The State Bar of California
83
rd
Annual Meeting
September 24, 2010
Program #56
The Impact of Lump Sum Settlements
on Public Benefit Recipients
SOCIAL SECURITY AND SSI
Julie Aguilar Rogado
Social Security Programs
Title II - Social Security
Disability Insurance
(SSDI) & Retirement
Benefits
Title XVI
-Supplemental Security
Income (SSI)
Retirement Benefits
Available to persons
62 years of age and
older
Must have paid into
Social Security (or be
a widow or minor
child)
Benefit amount is
based upon averaged
wages for the years
during which the
beneficiary paid into
the program
Social Security Disability Insurance
Title II of the Social
Security Act
Monthly benefits for
persons who worked
and paid into Social
Security for at least
40 quarters (or fewer
for workers younger
than 24 years of age)
Medicare eligibility in
25
thmonth
Monthly benefit amount
is based upon earnings
during the relevant
quarters
Must establish disability
Commonly known as
Supplemental Security Income
Title XVI of the Social
Security Act
Monthly benefits for
persons who have little
income and few assets
In California, there is a
supplemental payment
Commonly known as
SSI
Benefits are capped
at $845 per month
(with the state
supplement)
Recent reductions due
to CA state budget
Automatic eligibility
for Medi-Cal
Cannot get food
Social Security Disability
Income Limits:
SSDI is a wage replacement
Other wage replacement income over 80% of
“average current earnings” can reduce benefit
Recipients must report
Supplemental Security Income
Income Limits
Other income reduces the benefit amount (earned
income at 50%, unearned at 100%)
Unearned income over $890 per month can eliminate
eligibility for a benefit payment in that month
Resource Limits
SSI Resource Exclusions
Home
Household goods and personal effects
Automobile, if used for transportation
Property that is essential to self-support
Life Insurance
Limited burial spaces/expenses fund
MEDICARE & MEDI-CAL
Ann Rubinstein
11
Medicare – Overview
Medicare is a federal health insurance
program for seniors and people with
disabilities.
Medicare is not income or resource dependant.
Medicare Structure
A – Hospital- In patient
B – Out patient & non hospital care (Drs’ offices, labs etc) D – Prescription Drugs
Medicare Advantage Plans
Original Medicare covers medically necessary
care within the scope of covered benefits
12
Medicare – Eligibility
Eligibility
No income or asset limits
People 65 years old and older (with 40 quarters)
Those with less than 40 quarters may buy in
People receiving Childhood Disability Benefits
People receiving Title II (SSDI) benefits for 25 months or
13
Medicare Costs
Costs
Part A premium
For those w/ 40 quarters this is free, for those w/ less there is a premium, the
state will pay this for Medi-Cal benes over 65
Part B Premium ($96.40/ 110.50 for 2010)
CA pays for people with free Medi-Cal
People with higher incomes pay more than $110.50
Part D Premiums and drug co-pays
State pays for “benchmark” plans and subsidizes other plans for people on
free Medi-Cal
Medicare Advantage premiums
Medicare pays 80% of covered medical services
Medicare will not pay for care that is covered by another source (but it
14
Medi-Cal- Overview
California’s Medicaid Program (State and Federal Funding)
Medi-Cal is always the payer of last resort and only pays
when Medi-Cal providers are used
Adults: “services reasonable and necessary to protect life,
to prevent significant illness or significant disability, or to
alleviate severe pain” (22 CCR 51303)
Recent cuts to adult programs (no dental, vision, chiropractic,
psychological, etc.)
Children: “services necessary health care, diagnostic
services, treatment and other measures… to correct or
ameliorate defects and physical and mental illnesses and
conditions discovered by the screening services”
15
Medi-Cal – Eligibility
Categorical Eligibility
Children under 21 and their parents
Links through other public programs (CalWORKS, SSI, CAPI, foster care,
adoption assistance)
People with disabilities People older than 65
People with specific health conditions (BCCTP, ESRD)
Income/Resource Eligibility
Depends on linkage and on age of the child
Resources under $2,000 for an individual $3,000 for a couple
16
Medi-Cal – Costs
Medi-Cal is either free or has a share of cost
depending on monthly income and categorical eligibility
Share of cost is similar to a monthly deductible
SOC is assigned to beneficiaries with countable income
over the program limit, Medi-Cal subtracts the MNL and
the rest is the monthly SOC
Children with a share of cost whose income is under 250%
17
Medi-Cal Exempt Resources
(MC 007)
Principal residence
Household goods
One car
Irrevocable burial trust
Revocable burial trust up to $1,500
Life insurance w/ face value up to $1,500
IRA/ Keough/ Pension Plan when payments of
18
2014 Health Reform changes to
Medicaid
Able bodied adults without dependants will be
eligible for Medicaid
No resource limit for most people
19
Medi-Cal Law
WIC § 14000 et seq.
22 CCR § 50000 et seq.
Department of Health Care
Services All County Letters
(dhcs.ca.gov)
Health Reform
The Patient Protection and
Affordable Care Act, now Public Law 111-148 (Signed on March 23, 2010)
The Health Care and
Education Reconciliation Act of 2010 (Signed on March 30, 2010)
20
Resources
Health Consumer Alliance:
www.healthconsumer.org
National Health Law Program:
www.healthlaw.org
California Health Advocates:
www.cahealthadvocates.org
CASH & FOOD PROGRAMS
Jodie Berger
22
ID’g Likely Recipients
Category?
E.g. Family, single, refugee?
Don’t forget: mixed households
Financial threshold?
23
CalWORKs: Who
Category
Adult caring for related children
Includes “mixed households” of ineligible adults and eligible
kids
“Deprivation”
One or both parents dead, absent, under/ unemployed, or
incapacitated
Incap = physical/mental condition that reduces substantially or
eliminates the parent's ability to support or care for the child
I.e. includes if affects ability to work
24
CalWORKs: Who
(cont’d)
Age
Must be pregnant or have 1+ child under 18 (or to 19
if will graduate by 19
thb-day)
Or under 19 if can’t graduate on time because of current or
past
illness
or disability
California Resident
25
CalWORKs: $
Financial
Below income cap (see chart) – c 130% FPL for recips
Depends on where lives
Depends on whether receiving disability benefits
Below Resource cap
$2k or $3k for house w/ indiv’l w/ disability
$4650 of car not counted – rest is resource
26
Aid Charts
27
General Assistance
General Relief
Category
Singles and couples w/o children
Financial
Not eligible for any other program
Low grants/low income limits
Low resource limits
28
GA: Flag
“Last Resort”
100% county funded
Loan not grant
Retro SSI goes to county first
29
SSI
Category
Aged or disabled
Unable to do “significant gainful activity” for 12 months or more or
terminal
Financial
Grant is $674/1,011for couple + CA supplement*
Income limit (wages) is $1,433; not from wages is $694
Resource limit
30
Food Stamps/CFAP
Given to
households
People who buy/prepare food together Certain groups not eligible
Undocs, certain drug felons, certain students, etc.
Financial
130% FPL for applicants
Aged/disabled don’t have this test
“Countable income” below 130% FPL
Many deductions
$2k/$3k resources
31
Resources
CalWORKs Manual
www.wclp.org
(Publications) $75/2 years
Foster Care Manual
www.wclp.org
(Publications) Free
Food Stamp Guide
www.foodstampguide.org
– Free
Medi-Cal Guide
http://healthconsumer.org/publications.htm#medi-caloverview
– Free
CMSP rules
PUBLIC & SUBSIDIZED HOUSING
S. Lynn Martinez
Types of Subsidized Housing
Public Housing
Housing Choice Voucher (Section 8)
Federally-Subsidized or Insured Multi-Family
Developments (Project-Based)
HUD
USDA - Rural Housing
Low Income Housing Tax Credit
_
Public Housing
Project Based / Multi-Family Subsidized Housing
Housing Choice Voucher (aka Section 8 voucher)
Rural Housing Service State HCD Programs Low-Income Housing Tax Credit
HUD Structure & Authorities
(all federal subsidies
except
tax credit units)
Community Planning and Development
CPD
Public and Indian Housing
PIH
Housing H
Fair Housing & Equal Opportunity FHEO HUD 24 CFR Handbooks/Guidebooks Letters/Opinions Congress 42 USC
Public Housing
(PIH)
Rent
Assets & Income
Lump Sums
Addition to family
assets
Delayed start of
periodic payments
Failure to report change in income
Eviction and Loss of subsidy Owned & managed by the Public Housing Authority (PHA)
Housing Choice Voucher
(PIH)
No more certificates!!!!!
Owned and managed by private landlord
Facilitated by PHA
Special voucher types:
Moving to Work
Family Unification
People with Disabilities
Enhanced Voucher
Participation
Contract
HAP Contract
Housing
Authority
Lease with HUD Addendum
Landlord
Tenant
Application
HA Payment
General Rules Applicable to Vouchers
¾
Rent
Tenant generally pays 30-40% of her
income toward rent
¾
Assets
No limitation but income derived
from assets counts as income
¾
Lump Sums
Determine whether it’s a “lump
sum addition to family assets” or a “delayed
start of a periodic payment”
¾
Eviction
and possible loss of subsidy for
failure to report
Federally Insured or Subsidized
Multi-Family Developments
Housing, (H) or MFH
aka
“Project-Based Housing”
Owned and managed by private landlord
Rent: 30% of tenant’s income
Income & Asset Rules
Lump Sums
Types of Federally Insured or
Subsidized Housing
Section 236
Rent Supplement
Section 235 (h/o)
HoDAG
Section 221(d)(3), (4), (5)
Section 202
Section 811
Section 23
Project Based Section 8: Mod rehab, substantial rehab,
Other Subsidized Housing
Programs
Low Income Housing Tax Credit
USDA – Rural Housing
State Housing and Community Development
programs
Important Bookmarks & Subsidized
Housing Resources
HUD programs:
www.hud.gov
HUD publications:
www.hud.gov/offices/adm/hudclips/
Code of Federal Regulations:
www.access.gpo.gov/nara/cfr/cfr-table-search.html#page1
Overview re: subsidized housing programs:
www.nhlp.org
and
www.nlihc.org
Rural housing programs:
www.usda.org
