The Supreme Court decision on the Affordable Care Act (ObamaCare) has tremendous implications for our practice, primarily negative, but is a huge boon to planning for persons with disabilities who have been shut out of the private insurance market in the past.  Our law firm’s loss is our clients’ gains, and we couldn’t be happier about it.

Depending on the November election, if Obama is re-elected, our clients with Special Needs Trusts will have the option to get off of public health programs, like Medicaid, and begin to pay for private health insurance from private health companies.  For the reasons mentioned in the attached "Commentary", we believe there are substantial resons why this will be appealing to many.  Whether, how and when to do it, however, will require a careful analysis of individual client’s needs.  Click the link below:

www.floridaspecialneedslaw.com/uploads/file/Lillesand – Commentary on the Impact of Affordable Care Act.pdf

We’re working on an appeal of another attorney’s client’s case that was lost at a Social Security Adminsitration Administrative Law Judge hearing.  In reviewing the twelve page decision, we find the judge wrote the following (the typos are ALL his):

"Rather, when examined by Dr. Miguel xxxx, a psychiatrist at the request of the office of Dislikable Dtermiatnos, the claim was fully oriented and his speech was coherent and relevant.  While he seemed anxious, he was attentive and denied any suicidal intention so r ideas.  He also denied any homicidal ideas.  There w err no signs of hallcuiotnsm delusions, bizarre behavior and his cognitive function was age aprpruioatpe. HTer ewe rno signs of hyperactive or attendtion difficulties.  he knew the date, his socials ruvity number and his abstract thinking was intact. (Exhibit 9)."

Where to start.  The Office of Disability Determinations, labeled not-so-inaccurately as the "office of Dislikable Dtermaitnos" is not even called that any more.  And on, and on.  It will make funny reading for the Appeals Council at least while we win this man’s case.

The South Dakota Supreme Court decision attached actually pre-dates the U.S. Circuit Court of Appeals decision yesterday by a couple of weeks, but comes to the same conclusion, and further adds language that no state may avoid application of the federal rule:

“[¶ 44.] In a CMS memorandum from Gale P. Arden, Director of Disabled and Elderly Health Programs Group at the Center for Medicaid and State Operations in Baltimore, the transfer penalty and pooled trust statutes at issue in this case were clarified. See Memorandum from Gale P. Arden to Jay Gavens, Acting Assoc. Regional Adm’r, Div. of Medicaid and Children’s Health (Apr. 14, 2008). In part, the memorandum stated:

Although a pooled trust may be established for beneficiaries of any age, funds placed in a pooled trust established for an individual age 65 or older may be subject to penalty as a transfer of assets for less than fair market value. When a person places funds in a trust, the person gives up ownership of the funds. Since the individual generally does not receive anything of comparable value in return, placing funds in a trust is usually a transfer for less than fair market value. The statute does provide an exception to imposing a transfer penalty for funds that are placed in a trust established for a disabled individual. However, only trusts established for a disabled individual 64 or younger are exempt from application of the transfer of assets penalty provisions ․

“Id. (emphasis added). CMS issued this memorandum because “it was brought to [its] attention that in many States individuals age 65 or older are establishing pooled trusts, but the States may not be applying the transfer of assets penalty provisions as required by statute.” Id. The memorandum explain[ed] that “[i]f States are allowing individuals age 65 or older to establish pooled trusts without applying the transfer of assets provisions, they are not in compliance with the statute. [F]ederal statute requires the application of the transfer rules in this situation; it [is] not a decision for each State to make.”8 Id.”

When a person on SSI and Medicaid concludes a lawsuit for personal injuries, the Florida Medicaid agency swoops in and takes a big bite of the settlement or jury verdict to reimburse itself for the doctor and hospital bills caused by the person or corporation that hurt the disabled SSI/Medicaid recipient.  This action is based on the Florida Medicaid Third Party Liability Act, Florida Statutes, Section 409.910.

A few years ago, the U. S. Supreme Court substantially and appropriately reduced what Medicaid can get.  Click here for the Alhborn case.  Florida Medicaid has resisted the Supreme Court’s decision, but its position is now substantially weakened by a new U. S. Circuit Court of Appeals decision.

Based on a March 22nd U. S. Circuit Court of Appeals decision, more net settlement money is going to go to diasbled plaintiffs.  The court’s decision completely eviscerates the Florida Medicaid agency’s defense to avoiding the reduction in the Medicaid lien based on the U.S. Supreme Court Ahlborn decision in 2006. This is going to allow substantially MORE money to go into plaintiff’s Special Needs Trusts funded from  Personal Injury/Medical Malpractice settlements or jury verdicts.

Continue Reading Prediction: Florida Medicaid Liens will be reduced

It would be difficult to underestimate the positive impact of ObamaCare – the Affordable Care Act – on persons with disabilities.  In the last two weeks, I have had three clients who were seeking a finding of "disabled" by the Social Security Administration because being found eligible for a monthly disability check would qualify them to receive health care.  None of them are now that they can purchase health insurance.

The private profit-making health insurance industry will not take individuals with pre-existing health conditions.  One client, a published author, had lost her health insurance when she developed Crohn’s Disease.  Although it was initially somewhat managed, painfully, by medications, she now needs to have many feet of necrotic intestinal tissue removed surgically from her stomach.  Even though she has money, no insurance company would sell her health insurance.  She has too much money for Medicaid eligibility.  She will die without surgery.

Continue Reading The Impact of the Affordable Care Act on persons with disabilities

Each year the Social Security Administration announces in October if there will be any changes in the amount of payments of SSI and SSDI due to Cost of Living Adjustments.  The new payments for SSI for 2012 are $698 to and individual, and $1048 to a married couple who are both on SSI.  SSI is the welfare disability program for persons who were disabled since birth or who haven’t paid sufficient minimum taxes to qualify.

SSA administers another program for persons with disabilities who did pay taxes.  The payments for persons on Social Security Disability Insurance (SSDI) benefits are based on the amount of Social Security taxes paid during their working years. 

The average benefit paid to a disabled worker, his spouse and one or more children in $1,892 per month.

See the full description of benefits see www.floridaspecialneedslaw.com/uploads/file/2012 Social Security NUMBERS.pdfre.

Congratulations and a  big thank you to our Florida Congressmen, Ander Crenshaw and Kendrick Meek, who have introduced legislation to allow families to plan for their loved ones with some significant tax saings.   Information on the bill follows.  To see the bill in its entirety, click on H.R. 1205.

Disability Savings Accounts

The bipartisan Achieving a Better Life Experience Act of 2009 (ABLE Act), H.R.1205/S. 493, was introduced in both the House and Senate on February 26.  The bills would allow individuals and families to establish special accounts for meeting the future needs of children and adults with disabilities.  Funds in the accounts and expenditures which meet the requirements of the bills would not affect the individuals’ eligibility for federal benefits.  Using these accounts, parents would be able to save funds for a child’s future in a manner similar to the special "529 accounts" currently used to save for a child’s future educational expenses.  The House bill was introduced by Rep. Ander Crenshaw (R-FL) along with Representatives Patrick Kennedy (D-RI), Cathy McMorris Rodgers (R-WA), and Kendrick Meek (D-FL).  The Senate bill was introduced by Senator Robert Casey, Jr. (D-PA) along with Senators Sam Brownback (R-KS), Richard Burr (R-NC), Christopher Dodd (D-CT), Orrin Hatch (R-UT), and Edward Kennedy (D-MA).  The bills were referred to the House Ways and Means and the Energy and Commerce Committees and to the Senate Finance Committee.  The Arc and UCP worked with the sponsors and with other supporting organizations on development of the bills.

Special Needs Trusts in Florida and around the nation will be impacted by the new POMS on Special Needs Trusts issued in January.  The March meeting of the Academy of Special Needs Planners will have top experts discussing the changes, and other important information on Special Needs Trusts.  If you are an attorney, plan to attend.  You can register at the Academy’s website, http://www.specialneedsplanners.com/

The Social Security Administration published new POMS, the staff operating manual, on Special Needs Trusts.  As Chair fo the Special Needs Trust Committee of the Florida Bar’s Elder Law Section, I have set a meeting to review the new POMS in detail for March 19th, in Tampa.

Here’s a "CLEAN COPY" of the new 2009 POMS on Trusts.

I also prepared a word-by-word analysis of the 2009 changes from the original 2001 POMS.  Deletions are indicated by striking through the word, and additions by underlining.  See "THE CHANGES HERE."  See also the  5 PAGE MEMORANDUM that highlights the changes.

Generally, the POMS are claimant friendly, although attorneys who do not follow them closely, can cause some significant problems for their clients.  The new POMS specifically approve of child support Special Needs Trusts and Alimony Special Needs Trusts, which will go a long way in ehlping to resolve family law disputes where continued health insurance is an issue.

The Social Security Administration (SSA)  has provided attorneys and the general public with very useful information on their analysis of Special Needs Trusts – are you eligible or ineligible if you have such a trust.  There are a lot of ways that attorneys can inadvertently cause a Special Needs Trust to be found in violation of the many SSI resource rules.  While Special Needs Trusts are perfectly legal and will keep SSI benefits for disabled persons, simple drafting errors by attorneys can result in loss of SSI and Medicaid health insurance.

Fortunately, SSA is trying to help clients stay eligible by educating the public and attorneys.

Unfortunately, although the Regional Chief Counsel opinion letters, called "Precedents" in SSI-speak, are availabe as a category on the Internet in the POMS, they are poorly organized and not indexed.

The good news:  attached is a LENGTHY ANALSYS OF THE RCC OPINION LETTERS issued between 2006 through 2008, with a table that summarizes the issues and the holding, and an 18 page explanatory text of the "Top Ten Things Learned by Reviewing RCC Opinion Letters" and a 6 page chart, as well as the RCC opinion letters themselves.  The total package is 176 pages.