Lien Resolution Group advises clients how to protect their benefits before receipt of settlement monies, while also addressing any future medical obligations.

Medicare Set-Asides

Not all cases require a portion of the settlement to be allocated and “set-aside” for future medical expenses. But understanding which cases require a Medicare Set-Aside (MSA), and how much to set-aside, is best determined by an expert.

All parties in a Workers Compensation case have significant responsibilities under the Medicare Secondary Payer laws to protect Medicare’s interests when resolving workers compensation cases that include future medical expenses. The recommended method to protect Medicare’s interests is a Workers’ Compensation Medicare Set-aside Arrangement, which allocates a portion of the settlement for future medical expenses. The amount of the set aside is determined by us on a case-by-case basis and submitted to CMS for review. Once the CMS determined set aside amount is exhausted and accurately accounted for to CMS, Medicare will agree to pay primary for future Medicare covered expenses related to the workers compensation injury.

In liability cases there is an obligation to protect Medicare’s future interest but no guidance has been released as to how to do this. LRG works with clients to determine whether considering a MSA in a liability case is necessary or not. And if a MSA is needed, LRG determines the appropriate amount to set aside, submits to CMS, and provides clients with fully visibility and reporting.

Protecting Benefits

Government benefits are either based on an entitlement or based on need and assets. Depending on the type of benefit at issue, there are different items to consider before receipt of settlement monies.

Entitlement Benefits

Eligibility for Medicare, SSDI, and Social Security Retirement Income benefits are not determined by income or an asset test. These benefits are entitlement benefits and should not be disrupted by the receipt of settlement monies.

Needs and Asset Tested Benefits

Many government programs that provide monthly income or payments for medical services have strict income limits. Without careful planning, a settlement award may cause a client to lose their eligibility for such programs.  It is important that you know what, if any, government benefits you are receiving now, or could receive in the future. The following benefits are needs and/or asset tested benefits and could be interrupted by the receipt of settlement monies: Medicaid and SSI (Supplemental Security Income), Food Stamps, now known as Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), CHIP (Children’s Health Insurance Program) and Subsidized Housing programs.

LRG will work with clients to explore options to preserve these benefits before receipt of settlement funds.  Such options and considerations include “exemption planning”, spending your settlement monies down on exempt goods and services purchased for the benefit of the beneficiary after reporting it in order to requalify, and use of a Special Needs Trust. A Special Needs Trust allows clients to access settlement monies while maintaining needs based and asset tested benefits.

Trust Administration

Administering a trust can be a daunting task for a family. Our services include a group of attorneys and professionals that will administer the trust and in some cases, co-trustee the trust. This includes watching over the funds, looking out for claimant's best interest, preserving governmental benefits, and revising investments. Please contact us to learn more about our trust creation and administration services.