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5 Key Things to Know That Can Help Maximize A Beneficiary's Public Benefits

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This article is a part of True Link’s Guest Expert Series. We have interviewed leaders knowledgeable in disability planning, elder law, and trust administration and will be sharing their expertise with you in a series of videos and posts. Note: this article is not intended to provide investment, legal, tax, accounting or medical advice. Before making decisions involving investing, legal, tax, accounting or medical concerns, you should consult appropriate professionals regarding your specific situation.

Serving as the trustee of any trust can be challenging, but the administrators of Special Needs Trusts (SNTs) also need to consider how their actions may impact a trust beneficiary's eligibility for public benefits – particularly those related to medical care.

Many trustees know that they need to follow regulations around income, resources and in-kind support and maintenance to maximize the Social Security benefits (in particular, Supplemental Security Income or “SSI”) a beneficiary can receive (which in turn can impact Medicaid eligibility). However, as Ann Koerner, President and Founder of National Care Advisors (NCA), explains, “after you’ve received the benefit, the next challenge is maximizing those benefits.”

Public benefits programs go beyond Social Security and Medicaid/Medicare

As Koerner shares, “Whether it’s private health insurance, Medicaid, Medicare, Social Security, Developmental Disability Services, mental health services, Workers Compensation, Veterans Administration – there are so many benefits out there, and they can be extremely valuable [in a] situation where someone requires some care and support.” Trustees shouldn’t limit themselves to the most well-known programs; there may be other resources the beneficiary can utilize.

Programs and services vary by state

One of the things that can make it difficult to discover what programs are available is that many Medicaid Waiver Programs are state-specific in terms of what programs and services are offered, which communities they serve, etc. Bridget O’Brien Swartz, Attorney at Dyer Bregman & Ferris PLLC’s and Vice President of NAELA, recommends you, “get on the Medicaid website in your state[...], it likely will have specific information about waiver services available in your location, and it will likely direct you to an agency in that state.” Once you are directed to the agency’s site, she continues, “you can obtain even more information specifically about the population served, how you apply for those services, [and] whether there are waitlists.”

You want to get on waitlists early 

It’s important to sign-up for any waitlisted programs as soon as possible. O’Brien Swartz emphasizes, “Even if you’re not contemplating an out of home living arrangement [...], you want to get into the system and establish yourself well before you need those services. 

You might need to “shop around”

Another advantage of signing up for benefits before a beneficiary needs them is to allow for some trial and error. “The first provider may not be the best, don’t let that discourage you[...] It’s like anything, you have to shop until you find the right fit,” shares O’Brien Swartz. Being ahead of the game gives you more time to get comfortable with the system. As Sharon Reich, Senior Trust Advisor for AGED (a Pooled Special Needs Trust in Florida) explains, “There are techniques that allow you to qualify for some of these programs even if you have too much money – a little bit too much income to qualify, a little bit too much in the way of assets – there are [different] types of Special Needs Trusts that can be used.” Reich recommends reaching out to experts (Medicare Insurance specialists, Elder Law Attorneys, etc.) to learn more about what options are available.

Using proper language & documentation in claims is essential  

Getting eligible expenses approved by payers like Medicaid often requires clear and detailed documentation. Ensuring the appropriate language or codes are used may require some education of healthcare providers if they are not familiar with these benefits. As Koerner details, this includes “how you communicate with the case managers, with the physicians writing, authorization and prescriptions, with the therapists, with all the other service providers to make sure that they are documenting appropriately, so that those payer sources like Medicaid [...] are in a position to be able to approve the service or equipment that has been requested.” 

Have questions about ways to maximize public benefits for a beneficiary? You can reach out to one of these guest experts for guidance. You can also read more of NCA’s thoughts on maximizing benefits here.

‍Want to watch these videos on Vimeo? Here are the links to the guest expert videos related to this topic:

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