Distinguishing the Different Medicaid Programs

Medicaid is an assistance program. It serves disabled and low-income people of every age. A small co-payment is sometimes required. Medicaid is a federal program and its eligibility criteria varies from state to state.

A Special Needs Trust preserves Supplemental Security Income and Medicaid. Eligibility is based on disability and income.

Why consider a Special Needs Trust?

Medicaid Coverage + Tax Free SSI + IHSS may be worth thousands of dollars every month!

Disability-Based Medicaid

(Also Know as a needs-based or traditional medicaid)

CLIENT MUST USE SPECIAL NEEDS TRUST OR SPEND THE MONEY WITHIN THE SAME CALENDAR MONTH TO PRESERVE BENEFITS

  • Permanently disabled & unable to work
  • Only Income Test Applies in California
  • Income and Asset Test Applies - Needs based
  • Supplemental Security Income (SSI) recipients
  • In-Home Support Services (IHSS) recipients
  • Home and community-based waiver participants
  • Long Term Care Facility residents

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Income Based Medicaid

(Also Known as Expanded/MAGI Medicaid)

DOES NOT NEED A SPECIAL NEEDS TRUST (SNT)

  • Able to work & income is below 138% of the Federal Poverty Level (FPL)
  • MAGI Medicaid based on the household income
  • Assets are not counted towards eligibility
  • Parents / caretakers relatives
  • Pregnant women

CLIENT CAN TAKE SETTLEMENT PROCEEDS WITHOUT LOSING BENEFITS

The Difference Between Medicaid and Medicare Programs

Please note that your client may be on both programs

Medicaid

Low-income families and children
People with disabilities
Pregnant women
Seniors (65+)

68.6 million Americans

Primary, specialty, acute, custodial and long-term care

No premiums or copayments for lowest-income beneficiaries

Oversight by CMS

Medicare

Seniors (65+)
People who work enough work quarters to qualify
People of any age with End-Stage
Renal Disease (ESRD)

58.1 million Americans

Primary, specialty, skilled, and acute care

Beneficiaries must pay premiums and deductibles

Federal government through CM

Disclaimer: This resource provided by CPT Institute is for informational purposes only and arc intended to be used as a non-legal guide prior to consultation with an attorney familiar with your specific legal situation. CPT Institute is not engaged in the practice of law or in rendering legal advice or counsel. No such legal advice or counseling is either expressly or impliedly intended. If you require legal advice, you should seek the services of an attorney. © 2021 CPT Institute All rights reserved.