supported Living Program Transitional Living Personalized Emergency Response System SB passed this month should allow in-state funding for hard to place Single Entry Point coordinates brain injury waiver funding April 23,

9 Colorado Brain Injury Program- Adult Services Case management services with BI support specialist; classes and workshops may be available from program, administered through Colorado Department of Human Services. To be eligible, have to be lawfully present in Colorado, have medical documentation of TBI and ongoing impairments as result, and complete application and documentation. Applications are available at Brain Injury Alliance of Colorado or by calling or April 23,

10 Legal and Financial Control Consult attorney or organization such as Colorado Fund for People with Disabilities (CFPD) for court approved guardianship (legal control) and conservatorship (financial control) for person with severe brain injury. Forms available through Colorado court system egory=guardian In lieu of conservatorship, you can set up custodial trust with financial institution under state law, , Colorado Revised Statutes. April 23,

11 Disability Trust Contact CDHCPF to set up disability trust per , C.R.S, to protect assets from disqualifying under Medicaid. More information available at Once trust approved, any assets that remain after person with brain injury is no longer eligible for Medicaid become property of state. April 23,

12 Disability and Special Needs Trusts If trust funded with annuity or other periodic payments, CDHCPF must be named in contract or settlement as beneficiary up to amount of medical assistance paid. In order to protect inherited assets from Medicaid, consult attorney or organization such as CFPD on how to establish irrevocable special needs trust pursuant to federal law, 42 U.S.C. 1396p(d)(4)(A). April 23,

13 Special Needs Trust Comparison Individual (First Party) Private Trust 42 USC 1396p(d)(4)(A) C.R.S Pooled (First Party) Trust 42 U.S.C. 1396p(d)(4)(c) C.R.S Individual Third Party Private Trust Pooled (Third Party) Trust Administration Family member, professional fiduciary, bank Non-Profit organization Family member, professional fiduciary, bank Non-Profit organization Age Must be under 65 No age restrictions per se, but at the age of 65 and over the Beneficiary must be reasonable able to spend down the funds in their expected lifetime. Can Be of any age Can be of any age Transfer Penalty None Maybe under some circumstances for persons over age 65. None for persons under 65. None None Annuities Must name Medicaid as a beneficiary Trustee may be named as a beneficiary Do not need to name Medicaid or trustee as a beneficiary Do not need to name Medicaid or trustee as a beneficiary Definition of Disability Must meet definition of disabled for the purposes of the SSI program Must meet definition of disabled for the purposes of the SSI program ADA definition is used ADA definition is used Tax Status Earnings taxable Earnings may be tax exempt Earnings taxable Earnings taxable Distributions Supplemental Needs for the Sole Benefit of the Beneficiary Supplemental Needs for the Sole Benefit of the Beneficiary Supplemental Needs for the Sole Benefit of the Beneficiary Supplemental Needs for the Sole Benefit of the Beneficiary Costs Set up by private attorneys, cost varies. Administration costs vary No attorney fees. Non-profit sets fees to establish and administer Set up by private attorneys, cost varies. Administrative cost vary CFPD: Cost to set up is $ plus 2% of amount contributed to establish trust fund. 1% annual; Case Mgmt fees Remainder Interests (when Primary Beneficiary dies) Medicaid must be paid first. Will be paid back to the State Medicaid Agency to the extent it is not retained by the pooled trust. A beneficiary can be named. (Medicaid has no claim on third-party funds) A beneficiary can be named. (Medicaid has no claim on third-party funds) Portability May need to pay back Medicaid if moved out of state or terminated from Medicaid benefits. Trust is for life. Can move to any state with similar law of pooled trusts or ported to new pooled trust. Trust is for life. Can move to any state with similar law Trust is for life. Can move to any state with similar law of pooled trusts or ported to new pooled trust. Medicaid Approval Must be approved by Medicaid in all non- SSI cases. Pre-approved by Medicaid, but Medicaid must be notified. Must be approved by Medicaid in all non- SSI cases. Social Security Must approve all SSI cases. Pre-approved by SSA, but SSA must be notified. Must approve all SSI cases. Pre-approved by Medicaid, but Medicaid must be notified. Pre-approved by SSA, but SSA must be notified. Flexibility Depends on document. Streamlined process in place. Depends on document. Streamlined process in place.

14 Who needs an SNT? Persons on benefits receiving funds exceeding $2,000. Inheritance, back-payments of Social Security, gifts Settlements Personal Injury Worker s Compensation Note need for Medicare Set-Aside Trust as applicable Medical Malpractice Divorce Liquidation of personal assets Sale of home Excess resources Employment wages Persons unable to personally handle sums of money or may be vulnerable to exploitation. Persons who may receive benefits in the future.

15 What an SNT can pay for Q RECREATION Vacations Companionship Services Entertainment Subscriptions Memberships Pets Cable TV MEDICAL CARE (NOT COVERED BY BENEFITS) Dental Work Glasses Hearing Aids Massage Hair Care Co-Pays Personal Supplies Vitamins/Supplements

16 What an SNT can pay for HOUSEHOLD TRANSPORTATION Home Purchase Home Maintenance Public Transportation (Bus Passes, Light Rail, Etc.) Clothing Telephone Vehicle Purchase Vehicle Maintenance Q Appliances Furniture Gasoline Auto Insurance Home Insurance Accessibility Upgrades

17 What an SNT can pay for EDUCATION SERVICES Public/Private Education Training Computer Software Books Vocational Training Attorney Fees Alternative Therapies Guardian Fees Conservator Fees Burial Plan

18 SNT Trustee Selection Ideal SNT Trustee (most likely posthumous): In-depth public benefit knowledge Ability to stay abreast of all benefit and fiduciary law changes Unbiased decision making capability with beneficiary s best interests in mind in regards to discretionary distributions (i.e. beware of remainder persons) Advocate of the beneficiary Invests according to fiduciary standards (Prudent Investor Act) Up to date knowledge and adherence to statutory fiduciary requirements Expertise in tax law Immaculate bookkeeping abilities Carries Errors and Omissions Insurance/Liability Insurance or is bonded Can properly identify second rate service providers and/or beneficiary abuse or financial vulnerability Can appear in or petition the Court as needed Immortality

19 Trust Advisors, Protectors and Co-Trustees Trust advisors can be family members, attorneys, accountants or other trusted professions Fees vary, but if family member trustee, trust advisor fees may be more economical Trust Protector This is usually attorney or other professional to oversee trust and to change trustees need to. Usually quite inexpensive to have one in more sizable trust (over $100,000). Co-Trustee Consider a family member acting as co-trustee with professional trustee.

20 Government Benefits: Housing; Other Section 8 or Public Housing: Contact your local Housing Authority for eligibility and application information. *There are long waiting lists for these programs. Others: Govbenefits.gov

21 Government Benefits: LEAP LEAP (Low Income Energy Assistance Program) The Colorado LEAP program is a federally funded statesupervised, county-administered system and is designed to assist with your winter heating costs. The LEAP Program eligibility period runs from November 1st through April 30th. Apply at your Local LEAP office, attached. If you need heating assistance while LEAP is closed, please contact HEAT HELP at

22 Government Benefits: Telephone Contact your phone carrier directly to inquire about Federal Lifeline Assistance Program. No longer provided by the state.

23 Government Benefits: Food Stamps, Application 1. Go online/pick up application at local Human Services Department (supply information on income, assets, expenses and proof of citizenship) 2. Bring, fax, or mail application to the County Dept. of Social/Human Services 3. Interview. Will need to bring some/all of the following items Birth Certificate Drivers License Child Support - court order or cancelled checks Pay Stubs Unemployment Compensation Pensions Letter from Social Security, Veteran's Assistance Rental Agreement Mortgage Statement Utility Bills - telephone, electricity, gas, oil, water, sewerage, garbage Child Care Expenses - cancelled checks Medical Bills that you pay (if 60 years or older or disabled) Bank Book or Bank Statements 4. Applicant receive notice of eligibility/ineligibility and appeal rights

24 Other Services Colorado Fund for People with Disabilities, The Legal Center for People with Disabilities and Older People, Report on Governor s Executive Order on Brain Injury Services. Available through BIAC, Senior (and Disability) Law Handbook, Law-Handbook/ April 23,

25 April 23,