Special Needs Planning in NJ – Part 1 of 4

Government Benefits

PART I – GOVERNMENT BENEFITS

Many parents of a special needs child have an overwhelming concern: How (and by whom) will their child be taken care of when I die? In this series, I would like to explore the options that exist to ensure that your child will be provided for.

In order to understand the planning options available to your child, you first need to understand the government benefits that might be available to your child. There are 5 types of government benefits commonly available:

1. Supplemental Security Income (SSI)

Supplemental Security Income (SSI) – provides money for low-income individuals who are disabled, blind or elderly and have few assets.

SSI eligibility

SSI eligibility rules form the basis for most other government program rules, and so become the central focus for much special needs trust planning and administration.

You must live in the United States or the Northern Mariana Islands to get SSI. Non-citizen residents may be able to get SSI. Once a person qualifies for SSI, he or she is automatically eligible for Medicaid in New Jersey and most other states.

To qualify you must have little or no income and few resources – the value of the things you own must be less than $2,000 if you are single or less than $3,000 if you are married. The value of your home does not count. Usually, the value of your car does not count. And the value of certain other resources, such as a burial plot, may not count either.

To get SSI, you also must apply for any other cash benefits you may be able to get.

  • The amount a person is entitled to receive in 2009 is:
  • Person living alone or with others in own household $ 705.25
  • Person living with spouse who is not eligible for SSI $ 1,018.36
  • Person living in someone else’s household and receiving support and maintenance $ 493.65
  • Person living in licensed residential health care facility $ 884.05
  • Person living in public general hospital or Medicaid approved long-term health facility $ 40.00
  • Couple living alone or with others in own household $ 1,036.36
  • Couple living in someone else’s household and receiving support and maintenance $ 767.09
  • Couple living in licensed residential health care facility $ 1,730.36

The above includes both federal and state payments.

The benefit is reduced dollar for dollar for any other income the beneficiary may receive. This means that once an SSI beneficiary’s income reaches a certain level, his or her SSI benefit will terminate.

2. Social Security Disability Income (SSDI)

Social Security Disability Income (SSDI) – provides money for individuals with a disability who qualify for Social Security based upon their own work history or the work history of such person’s parents.

The SSDI program pays benefits to adults who have a disability that began before they became 22 years old. The government considers this SSDI benefit as a “child’s” benefit because it is paid on a parent’s Social Security earnings record. For a disabled adult to be entitled to this “child” benefit, one of his or her parents:

  • Must be receiving Social Security retirement or disability benefits; or
  • Must have died and have worked long enough under Social Security.

SSI v. SSDI

  1. SSI is a needs based program and SSDI is an entitlement program. There is no “means” test for SSDI eligibility.
  2. SSDI can be a much higher income level than SSI, and with no payback.
  3. Under both SSI and SSDI, the child must not be doing any “substantial” work, and must have a medical condition that has lasted or is expected either to last for at least 12 months or to result in death.
  4. In order to qualify for SSI, individuals must first apply for SSDI if eligible as SSI is a last benefit of last resort. A person switching to SSDI from SSI can still qualify for Medicaid.

3. Medicaid

Medicaid is a benefit program available to low-income individuals which makes payments directly to health care providers for medical needs over and above what Medicare will pay. The largest health and long term care program operated and funded by the government – in this case, the federal government. The fixed monthly income cap for Medicaid in 2009 is $2,022.

4. Medicare

Medicare is a federal program that makes payments directly to hospitals, doctors and drug companies. People can qualify for benefits if they are 65 and over (and are entitled to receive Social Security benefits, whether or not they have actually retired) and those who have been receiving SSDI for at least two years.

  • Part A – Covers most medically necessary hospital, skilled nursing facility, home health and hospice care.
  • Part B – Covers most medically necessary doctors’ services, preventative care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, home health care and ambulance services. (There is a monthly premium for Part B based upon a person’s income.)
  • Part D – Covers prescription drugs.

Medicaid v. Medicare

Medicaid differs from Medicare in three important ways:

  1. Medicaid is run by state governments (though partially funded by federal payments);
  2. it is available to those who meet financial eligibility requirements rather than being based on the age of the recipient, and
  3. it covers all necessary medical care (though it is easy to argue that Medicaid’s definition of “necessary” care is too narrow).

Because Medicaid is a “means tested” health care program and Medicare covers a smaller portion of long-term care costs, maintaining continuous Medicaid availability is often the central focus of special needs trust administration.

5. SCHIP

SCHIP – State Children’s Health Insurance Program. This program has higher income eligibility limits and provides health insurance for many who earn too much to qualify for other programs.