1. CHILDREN’S HEALTH INSURANCE PROGRAM CHIP

2. Case Example Parent, Mary, receiving lump sum settlement of $300,000
She earns $2,000 per month as clerk (200% of FPL = $2,452)
Mary has one child, not disabled
Child has health insurance through state Medicaid agency CHIP program
After an injury, clients need help with numerous issues, including health insurance, available benefits to help pay the bills and provide needed services
You need to know your client’s thoughts about importance of maintaining benefit eligibility versus retaining control over the funds
They need to understand the structured settlement as an option
You may be able to get benefits in place prior to settlement that maximizes the value of the settlement to the client

3. Will Mary’s settlement affect child’s CHIP health insurance?
Does your state have an asset limit for CHIP?
If Mary structures her settlement will that put her income over the CHIP income limit?
Does CHIP require 12 month reporting or immediate reporting of change of circumstances?
With lead time, we were able to get the client qualified for Medicaid quickly by setting up a special needs trust immediately and transferring existing assets into trust.
We got the client on the Medicaid waiver program, so any allocation to his wife for her loss of consortium claim did not affect his eligibility
We allocated a larger amount than we might otherwise have to the consortium claim, and the wife agreed to pace the funds in an irrevocable trust which provided that if she divorced or left the client, she would be entitled to a fixed sum with the remainder to stay in the trust for the benefit of client and the children.

4. What if the child receives the lump sum
What if the child receives the lump sum? Is there an asset limit for household members or just parents?
What if child’s settlement is structured? Is CHIP based on parent’s income only or also child’s income?

5. CHIP and Subrogation Issues
If child on CHIP is injured, what subrogation rules apply?
Does your state CHIP program a Medicaid program or does Medicaid just pay the premiums for private health insurance

6. MEDICARE SAVINGS PLANS (MSP) LOW INCOME SUBSIDY (LIS or Extra Help)

7. Qualified Medicare Beneficiary
Income below 100% of FPL - $908
Non-exempt assets below $6,680
Home and vehicle of any value exempt
QMB benefit: pays Medicare Part A, B and D premiums, Medicare co-pays and deductibles, automatically enrolled in Part D LIS

8. Specified Low-Income Beneficiary
Income below 120% of FPL - $1,178
Non-exempt assets below $6,680
Home and vehicle of any value exempt
SLMB benefit: pays Medicare Part B premium, automatically enrolled in Part D LIS

9. Qualified Individual - QI
Income below 135% of FPL - $1,226
Non-exempt assets below $6,680
Home and vehicle of any value exempt
QI benefit: pays Medicare Part B premiums, Medicare co-pays and deductibles, automatically enrolled in Part D LIS

10. Extra Help – Low Income Subsidy
Medicare, not Medicaid program
Pays all or part of Part D premiums for prescription drug coverage
Pays all or part of prescription drug co-pays

11. Extra Help Eligibility
Full subsidy:
QMB, SLMB, QI deemed eligible
Income below 135% of FPL
Assets below $6,680 single $10,020 couple

12. Extra Help Eligibility
Partial subsidy:
Income between 135% and 150% of FPL
Assets below $11,140 single
$22,260 couple

13. Case Example Mrs. Lee is 69, LPR for 10 years
Did not pay into Social Security
Has Medicare Part A, B and D
Income of $700/month from a foreign pension
She will be getting a $50,000 personal injury settlement
There is information in the handout which addresses eligibility for SSDI, CDB and DAC
SSDI is available 5 months after the person is disabled.
Children disabled prior to age 22 get DAC or CDB benefits when a parent retires, dies or becomes disabled
Medicare kicks in 24 months after SSDI begins. This is why COBRA benefits have an extension period for persons who are disabled – ensure that your client files the necessary notices to get this extension if they want/need the COBRA benefits until Medicare is available
Shorter waiting period end stage renal disease, one month for Amyotropic Lateral Sclerosis (Lou Gehrig’s disease)

14. QMB
QMB is paying Mrs. Lee’s Medicare premiums, co-pays and deductibles
Part A premium $450/mo
Part B premium $96.40/mo
Part A deductible $1,132/yr
Part B deductible $162/yr
Part D premium $50/mo
Donut hole medications $4,500/yr
Part A & B co-pays $4,000/yr

15. Cost to lose QMB for 1 year
Part A premiums $5,400
Part B premiums $1,156
Part D premiums $600
Part A & B deductibles $1,294
Part A& B co-pays $4,000
Part D co-pays in donut $4,500
Total $16,950

16. Options to preserve MSP/LIS
Asset limit $6,680 + car + house
Pooled SNT if allowed in your state for person over 64
Give away settlement/no transfer penalty
Purchase exempt assets (home/car)
Spend down and re-apply