The post Repeal and replace the ACA? first appeared on SEONewsWire.net.]]>The incoming administration is determined to repeal and replace the Affordable Care Act (ACA). It is difficult to know yet, what is to replace it and how the new system will work. Some provisions from the ACA may be kept in place like keeping kids on a parent’s health plan until they are 26 years-old and not denying people health insurance if they have pre-existing conditions. But the question…
The post The Affordable Care Act’s future for 2017 first appeared on SEONewsWire.net.]]>With a new administration promising to repeal the Affordable Care Act (ACA), 2017 may be a different year. However, with all large changes that may be coming, it is virtually guaranteed that repealing the ACA and replacing it with something else requires, in the words of House Speaker Paul Ryan, “a good transition period.” No matter how much Americans want change that change will need to…
The Wall Street Journal reported today that multiple insurers across the country have requested rate increases ranging from 8.2% to 65.2%. While those requests will most likely be pushed down by regulators, consumers will be faced with significant increases this fall.
Why Is This Important to You?
- Consumers will be seriously searching for alternatives when they see the increases
- Many will drop their expensive exchange plans
- Consumers will be open to hearing about alternatives
- Consumers priced out of the exchange market have an established budget to buy health insurance, and will take your offerings seriously
- Consumers who stay in the market will most likely be buying plans with much higher out of pocket costs, increased copays, and deductibles and they will be very open to ancillary products like accident, critical illness and metal gap plans.
- Consumers will be seriously searching for alternatives when they see the increases
- Many will drop their expensive exchange plans
- Consumers will be open to hearing about alternatives
- Consumers priced out of the exchange market have an established budget to buy health insurance, and will take your offerings seriously
- Consumers who stay in the market will most likely be buying plans with much higher out of pocket costs, increased copays, and deductibles and they will be very open to ancillary products like accident, critical illness and metal gap plans.
Right now is the time to start planning your strategy for open enrollment. Having a game plan in place now for the impact of these rate increases this fall will
The post Get Ready to Sell Alternative Alternatives to the ACA this fall first appeared on SEONewsWire.net.]]>by Thomas D. Begley, Jr., CELA
Personal Injury attorneys must inquire as to whether their clients are receiving public benefits. Certain benefits are means-tested, so that if the client receives money directly those benefits are reduced or lost completely. This article will outline the common public benefits and indicate whether the receipt of a personal injury settlement will affect those benefits.
Supplemental Security Income
Supplement Security Income (SSI) is a means-tested federal program that provides income (a cash assistance grant) to certain aged (65 or over), blind, and persons with disabilities. The program is administered by the Social Security Administration. It is governed by federal statute,[1] federal regulations,[2] and the Program Operating Manual System of the Social Security Administration (POMS). For 2016, the maximum federal SSI benefit is $733 per month. In addition, the State of New Jersey has a supplement in the amount of $31.25 per month. If an individual has more than $2,000 of assets, he or she will lose SSI. Therefore, the receipt of a personal injury settlement will disqualify the plaintiff from SSI, unless the funds are placed in a Special Needs Trust.
Social Security Disability Income
This program is known as Old Age Survivors and Disability Insurance (OASDI). It is governed by the Social Security Act.[3] Unlike SSI, which is a means-tested welfare program, Social Security Disability Income (SSDI) is an insurance program. Coverage is based on quarters of Social Security insurance coverage during the applicant’s employment. Receipt of a personal injury settlement will not affect the plaintiff’s SSDI.
Medicaid
Medicaid is a medical insurance program that benefits millions of Americans. There are many ways that individuals qualify for Medicaid. The vast majority of Medicaid recipients receive that benefit, because they are also receiving SSI. If they lose their SSI, they also lose their Medicaid. However, since the Affordable Care Act (ACA), millions of Americans now receive Medicaid regardless of whether or not they are disabled and regardless of whether they are receiving SSI.
For SSI-based Medicaid, there is an asset limit of $2,000. For ACA Medicaid, there is no resource limit. Therefore, receipt of a personal injury settlement by an SSI recipient will cause a loss of Medicaid. However, receipt of a personal injury settlement by a Medicaid recipient who obtained Medicaid through the ACA will not affect eligibility, except that the income from the settlement may push the income of the plaintiff above the income limits for eligibility under the ACA. The solution for an individual receiving SSI-linked Medicaid is a Special Needs Trust. However, under the ACA, only individuals with disabilities are qualified for a Special Needs Trust. Individuals receiving Medicaid under the ACA who are not disabled may not utilize a Special Needs Trust.
Medicaid Waiver Programs
Medicaid Waiver Programs are designed to provide Medicaid coverage for long-term care services. These services are typically delivered in the home or assisted living facilities. These services are vital to catastrophically-injured individuals. These programs have an asset maximum of $2,000. Receipt of a personal injury settlement would disqualify the plaintiff from Medicaid Waiver services, unless the funds are placed in a Special Needs Trust.
Medicare
Medicare is a program that pays medical costs of eligible beneficiaries. Unlike Medicaid, which is a welfare program, Medicare is an insurance program. Receipt of a personal injury settlement will not affect Medicare eligibility.
Federally Assisted Housing
The federal government has two housing programs that provide assistance for low-income individuals and people with disabilities. These are known as Section 2.02 and Section 8. Section 8 is the program that has the most effect on personal injury plaintiffs. The Department of Housing and Urban Development (HUD) pays rental subsidies so eligible families can afford decent, safe and sanitary housing. Each section of the country has a maximum income limit for eligibility for public housing. If a tenant is eligible, they pay 30% of their net income for rent. While there is no asset test for federally assisted housing, if the assets produce income, the income may render the plaintiff ineligible or cause an increase in monthly rental. Income for the entire household is considered.
Payments from a Special Needs Trust are not counted as income, so long as the payments are irregular and sporadic.
Supplemental Nutritional Assistance Program
The Supplemental Nutritional Assistance Program (SNAP) is now the name for a program that used to be called Food Stamps. Recipients are provided an electronic benefit transfer (EBT) card that looks much like a credit card. SNAP eligibility is determined on the basis of household eligibility.
In New Jersey SNAP has complex resource and income limits. Therefore, receipt of a personal injury settlement could disqualify the individual from these benefits, unless the personal injury proceeds are placed in the Special Needs Trust.
Division of Developmental Disability
Many Division of Developmental Disability (DDD) programs are now based on Medicaid eligibility. The asset limit is $2,000. If the plaintiff is receiving or would otherwise be eligible to receive those benefits, then receipt of a personal injury settlement would disqualify them unless it has been placed into a Special Needs Trust. Other DDD benefits would be unaffected by receipt of a personal injury recovery.
Group Home
In New Jersey most group homes are paid with Medicaid dollars. The asset limit is $2,000. Therefore, receipt of a personal injury settlement would disqualify the individual from those benefits, unless it is placed in a Special Needs Trust.
Psychiatric Institutions
Many psychiatric institutions are paid for by Medicaid dollars under Medicaid Waiver Programs. Again, the asset limit is $2,000, so receipt of a personal injury settlement would disqualify the plaintiff unless the funds are placed in a Special Needs Trust.
[1] 42 U.S.C. §1381 et seq.
[2] 20 C.F.R. §416.
[3] 42 U.S.C. §401 et seq. The Regulations are found at 20 C.F.R. §404.1 et seq.
The post PUBLIC BENEFITS CONSIDERATIONS IN PERSONAL INJURY CASES first appeared on SEONewsWire.net.]]>by Thomas D. Begley, Jr., CELA
Personal Injury attorneys must inquire as to whether their clients are receiving public benefits. Certain benefits are means-tested, so that if the client receives money directly those benefits are reduced or lost completely. This article will outline the common public benefits and indicate whether the receipt of a personal injury settlement will affect those benefits.
Supplemental Security Income (SSI)
Supplement Security Income (SSI) is a means-tested federal program that provides income (a cash assistance grant) to certain aged (65 or over), blind, and persons with disabilities. If an individual has more than $2,000 of assets, he or she will lose SSI. Therefore, the receipt of a personal injury settlement will disqualify the plaintiff from SSI, unless the funds are placed in a Special Needs Trust.
Social Security Disability Income (SSDI)
This program is known as SSDI. It provides an income to disabled workers. It is an insurance program, not a welfare program. Receipt of a personal injury settlement will not affect the plaintiff’s SSDI.
Medicaid
Medicaid is a medical insurance program. There are many ways that individuals qualify for Medicaid. The vast majority of Medicaid recipients receive that benefit, because they are also receiving SSI. If they lose their SSI, they also lose their Medicaid. However, since the Affordable Care Act (ACA), millions of Americans now receive Medicaid regardless of whether or not they are disabled and regardless of whether they are receiving SSI.
For SSI-based Medicaid, there is an asset limit of $2,000. For ACA Medicaid, there is no resource limit. Therefore, receipt of a personal injury settlement by an SSI recipient will cause a loss of Medicaid. However, receipt of a personal injury settlement by a Medicaid recipient who obtained Medicaid through the ACA will not affect eligibility, except that the income from the settlement may push the income of the plaintiff above the income limits for eligibility under the ACA. The solution for an individual receiving SSI-linked Medicaid is a Special Needs Trust.
Medicaid Waiver Programs
Medicaid Waiver Programs are designed to provide Medicaid coverage for long-term care services. These services are typically delivered in the home or assisted living facilities. These services are vital to catastrophically-injured individuals. These programs have an asset maximum of $2,000. Receipt of a personal injury settlement would disqualify the plaintiff from Medicaid Waiver services, unless the funds are placed in a Special Needs Trust.
Medicare
Medicare is a program that pays medical costs of eligible beneficiaries. Unlike Medicaid, which is a welfare program, Medicare is an insurance program. Receipt of a personal injury settlement will not affect Medicare eligibility.
The post PUBLIC BENEFITS CONSIDERATIONS IN PERSONAL INJURY CASES first appeared on SEONewsWire.net.]]>
THE IMPORTANCE OF A FINANCIAL ANALYSIS TO DETERMINE IF A SPECIAL NEEDS TRUST IS REQUIRED IN A PERSONAL INJURY CASE
by Thomas D. Begley, Jr., CELA
When a plaintiff receiving public benefits achieves a personal injury settlement, the plaintiff essentially has four choices: (1) use a special needs trust (SNT) only; (2) use the SNT, but also buy ACA private health care; (3) do not use an SNT and buy ACA private insurance; or (4) do not use an SNT and attempt to become eligible for Medicaid-funded insurance through programs such as New Jersey Family Care.
Analysis of the Four Options with Respect to Special Needs Trusts
Let’s examine the advantages of each option.
- Using an SNT only. The advantage is that the plaintiff will continue to receive SSI, Medicaid, and other means-tested public benefits. The disadvantages are that distributions from the trust must be for the sole benefit of the individual and that there is a Medicaid payback on the death of the trust beneficiary.
- Use the SNT but also buy ACA private health care. The advantage here is that the plaintiff’s SSI and Medicaid are protected. The ACA insurance will result in a reduction or elimination of the Medicaid payback. Also, purchase of the ACA insurance may result in better health care and more access to health care providers than Traditional Medicaid. The disadvantage is that the trust must pay the premiums for the ACA insurance, so this is a consideration in smaller trusts but definitely a good strategy for larger trusts.
- Not use an SNT and buy ACA private insurance. The advantage is that there is greater flexibility with respect to accessing the recovery. The disadvantages are that the personal injury victim may squander the money and ACA insurance only covers what typical private medical insurance covers (i.e., hospitals and physicians), but does not cover what Medicaid Waiver programs cover, such as home- and community-based services or placement in group homes, assisted living facilities, or nursing homes.
- Not use an SNT but rely on programs such as New Jersey Family Care. The advantage is that there is greater access to the litigation proceeds. The disadvantage is the money may be squandered, not everyone is eligible for New Jersey Family Care, and New Jersey Family Care does not cover hospital and physician costs.
Importance of SSI
If a personal injury victim is receiving means-tested public benefits such as SSI, Medicaid, Medicaid Waiver benefits, etc., it is often assumed that the plaintiff will require an SNT to preserve those benefits. In the past, that conclusion was almost always true. However, with the passage of the Affordable Care Act effective January 1, 2014, individuals with pre-existing conditions are now able to obtain private medical insurance and may not need to rely on Medicaid as much as prior to the ACA. However, the analysis does not stop there.
Currently in New Jersey an SSI recipient is entitled to approximately $750 per month. SSI comes with a COLA. The value of the SSI payment over a lifetime is usually hundreds of thousands of dollars.
Who Will Hold the Money
In most cases, it makes financial sense to utilize an SNT if the plaintiff also receives SSI, unless the net settlement to the plaintiff exceeds roughly $3,000,000. The SNT preserves SSI, which is often the individual’s only access to income. In addition, if the plaintiff is incapacitated and is receiving means-tested public benefits, the litigation recovery must be placed in some kind of court-supervised entity, typically a guardianship or the Surrogate’s office. It is always less expensive and easier to access funds held in an SNT than those held by a guardianship account or the Surrogate’s Court. Funds held in a guardianship account or Surrogate’s Court are considered to be available for public benefits purposes and would cause a loss of both SSI and Medicaid.
Protecting the Plaintiff from Himself and Predators
Even if the plaintiff has legal capacity, frequently they do not have the sophistication to properly manage wealth. An SNT allows the plaintiff to preserve eligibility for benefits, usually without court supervision in New Jersey, and to have a trustee with a fiduciary obligation to utilize the funds for the plaintiff’s sole benefit under a prudent investment strategy. The trust also offers protection from financial predators including strangers, members of the opposite sex, and even family members looking to take advantage. Under these circumstances, the SNT will provide the best option to safeguard and protect the person with a disability.
Budgeting
According to an analysis by Scott MacDonald, CSNA, Affordable Care Act’s Financial Effect on Settlement Planning, an individual receiving a net settlement of $1,000,000 that is placed into an SNT will receive an attainable annual total budget of $33,484. If instead the plaintiff took the settlement and purchased private health care, even under the ACA, the annual budget would be reduced to $15,494. If you add in the loss of the SSI COLA estimated at 2.5% over time, the plaintiff would be taking a 52% annual pay cut by not utilizing an SNT. Using a similar analysis with a $100,000 net settlement, the SNT could provide $12,610 toward an annual budget, but if the beneficiary took the funds directly and lost SSI, the annual spending amount would be $3,614, a 71% reduction for life. Under MacDonald’s analysis unless the plaintiff is netting at least $3,000,000, he will always be better off with an SNT.
The post THE IMPORTANCE OF A FINANCIAL ANALYSIS TO DETERMINE IF A SPECIAL NEEDS TRUST IS REQUIRED IN A PERSONAL INJURY CASE first appeared on SEONewsWire.net.]]>
A recent article on the Washington Times Communities website suggests that the Affordable Care Act (ACA), or Obamacare, may lower this barrier to divorce if it succeeds in making health care more affordable.
A study by the University of Michigan in 2012 found that each year, some 115,000 American women lose their health insurance after they get divorced. Many of them are not employed outside the home, work part-time, or work for companies that do not offer insurance. Some are eligible for COBRA benefits, but of those, many cannot afford the premiums while living alone.
Concerns over health insurance are especially prevalent among couples divorcing after age 50, cases sometimes called “gray divorces.” If individuals are too young to qualify for Medicare, they may find themselves priced out of insurance markets. An unknown number of couples remain married until age 65 for this very reason.
Individuals with pre-existing conditions who are covered under their spouse’s plan also face strong incentives to remain legally married.
Beginning January 1 2014, the ACA could change this dynamic for many people. Presumably, some number of people will be able to afford health insurance on their own where previously they could not. If the program is a success, and large numbers of couples find themselves in this situation, the divorce rate could rise sharply, especially among the unemployed or underemployed, seniors and those with pre-existing conditions.
The ACA could also bring about changes in spousal support. The cost of health insurance affects the need for spousal support, with one party often having to pay enough for adequate coverage. Any change in the overall insurance market could affect how much support is awarded in some cases.
Accounting for these changes will likely be highly contentious in several ways. Opposing parties might disagree over whether spousal support should provide for excellent (“platinum”) insurance, or only basic (“bronze”) plans. If the spouse receiving support is eligible for a federal insurance subsidy, the other party may argue that that should lower the support awarded. Likewise, the expansion of Medicaid in some states will make more individuals eligible—another possible argument for lower support.
Among those couples who find themselves better able to afford health insurance under the Affordable Care Act, some who might otherwise have remained married may opt for divorce. The specific effects of such a change will take time to recognize and understand.
Kristi J. McCart is a Tampa divorce lawyer and Brandon child custody attorney with the Osenton Law Offices, P.A. To learn more, visit http://www.brandonlawoffice.com/
The post If Affordable Care Act Lives Up To Its Name, Divorce Rate May Rise first appeared on SEONewsWire.net.]]>Mark J. Mazur, the Assistant Secretary for Tax Policy at the U.S. Department of the Treasury, published the news yesterday on the treasury site. The post, Continuing to Implement the ACA in a Careful, Thoughtful Manner, attempts to paint this as a deliberate move to ease the reporting burden on employers as the initial forms were overly complex.
While this postponement does not change other parts of the law, analysts have noted that this delay may be a harbinger of more bad news for Obamacare to come. Especially considering that the federal government has not completed the work necessary to setup exchanges in the 30 states who will not be setting up their own exchanges. This is a herculean task that many experts believe cannot be accomplished in the remaining four months prior to open enrollment.
The Washington Post noted that this is a significant event for the administration, diminishing Obama’s credibility and threatening his legacy as the employer mandate is now in jeopardy of being permanently removed from the act. Which would undermine the entire law as the revenue the mandate will generate significantly contributes to the cost of this new entitlement program.
Another article you should read is a thoughtful piece in Forbes where they go into the potential impact of this policy change on employer coverage and they also note that it may not be legal to delay the implementation without an actual change in the law. Essentially, the administration can choose to not enforce the law, but its still the law.
The coming months are going to be exceptionally interesting as we all count down to implementation of one of the largest government run programs in the history of the country.
The post Affordable Care Act Postpones Employer Penalty first appeared on SEONewsWire.net.]]>
Recently, Employee Benefit News published an article by Craig J. Davidson, CEBS on how reducing employee hours may create an ERISA problem for employers. Essentially his argument states that employers will be reducing employees hours to to avoid setting up a benefit plan, which interferes with the right of the employee to participate in the plan and therefor this is a violation of ERISA Section 510.
The portion of ERISA which he is basing his thesis states “”It shall be unlawful for any person to discharge, fine, suspend, expel, discipline or discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan … or for the purpose of interfering with the attainment of any right to which such participant may become entitled under the plan … ”
Here’s the problem with this argument – there has to be a plan in place which the employee would otherwise have a right to participate in.
The fact is, employers will be reducing hours to avoid a penalty assessed by the government. There is no obligation for the employer to setup a plan so ERISA does not apply to an employer who does not offer a benefit plan and is seeking to legally avoid the penalties of the ACA.
The ACA does not require employers to setup a health plan, it simply penalizes them for not doing so.
Reducing employee hours to reduce or eliminate government penalties does not infringe on an employee’s right to participate in a plan because there is no plan.
At the very least, this interpretation of ERISA is a stretch. A stretch that will make a lot of money for attorneys at the very least.
This does not mean that there won’t be an attempt to enforce this interpretation of ERISA but if you or your client does not offer a plan, applying ERISA will be a hard argument for the government to make.
The post The ACA and a Unique Interpretation of How ERISA May Apply first appeared on SEONewsWire.net.]]>
Covering more than 60 million individuals, Medicaid is the nation’s primary health insurance program for low-income and high-need Americans.
(Related: GOP Gov. Rick Snyder Supports Michigan Medicaid Expansion)
Major federal funding is allocated by the Affordable Care Act’s expansion of Medicaid to a national eligibility floor of 138% of the federal poverty level (FPL). The Supreme Court upheld the ACA but limited the federal government’s ability to enforce the Medicaid expansion to low-income adults, effectively making implementation of the Medicaid expansion a state choice.
(Related: Legal and Financial Resources for People with Alzheimer’s Disease)
The report below examines the latest Congressional Budget Office (CBO) projections for federal Medicaid spending over the 2013-2023 period. CBO’s budget projections, also referred to as “baseline” projections, reflect CBO’s best judgement about how the economy along with other factors will affect federal revenues and spending under the existing laws.
(Related: The Doctor’s New Prescription: An Elder Attorney)
It is important to understand the CBO baseline estimates because they are the basis to evaluate the federal cost and coverage implications of proposed federal policy changes. Federal budget and federal deficit reduction have ignited an active debate and discussion. The fiscal effect of any federal policy changes will be measured against the CBO baseline.