When an unexpected inheritance or lawsuit proceeds are received by a person with disabilities who is on SSI-disability or SSI-elder benefits, the event calls for some special needs planning to continue the SSI monthly checks and Florida Medicaid without going over the $2,000 resource limit. Many think the best or only answer may be an individual or pooled Special Needs Trust. That is not the case. This practice note discusses the advantages of a room and board contract for a term of months or for lifetime, can in some circumstance have significant cash and other benefits over a personal services contract or a special needs trust.

In 1999 the Social Security Act was changed to impose an Supplemental Security Income (SSI) transfer of resources penalty for transferring assets for less than fair market value (FMV) for a period of months capped at 36 months. Prior to that persons with disabilities could simply give away excess resources, continue to receive SSI which would trigger continuation of Medicaid. The Social Security Administration (SSA) immediately added Section SI 01150.005 to the Program Operations Manual System (POMS) to explain how the agency is to assess fair market value and delineate the exceptions to the transfer penalty, giving the special needs attorney some additional and often better tools to maintain public benefits. SSA defines fair market value as “the current market value (CMV) at the time the resource transfers,” noting that CMV is the going price that the resource could be reasonably be expected to sell on the open market in the local area involved. 3 SSA also defines “compensation” as the cash or other valuable consideration provided in exchange for the resource, paid by cash or real or personal property received in exchange.

The value of the compensation received by the SSI claimant is determined by looking at the legally binding agreement between the SSI claimant-transferor and the person or entity receiving the resource. Particularly important is the POMS statement that “The transferor may actually receive the compensation before, at, or after the actual time of transfer.”

Inkind support and maintenance (ISM) may provide the compensation for the transfer valued at its full current market value multiplied by the length of time for which the ISM is to be provided under the agreement. SSA provides a helpful example of a contract for a period of years:

Example: Determining whether ISM applies:

Mr. Thomas transfers $30,000 cash to his sister based on a written contract that she would provide him with food and shelter for 5 years. The sister values the food and shelter at $500 per month. The CR develops Mr. Thomas’ living arrangements and determines that he has a flat fee arrangement with his sister and required to pay $500 per month. The food and shelter for 5 years is worth $30,000 (5 years x $6,000 per year). Therefore, Mr. Thomas received FMV for the $30,000 he transferred. ISM is not counted because the Mr. Thomas has prepaid for his food and shelter with the $30,000 he transferred. SSA Staff are instructed to use the actual value of the ISM as defined in the standard food and shelter instructions and not the one-third reduction or presumed maximum value (PMV) to set the value of the compensation in the agreement. Staff are further instructed to obtain a statement from the ISM provider to confirm that the ISM is being provided using SSA’s form 8011-F3 (Statement of Household Expenses and Contributions).

What about a legally binding agreement that in exchange of some real property, personal property or cash, the SSI claimant will receive ISM for his or her life? Staff are instructed to multiply the yearly CMV of the ISM provided by the “Years of Life Remaining” corresponding to the SSI claimant’s age (or next lower age) found in POMS SI 01150.005F. Note that this chart may be different that the life expectancy charts in the Florida Medicaid Manual. SSA provides two useful examples showing the effect of an agreement to provide ISM for life: Example 1: Total value of ISM results in FMV compensation Valerie Payne transferred nonhome real property valued at $185,000 to her sister. As compensation, her sister agreed to provide Ms. Payne with room and board in the sister’s home for the rest of Ms. Payne’s life. ISM development showed that her sister’s total household expenses were $1,500 per month. The household consisted of 3 persons, including Ms. Payne who was age 53 at the time of the transfer. The CMV of the ISM was $6,000 per year ($1,500/3 = $500 per month X 12 months = $6,000). Then, $6,000 X 31.61 (average years of life remaining at age 50) = $189,660 compensation. In this case, Ms. Payne received FMV for the transferred resource. We do not count ISM because the individual prepaid for her own food and shelter with the value of the home she transferred. For procedure on determining an individual’s contribution
toward household operating expenses, see SI 00835.480D.

Example 2: Total value of ISM results in uncompensated value

Assume the same case facts as Example 1 except that Ms. Payne is 80 years old at the time of the transfer. As in Example 1 the ISM is worth $6,000 per year. At 80 years of age the life expectancy table indicates 7.16 years. Multiplying 7.16 years times $6,000 results in compensation of $42,960. In this case there is uncompensated value of $142,040 ($185,000 minus $42,960). Therefore, Ms. Payne is subject to a period of ineligibility for SSI because she transferred the house for less than FMV. The agreement between Valerie Payne, the SSI claimant, and her sister could arise in a couple of ways. Perhaps Valerie and her sister were living together for years, and Valerie then inherited a home (described in the example as “nonhome real property”) as an inheritance from another person. Or perhaps Valerie was living in her own home, and as she became more physically wanted to move in with her sister who could help care for her. Her former home then became a countable resource since it was no longer her primary residence.
In all likelihood, before the ISM agreement and property transfer, either scenario would see Valerie’s SSI check go down due to her inability to pay her fair share of her sister’s household expenses.

SSA is required to deducted for the ISM received by her sister shouldering disproportionately more of the household expenses. This one-third loss of Valerie’s SSI check amounts to approximately $3,000 per year. At this point Valerie decides to sell for cash or transfer the real property and move with her sister. What are the options?


Option 1.

Just give the money to her sister. If Valerie sells the house and receives the $185,000 sales proceeds and just gives the money to her sister, with no agreement for anything in return, the transfer penalty applies in full. The amount transferred ($185k) divided by the Federal Benefit Rate (currently $794 per month), produces the number of months that Valerie would receive no SSI checks at all, but capped at a 36 month penalty. The amount transferred in this case results in a penalty
calculation of 232 months but capped at 36 months causes the loss of benefits from the date of transfer for three years. While that choice is only a loss of approximately $10,000 per year tax free for three years, or $30,000 total, the more significant potential loss is the SSI-related Medicaid health insurance coverage. There are no income tax consequences to the sister since it is a gift.

Option 2.

Use a Special Needs Trust. If she sells the home, receives $185,000 cash and puts
the funds in a special needs trust with the trust paying Valerie’s share of the household expenses, the trust’s contribution triggers the ISM reduction anyway for payments for food and shelter. She still loses over $3,000 per year in tax free SSI benefits by having a trust because her SSI check is reduced from $794 to $530 per month. And she incurs attorney fees, trustee fees, and CPA fees, and if she uses a
pooled or individual SNT, and a potential startup fee as well. The result is that Valerie has more expense and less tax-free income. At 31 years of life expectancy the one-third loss of tax free SSI income amounts to $93,00 alone, and the trustee fee could amount to $172,000 (at 3% over 31 years).

Option 3.

Use a personal services contract. Instead, Valerie decides to engage in some other
special needs planning and transfers the sales proceeds to her sister in an agreement for personal services to be received in the future. Such Personal Service Contracts (PSC) are specifically allowed under the same POMS. 8 How to draft a proper PSC is laid out in a SSA Atlanta Regional Chief Counsel Precedent (opinion letter). The amount the sister receives is IRS-taxable income of $185,000 which results in a potential substantial loss of $36,011 if using the standard deduction.


Option 4.

Use the ISM contract for room and board detailed in the POMS above. The benefit
of using the SSA-suggested option of transferring the sales proceeds, or transferring title to the non-home property, to the sister would include avoiding:
the ISM deduction from her SSI checks; attorney fees for trust preparation; and
lifetime trustee fees and expenses. Once received, the sister does not have to account further for the funds. She is required under the contract to provide food and shelter, but not maintain an account to do so. Ongoing accounting
fees are also eliminated. In addition, three separate tax experts have advised our office in three separate cases that the room and board contract to share food and shelter expenses results in no federal income tax consequences for the person who receives the funds and agrees to provide the food and shelter. Thus, the $36,011 income tax loss by using the Personal Services Contract is eliminated by the ISM agreement.

Special needs planning should not be one shoe fits all, nor should special needs planners apply only one single technique to a particular SSI claimant’s situation. Combinations of some appropriate spend down (paying off credit card bills, paying down mortgages, purchasing new appliances, vehicles, clothes, computers, dental care, and infinitely more), ABLE accounts for those eligible, some funds in ISM contracts, etc., can make clients extremely happy to have a special needs plan tailored to meet their individual needs.

Room and board or ISM contracts can effectively handle small or larger amounts of funds since such contracts can be for a term of several months, several years or as described SSA in the POMS’ example, for a lifetime. Additionally, room and board contracts increase the SSI check over the use of Special Needs Trusts by legally avoiding the monthly loss of full SSI benefits due to Inkind Support and
Maintenance deductions. Such contracts are not appropriate in every case, but where they are, the advantages over SNTs and PSCs are substantial.


1 Foster Care Independence Act of 1999 (P.L. 106-169).
2 Florida Statutes §409.903(2) enacted pursuant to the Social Security Act, Section 1634.
3 SI 01150.005.B.1.
4 SI 01150.005.B.2.
5 SI 01150.005.C.2.
6 POMS SI 00835.001
7 POMS SI 01150.005.D.3.
8 POMS SI 01150.005.D.4
9 PS 01820.011 Florida, A. PS 14-102 Supplemental Security Income Resource Determination—Validity Of Personal
Services Contract.

Man who uses wheelchair does taxes on computer at desk in home office.Approximately 6 percent of adult Americans experience an activity-limiting injury every three months, according to the Centers for Disease Control and Prevention (CDC). Injuries can happen because of carelessness, such as distracted driving or a slippery floor at a restaurant or store. In fact, accidental injuries are also the fourth-leading cause of death.

Many people become injured in their workplace, resulting in a disability. According to the National Safety Council, workplace injuries occur as often as every seven seconds. The Social Security Administration (SSA) reports that 45 percent of men and 26 percent of women receiving disability benefits became impaired because of workplace accidents, injuries, or illnesses. 

In addition to causing death and disability, injuries claim a significant economic toll. The CDC estimates that in 2019, the economic cost of injuries was $4.21 trillion. This comprised $327 billion in medical care and $69 billion in loss of work.

Personal Injury Lawsuits 

If someone’s negligent actions cause an injury, the injured person can make a personal injury claim. This is where the help of personal injury lawyers comes in. The purpose of these types of claims is to recover compensation for the injury. 

Most claims primarily involve compensation for the financial and emotional cost of the injury. However, in cases of severe negligence, injured people can also receive additional money intended to punish the party responsible. 

Personal Injury Settlements 

When injured people bring claims against those at fault, they often reach a settlement agreement and receive compensation. For example, in the case of car accidents caused by negligence, automobile insurance companies would typically pay the settlement payments. (These payments might go to the injured individual as a lump sum or in installments.) 

The Law Dictionary reports that approximately 95 percent of personal injury cases settle before trial. For those cases that result in a trial, more than 90 percent end with an injured person or surviving family winning the case and receiving a money judgment. 

Are Lawsuit Settlements Taxable?

Whether a personal injury settlement is entirely or partially subject to federal income tax depends on the type of compensation the injured party receives. Personal injury damages fall into different categories, such as compensatory damages. These types of damages may compensate for things like lost wages or the cost of litigation. Other categories include punitive damages and damages for emotional distress. Some damages are not subject to federal income tax. 

The purpose of compensatory damages is to make the injured person “whole.” This type of compensation provides for money lost. 

For example, someone injured by a distracted driver could receive compensatory damages that make up for the financial losses from the accident. Compensatory damages could cover the cost of medical bills, follow-up appointments, and physical therapy. It also can address income diminished by loss of wages as well as the impact of pain and suffering. 

Because compensatory damages make up for financial losses directly resulting from the incident, they are generally not subject to income tax. To be tax-exempt, however, the compensation must address a physical injury. 

The Internal Revenue Service (IRS) typically considers compensation for emotional distress, mental harm, and mental illness as taxable income received. This is because the financial toll of mental anguish can be more challenging to measure. For example, someone who developed post-traumatic stress disorder (PTSD) following an accident might have to pay taxes on compensation for their PTSD. 

Although not common, victims of gross negligence may receive punitive damages in addition to compensatory damages. 

Punitive damages do not seek to make the person whole; instead, they punish the wrongdoer. Punitive damages do not provide compensation for direct, measurable loss. Therefore, they do count as income and are subject to federal income tax. 

State income tax rules vary. Some states, such as Florida, do not have an income tax. When states impose an income tax, taxation of settlements often reflects the federal rules. 

How to Avoid Paying Taxes on Settlement Money 

Advocating for their client, an attorney may negotiate a settlement that avoids federal income tax. Compensatory damages for physical injuries are generally not taxable. So, the attorney may emphasize the need for this type of compensation during negotiations. Some agreements explicitly state that the damages are not taxable. 

Even before you settle a personal injury lawsuit, consider consulting with your special needs planning attorney. Or you may want to direct your personal injury attorney to connect with them. Your special needs planning attorney can offer guidance on settlement planning.

If you have suffered an injury that has resulted in disability, you may qualify for public assistance. Your special needs planner can help identify the benefits programs for which you are eligible. They will have expertise on how a settlement might affect certain government benefits, such as Social Security Disability Insurance.

They also can assist you in establishing a Medicare Set-Aside trust when necessary. (These types of arrangements hold settlement money for future medical bills.)

According to a report published this month on Medicaid disenrollment by the Center for Children and Families, nearly 600,000 Florid children have been disenrolled from Medicaid since the pandemic protections theat provided for continuous coverage of Medicaid throughout the COVID-19 pandemic were eliminated by the Consolidated Appropriations Act (CAA) on April 1, 2023. Thereafter, some states started hastily removing many Medicaid-eligible children from its rosters.

Nationwide, by December 2023, nearly 4.16 million children had been disenrolled from Medicaid, with Florida, Texas, Georgia and California seeing the largest declines. Many of these children were provided coverage through the Medicaid/CHIP program, but others categories of affected individuals include those who received Medicaid under Disabled Adult Child benefits. The Disabled Adult Child program is a SSA-eligible determination that allows Medicaid coverage to continue, despite being ineligible because the child now receives a higher Social Security check due to the death or retirement of a parent.

It appears that many who received such notices have moved to the Florida KidCare program. As of April 2024, nearly 182,000 children have enrolled in Flordia KidCare, which represents a 66% increase year-over-year from 2023. But this still leaves a significant number of children possibly uninsured.

Florida is currently facing a class-action lawsuit filed by the Florida Health Justice Project. If you believe that you have received a termination of CHIP/Medicaid that might be incorrect, the Florida Health Justice Project has created a toolkit that guides parents on what they need to do. Included in the toolkit is an email template where you can request an appeal.

However, if you lost coverage of your Medicaid as a result of being a Disabled Adult Child and your Social Security payment increasing above the SSI amount, and you feel you were inappropriately included in the recent unwinding of Medicaid rosters in Florida, please reach out to our firm, as we are actively working on finding a solution to these issues.

Young woman with Down syndrome smiles with smartphone in hand while sitting on sofa.Half of Americans report that access to affordable housing is a problem in their community, according to the Pew Research Center. For families affected by disability, housing costs can pose a particularly significant concern. According to the Center on Budget and Policy Priorities (CBPP), more than 4 million people with disabilities are part of families that put more than half of their household incomes toward rent and utilities. 

In the United States, 5 million people rely on Section 8 housing vouchers to help pay rent. This includes families affected by disability, the CBPP reports. Meanwhile, the Urban Instituteestimates that 18 million people with disabilities may qualify for assistance that they do not receive. 

Many low-income people with disabilities use special needs trusts (SNTs) to maintain eligibility for public assistance programs such as Medicaid and Supplemental Security Income (SSI). While you can qualify for the Section 8 voucher program with an SNT, it can affect how much housing assistance you receive. 

What Is Section 8 Housing?

The Housing Choice Voucher Program, or Section 8 Housing, is the nation’s most significant source of rental assistance. The program aims to provide affordable, safe, sanitary housing to low-income families, seniors, and people with disabilities. 

Section 8 of the United States Housing Act of 1937 established the program. The Housing Choice Voucher Program is the formal name. However, many people refer to it as Section 8 because of the legislation that created it. 

A Section 8 housing voucher’s amount varies. It can depend on household income and size, local housing costs, and the Fair Market Rent (FMR). (The Department of Housing and Urban Development (HUD) calculates new FMR rates each year; they differ by region.) Typically, when families pay 30 percent of their income toward rent and utilities, the voucher covers the remainder up to the FMR’s limit. 

Special Needs Trusts 

Many people with disabilities have special needs trusts (SNTs) in place. Some individuals who establish SNTs may, for example, have received a sizeable settlement in a personal injury lawsuit. Because these assets are in an SNT, they can still qualify for needs-based government assistance like Medicaid and SSI.

Special needs trusts typically pay for goods and services that Medicaid and SSI do not cover. This may include such expenses as education, recreation, hobbies, and transportation. 

People with SNTs can also obtain Section 8 housing vouchers. However, withdrawals from a special needs trust can count as household income; in turn, this impacts how much one’s housing voucher will cover. The more income a household receives in a particular location, the less the voucher covers. For example, if an individual receives $200 monthly from a special needs trust, that is part of their household’s income. 

Often, trustees pay the beneficiary’s bills directly from the trust. Distributions from a special needs trust count as income whether the trustee gives the money to the recipient or uses trust money to pay the beneficiary’s bills. 

Assets do not disqualify households from Section 8. However, HUD uses the standard increase in asset value to calculate income. Annual income, per HUD, can affect the amount of one’s housing voucher. (Read more about income limits on the HUD website.)

How to Apply for Section 8 

Contact your local Public Housing Agency (PHA) to apply for the Housing Choice Voucher Program. HUD provides an agency directory online. 

Completing an application involves supplying documentation on your family composition, income, and assets. In addition, you will need to provide identification, your Social Security number, and proof of citizenship or immigration status. 

After applying, it can take months or even years to receive a voucher depending on how long the wait list is in your area. The need for vouchers typically exceeds government resources. The PHA may close the list when many families are waiting.

Speak with Your Special Needs Planning Attorney 

Note that different types of special needs trusts come with certain limitations. They also may follow different rules, depending on where you live. Be sure to work with your special needs planner when establishing a special needs trust.

Your attorney can also help you through the process of applying for the housing voucher program. They can help you determine how your particular SNT could affect your housing voucher.

DOCTORS QUIT? Is the Wall Street Journal becoming Faux News?

As Judy Lieberman of the Columbia Journalism Review reported on August 12th, the Wall Street Journal had printed a story called “More Doctors Steer Clear of Medicare: Some Doctors Opt Out of Program” on July 29, 2013, that last year, according to the Centers for Medicare and Medicaid Services, 9,539 physicians opted out of Medicare, up from 3,700 opting out in 2009. [A four-year period of time]

Dan Diamond of California Healthline looked at the same figures from the same source. What the Journal didn’t report is that also per CMS, the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013. [A one-year period of time]

A one percent drop of physicians wouldn’t be shocking given aging, retirement, sickness and death of physicians in the general population. But it is “shocking” if you write the story from an angle that sensationalizes and purposely attempts to mislead – not shocking that professionals get old and retire – but shocking that the WSJ is in danger of becoming a hack rag disguised as legitimate journalism.

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 PCIP program is now cheaper – premiums have been reduced.  PCIP is "Pre-existing Condition Insurance Program,"  a part of the Affordable Care Act (ObamaCare) that is currently available to persons who have been denied health insurance by private health insurance companies because of even minor health conditions.  It also insures individuals with significant medical issues who have been without health insurance for six months or more.  Some of our clilents who have funds are purchasing the PCIP health insurance (the same non-profit company that insures Congresspersons and U.S. Senators).  The coverage is excellent.  And the doctors are first class private physicians and hospitals – after all, Congress wrote this insurance for themselves and their families – Obama is just letting disabled persons and others previously excluded from purchasing insurance, to buy this insurance.

The new rates are significantly lower than what our law firm’s group health insurance costs: for a person age 32, our office policy costs $525 per month; the PCIP plan cost is $176 per month; for an employee age 48, our plan costs us $755 per month, and the PCIP is only $270 for even better coverage.

CLICK HERE for more descriiptions on how to sign up online for PCIP and the coverage and rates.  A full description of the program – about 81 pages – is available here.

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.”