As professionals, the members of Summit Settlement Services are experienced in the arenas of public benefit coordination. Whether there is a need for a Special Needs Trust or a Medicare Set-Aside, our professionals understand how such vehicles are crafted and employed to preserve public benefits. Assuring availability of future dollars through a structured settlement annuity, while preserving any available public benefits, takes knowledge and experience.

Summit Settlement Services has built a network of public benefits professionals. Whether it is associations such as the National Structured Settlement Trade Association (NSSTA) or the National Association of Medicare Set-Aside Professionals (NAMSAP), legal or financial professionals or experienced individuals, we have the answers related to complex public benefits programs and settlement of your claim.

Special Needs Trusts

It takes careful planning when money or property is being received by someone with a disability. Otherwise, the ability to receive Supplemental Security Income (SSI) and Medicaid benefits may be jeopardized. By setting up a “special needs trust”, most, if not all, of these problems can be avoided.

Owning a house, a car, furnishings, and normal personal effects does not affect eligibility for SSI or Medicaid. Other assets, however, including cash in the bank, can disqualify you from benefits. For example, if you leave your loved one $10,000 in cash, he or she won’t be able to get SSI or Medicaid.

How a Special Needs Trust Can Help

A losing eligibility for SSI or Medicaid is to create what’s called a “Special Needs Trust”. Instead of property being received directly, the money or property can be sent to the Special Needs Trust.

An assigned trustee, will have complete discretion over the trust property and will be in charge of spending money on the disabled person’s behalf. Because the trust beneficiary has no control over the money, SSI and Medicaid administrators will ignore the trust property for program eligibility purposes. The trust ends when it is no longer needed — commonly, at the beneficiary’s death or when the trust funds have depleted. When the beneficiary dies Medicaid can assert a lien on the Trust property. Once the lien issue has been resolved, the Trust property is then free to be distributed according to the Trust document, probate, or other directing authority. If the Trust property is depleted, Medicaid has no lien against the Trust.

Medicare Set-Aside

When a person is Medicare eligible, part of any injury settlement received for future medical treatment must be “set-aside” and used to pay for medical expenses that would normally be paid for by Medicare, if it were not for the injury.

42 USC §1395y (b) (2) – If a settlement contains an amount for future medical expenses, the settlement is considered the primary coverage for payment. The regulations provide that if a reasonable portion of the settlement proceeds are allocated, or set-aside, for expenses otherwise covered by Medicare, only the allocated funds must be properly spent down; not the entire amount of the settlement – 42 CFR §411.46-§411.47.

Federal law precludes Medicare payments for any item or service if payment has been made or can reasonably be expected to be made by a responsible third party (i.e. Workers Compensation or Liability or Health Insurance Company).

A Medicare Set-Aside estimate is prepared and sent to The Centers for Medicare and Medicaid Services for their determination of adequacy. Sounds simple, but in reality can be very difficult in the throes of litigation.

A proper Medicare Set-Aside will coordinate and preserve your Medicare benefits.

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