The Impact of Lump Sum Settlements on Public Benefit Recipients

Transcription

1 Program #56 The Impact of Lump Sum Settlements on Public Benefit Recipients The State Bar of California 83 rd Annual Meeting September 24, 2010

2 SOCIAL SECURITY AND SSI Julie Aguilar Rogado Legal Services of Northern California

3 Social Security Programs Title II - Social Security Disability Insurance (SSDI) & Retirement Benefits Title XVI - Supplemental Security Income (SSI)

4 Retirement Benefits Available to persons 62 years of age and older Must have paid into Social Security (or be a widow or minor child) Benefit amount is based upon averaged wages for the years during which the beneficiary paid into the program

5 Social Security Disability Insurance Title II of the Social Security Act Monthly benefits for persons who worked and paid into Social Security for at least 40 quarters (or fewer for workers younger than 24 years of age) Medicare eligibility in 25 th month Monthly benefit amount is based upon earnings during the relevant quarters Must establish disability Commonly known as SSDI

6 Supplemental Security Income Title XVI of the Social Security Act Monthly benefits for persons who have little income and few assets In California, there is a supplemental payment Commonly known as SSI Benefits are capped at $845 per month (with the state supplement) Recent reductions due to CA state budget Automatic eligibility for Medi-Cal Cannot get food stamps

7 Social Security Disability Income Limits: SSDI is a wage replacement Other wage replacement income over 80% of average current earnings can reduce benefit Recipients must report No Resource Limits

8 Supplemental Security Income Income Limits Other income reduces the benefit amount (earned income at 50%, unearned at 100%) Unearned income over $890 per month can eliminate eligibility for a benefit payment in that month Resource Limits $2,000 for an individual; $3,000 for a married couple

9 SSI Resource Exclusions Home Household goods and personal effects Automobile, if used for transportation Property that is essential to self-support Life Insurance Limited burial spaces/expenses fund Retroactive payments of SSDI or SSI*

10 MEDICARE & MEDI-CAL Ann Rubinstein Homeless Action Center

11 Medicare Overview 11 Medicare is a federal health insurance program for seniors and people with disabilities. Medicare is not income or resource dependant. Medicare Structure A Hospital- In patient B Out patient & non hospital care (Drs offices, labs etc) D Prescription Drugs Medicare Advantage Plans Original Medicare covers medically necessary care within the scope of covered benefits Advantage plans may cover more

12 Medicare Eligibility 12 Eligibility No income or asset limits People 65 years old and older (with 40 quarters) Those with less than 40 quarters may buy in People receiving Childhood Disability Benefits People receiving Title II (SSDI) benefits for 25 months or more

13 Medicare Costs 13 Costs Part A premium For those w/ 40 quarters this is free, for those w/ less there is a premium, the state will pay this for Medi-Cal benes over 65 Part B Premium ($96.40/ for 2010) CA pays for people with free Medi-Cal People with higher incomes pay more than $ Part D Premiums and drug co-pays State pays for benchmark plans and subsidizes other plans for people on free Medi-Cal Medicare Advantage premiums Medicare pays 80% of covered medical services Medicare will not pay for care that is covered by another source (but it is often the primary payor)

14 Medi-Cal- Overview 14 California s Medicaid Program (State and Federal Funding) Medi-Cal is always the payer of last resort and only pays when Medi-Cal providers are used Adults: services reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain (22 CCR 51303) Recent cuts to adult programs (no dental, vision, chiropractic, psychological, etc.) Children: services necessary health care, diagnostic services, treatment and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services Expanded services provided through EPSDT

15 Medi-Cal Eligibility 15 Categorical Eligibility Children under 21 and their parents Links through other public programs (CalWORKS, SSI, CAPI, foster care, adoption assistance) People with disabilities People older than 65 People with specific health conditions (BCCTP, ESRD) Income/Resource Eligibility Depends on linkage and on age of the child Resources under $2,000 for an individual $3,000 for a couple Citizen or documented immigrant

16 Medi-Cal Costs 16 Medi-Cal is either free or has a share of cost depending on monthly income and categorical eligibility Share of cost is similar to a monthly deductible SOC is assigned to beneficiaries with countable income over the program limit, Medi-Cal subtracts the MNL and the rest is the monthly SOC Children with a share of cost whose income is under 250% FPL are enrolled into Healthy Families program

17 Medi-Cal Exempt Resources (MC 007) 17 Principal residence Household goods One car Irrevocable burial trust Revocable burial trust up to $1,500 Life insurance w/ face value up to $1,500 IRA/ Keough/ Pension Plan when payments of principal and interest are being received

18 2014 Health Reform changes to Medicaid 18 Able bodied adults without dependants will be eligible for Medicaid No resource limit for most people A simpler income test for most people

19 Medi-Cal Law WIC et seq. 22 CCR et seq. Department of Health Care Services All County Letters (dhcs.ca.gov) Health Reform The Patient Protection and Affordable Care Act, now Public Law (Signed on March 23, 2010) The Health Care and Education Reconciliation Act of 2010 (Signed on March 30, 2010) 19

20 Resources 20 Health Consumer Alliance: National Health Law Program: California Health Advocates:

21 CASH & FOOD PROGRAMS Jodie Berger Legal Services of Northern California

22 ID g Likely Recipients 22 Category? E.g. Family, single, refugee? Don t forget: mixed households Financial threshold? Behavioral threshold?

23 CalWORKs: Who 23 Category Adult caring for related children Includes mixed households of ineligible adults and eligible kids Deprivation One or both parents dead, absent, under/ unemployed, or incapacitated Incap = physical/mental condition that reduces substantially or eliminates the parent's ability to support or care for the child I.e. includes if affects ability to work Employment: < 100 hours in prior 4 weeks

24 CalWORKs: Who (cont d) 24 Age Must be pregnant or have 1+ child under 18 (or to 19 if will graduate by 19 th b-day) Or under 19 if can t graduate on time because of current or past illness or disability California Resident Citizenship or legal immigration status

25 CalWORKs: $ 25 Financial Below income cap (see chart) c 130% FPL for recips Depends on where lives Depends on whether receiving disability benefits Below Resource cap $2k or $3k for house w/ indiv l w/ disability $4650 of car not counted rest is resource

26 Aid Charts June

27 27 General Assistance General Relief Category Singles and couples w/o children Financial Not eligible for any other program Low grants/low income limits Low resource limits Time limited for employables

28 GA: Flag 28 Last Resort 100% county funded Loan not grant Retro SSI goes to county first Rules vary by county

29 SSI 29 Category Aged or disabled Unable to do significant gainful activity for 12 months or more or terminal Financial Grant is $674/1,011for couple + CA supplement* Income limit (wages) is $1,433; not from wages is $694 Resource limit $2k single; $3k couple

30 Food Stamps/CFAP 30 Given to households People who buy/prepare food together Certain groups not eligible Undocs, certain drug felons, certain students, etc. Financial 130% FPL for applicants Aged/disabled don t have this test Countable income below 130% FPL Many deductions $2k/$3k resources NO resources limit if family with children (not on CalWORKs)

31 Resources 31 CalWORKs Manual (Publications) $75/2 years Foster Care Manual (Publications) Free Food Stamp Guide Free Medi-Cal Guide Free CMSP rules - follow link Free

32 PUBLIC & SUBSIDIZED HOUSING S. Lynn Martinez Western Center on Law & Poverty

33 Types of Subsidized Housing Public Housing Housing Choice Voucher (Section 8) Federally-Subsidized or Insured Multi-Family Developments (Project-Based) HUD USDA - Rural Housing Low Income Housing Tax Credit State HCD Programs

34 Public Housing Project Based / Multi-Family Subsidized Housing Rural Housing Service _ State HCD Programs Low-Income Housing Tax Credit Housing Choice Voucher (aka Section 8 voucher)

35 HUD Structure & Authorities (all federal subsidies except tax credit units) Congress 42 USC HUD 24 CFR Handbooks/Guidebooks Letters/Opinions Community Planning and Development CPD Public and Indian Housing PIH Housing H Fair Housing & Equal Opportunity FHEO

36 Public Housing (PIH) Owned & managed by the Public Housing Authority (PHA) Rent Assets & Income Failure to report change in income Lump Sums Addition to family assets Delayed start of periodic payments Eviction and Loss of subsidy

37 Housing Choice Voucher (PIH) No more certificates!!!!! Owned and managed by private landlord Facilitated by PHA Special voucher types: Moving to Work Family Unification People with Disabilities Enhanced Voucher Homeownership Option

38 Housing Authority Participation Contract HA Payment HAP Contract Application Rent Tenant Lease with HUD Addendum Landlord

39 General Rules Applicable to Vouchers Rent Tenant generally pays 30-40% of her income toward rent Assets No limitation but income derived from assets counts as income Lump Sums Determine whether it s a lump sum addition to family assets or a delayed start of a periodic payment Eviction and possible loss of subsidy for failure to report

40 Federally Insured or Subsidized Multi- Family Developments Housing, (H) or MFH aka Project-Based Housing Owned and managed by private landlord Rent: 30% of tenant s income Income & Asset Rules Lump Sums

41 Types of Federally Insured or Subsidized Housing Section 236 Rent Supplement Section 235 (h/o) HoDAG Section 221(d)(3), (4), (5) Section 202 Section 811 Section 23 Project Based Section 8: Mod rehab, substantial rehab, loan management & property disposition set-aside

42 Other Subsidized Housing Programs Low Income Housing Tax Credit USDA Rural Housing State Housing and Community Development programs

43 Important Bookmarks & Subsidized Housing Resources HUD programs: HUD publications: Code of Federal Regulations: Overview re: subsidized housing programs: and Rural housing programs: California Code of Regulations: California Tax Credit program: