Medi-Cal (California's Medicaid Program) is a means-tested program or also known as needs-based. Meaning, that there are certain income, asset/resource requirements to qualify to be eligible for Medi-Cal.
The answer to this question depends on if a beneficiary is receiving Supplemental Security Income (SSI) or Medi-Cal (Medicaid program for California). If a beneficiary receives Supplemental Security Income (SSI) then there is no negative effect on a beneficiary’s Supplemental Security Income (SSI) benefits or eligibility.
If a beneficiary receives Medi-Cal (California Medicaid Program) benefits only he/she is obligated to report specific changes to the Medi-Cal regional office that serves his/her county of residence.
A common question by beneficiaries is related to their pets. “Can my Special Needs Trust pay for a pet or provide care for my pet? The answer to this question is yes, of course! Disbursements made from a beneficiary’s Special Needs Trust for his or her pet(s) will not interfere or jeopardize a beneficiary’s Supplemental Security Income (SSI) or Medi-Cal (California Medicaid Program). Making disbursements for the beneficiary’s pet(s) does not violate the sole benefit rule for a First Party Special Needs Trust.
Needs-based public benefits are also known as means-tested public benefits. Needs-based public benefits are benefits that have more strict income asset/resource requirements to qualify and be eligible for. Needs-based public benefits are the essential benefits that, CPT, as Trustee, protects.
If a beneficiary receives Medi-Cal (California’s Medicaid Program), and not Supplemental Security Income (SSI), CPT, as Trustee, can pay for a certain portion or percentage of the beneficiary’s request to purchase food, shelter, utilities, or other In-Kind Support Maintenance (ISM) items without impacting Medi-Cal eligibility. Other items that are not considered as In-Kind Support Maintenance, can be paid in full without jeopardizing Medi-Cal eligibility.
When establishing a Special Needs Trust, it is vital to know what government/public benefits an individual is receiving. It is extremely important for the trustee to know what benefits a beneficiary is receiving due to the sole responsibility of ensuring that the specific benefits being utilized are not jeopardized.
Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.
When qualifying and establishing an appropriate Special Needs Trust there are certain words or verbiage that may seem a bit confusing or unclear. To lessen the confusion and increase a better understanding of specific terms we have created a list of relevant terms with appropriate definitions related to the Pooled Special Needs Trusts.
Some clients are already eligible for public benefits such as Medi-Cal, or SSI, or may be eligible for these public benefits as a result of their work comp injury. To best protect these clients, the applicant attorney should understand what steps are needed to protect the client’s public benefits. Good planning is essential because the receipt of settlement funds may jeopardize public benefits eligibility.
William E. Lindahl, MBA, CLPF