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After a brain injury, many people face financial struggles and challenges that may be overwhelming. This section provides a background of financial planning and discusses different government financial resources and options for persons with brain injury and their families.
Brain injury can greatly affect the financial situation of the person with the injury and their loved ones/dependents. There may be a change in earning potential and the projected income from salary/wages. Income from government benefits, legal settlements and other sources may become necessary. Changes in expenses, such as housing, transportation, and personal care may also affect finances. Other issues to consider include lifestyle, debt, insurance, estate planning and investments.
Although it can seem like a lower priority during time of crisis, it is imperative to take time to develop a comprehensive plan for meeting current and future financial needs. This information needs to be revisited regularly, because it is an important step in making sure you and/or your loved one can live the quality of life desired.
There are public benefits available to persons with disabilities, as detailed in the "Government Financial Resources" section on the following page. Some of these resources place limits on income and certain types of assets. Exceeding such limits, which include insurance settlements or inheritance money, can lead individuals to lose some or all of their benefits. There are many other qualification criteria that need to be met to keep public funding, such as having properly titled assets and beneficiaries.
Proper planning can help protect a person's continued eligibility for public benefits. It's advised that you consult with a qualified attorney or a financial planner who specializes in Special Needs Planning to structure a solid financial plan. Click here for general questions to ask a financial planner and/or attorney. Click here for suggestions about how to select a qualified attorney.
Special Needs Trust (SNT)
Government cash benefits, as detailed in the “Government Financial Resources” section on the following page, provide for the bare necessities of care. Parents or guardians of an individual with special needs often provide extras beyond the bare necessities to make their life comfortable. An important aspect of care is to consider how the loved one will be cared for when the parent or guardian is no longer able.
To maintain eligibility for government benefits and leave assets to an individual with brain injury, a Special Needs Trust (SNT) needs to be set up. Special Needs Trusts are designed specifically to supplement, not replace, government benefits, to ensure “extra” expenses are covered. Some of these extras include but are not limited to out-of-pocket medical expenses, eyeglasses, vehicle maintenance, insurance, hobby materials, entertainment, personal care attendant, or essential dietary needs.
Money from the SNT cannot be distributed to the person with a disability; it must be distributed directly to a third party. Trust assets are not held in the name of the person with the disability. Family members can become the beneficiary of the trust assets. The laws governing trusts are complex and vary, so it's advised that a qualified attorney or a financial planner who specializes in Special Needs Planning is consulted when setting up a SNT.
Government Financial Resources
All government financial programs have an appeals process for individuals who have been denied benefits. It is necessary for persons with brain injury to appeal negative financial decisions. If you think that you should be eligible and have been denied benefits, you are encouraged to begin the appeals process immediately. Please do not feel that you are “complaining” or “being difficult” or that it will be “no use.” The appeals process is part of the application process.
Social Security Disability Insurance (SSDI)
hysical or mental impairment that is expected to keep him or her from doing any substantial work for at least one year, or a condition that is expected to result in death. The amount of a person's SSDI payment depends upon how much he or she has worked and how much he or she has paid into the Social Security system through taxes. Some people who have SSDI may also be eligible for Minnesota Supplemental Aid (MSA).
Once you have qualified for SSDI, a knowledgeable financial planner or lawyer should be able to assist you in structuring a compensation plan that will allow you to keep eligibility for government benefits. When choosing a financial planner or attorney, be sure to ask the questions found in the Legal Resources section.
It is advised that you apply for SSDI benefits as soon as possible because of a six-month waiting period. If a person has qualified for SSDI, benefits begin on the sixth full month after the application is accepted.
To apply for SSDI, call your local Social Security Administration (SSA) office. It also can be useful to work with an attorney during the SSDI application. For more information on working with an attorney, see the Legal Resources section. To find out where the nearest SSA office is located, call 800-772-1213 or see the Administration's Web site at www.ssa.gov. You can also call the Minnesota Brain Injury Alliance at 612-378-2742 or 800-669-6442 for assistance in locating the nearest office.
Supplemental Security Income (SSI)
Supplemental Security Income (SSI) is a strictly need-based federal financial assistance program for persons with disabilities who have limited resources. The program is intended to guarantee a minimum monthly income to persons with disabilities who have little or no income and resources.
Persons with disabilities can be eligible for SSI even if they have never worked. Age is not a factor. If a person is eligible for SSI, he or she is automatically eligible for Medicaid. People receiving SSI must meet certain income and resource limitations to be eligible. Insurance policy payments, court settlements, worker's compensation and other financial resources may limit your eligibility for SSI.
Minnesota Supplemental Aid (MSA) is a state-based program where SSI payments are supplemented with a state grant. For questions about MSA, contact your county social service agency at the telephone number in the phone listings section.
To apply for SSI, call your local Social Security Administration (SSA) office. To find out where the nearest SSA office is located, call 800-772-1213 or see the Administration's Web site at www.ssa.gov.
Medicare is a federal health insurance plan that includes persons with disabilities that are determined to be eligible for SSDI due to disability. Medicare is not based on income. Medicare has four components: hospital insurance (Part A), medical insurance (Part B), Medicare Advantage Plan (Part C) and Prescription Drug Coverage (Part D). Local Social Security Administration offices process applications and provide information about the program.
Information on requirements for certification and covered benefits is addressed in a booklet published by the Social Security Administration. For a copy, call 800-772-1213 or visit www.medicare.gov. To be eligible, a person must have been entitled to SSDI benefits for 29 months or turn age 65. Medicare parts A and B are often called "Traditional Medicare."
Hospital Insurance (Part A)
Any person who has received SSDI for 29 months automatically becomes eligible for Medicare hospital insurance at no monthly cost without an application process. You may wish to call the Centers for Medicare & Medicaid Services at 800-633-4227, TTY at 877-486-2048 or visit www.cms.hhs.gov. Medicare will help pay for the following health care options:
- Hospital Inpatient Care: Patients are responsible for a deductible. After the deductible is met, Medicare will pay a certain percentage of inpatient care based upon length of stay.
- Skilled Nursing Home Care: Medicare pays 100 percent for the first 20 days for skilled care or physician-ordered rehabilitation when the person has been hospitalized for at least three days. There is a daily charge beginning on the 21st day. It does not cover Long-Term or Custodial Care.
- Home Health Care:Medicare can pay for a limited amount of home-based skilled nursing care and physical, occupational, and speech therapy.
- Hospice Care: Medicare provides full coverage for inpatient and home care services. There is no deductible.
Medical Insurance (Part B)
After receiving SSDI benefits for 29 months, a person with brain injury may choose to enroll in the Medicare medical insurance program (Part B). Premium and deductible charges do apply. If a recipient does not want the medical insurance Part B, he or she must refuse it in writing. After the deductible is met, and premiums are paid, Medicare will cover:
- Doctor's Services: After the deductible is met, Medicare pays 80 percent of allowable or approved charges for an unlimited number of surgical, diagnostic and other medical doctor-administered services.
- Other Services: Services covered may include ambulance transport, home health visits, outpatient services such as emergency room or clinics and certain durable medical equipment..
*Currently, many persons receiving Medicare also purchase supplemental insurance (Medigap) to ensure more reliable health coverage. For more information, call your county social service office found in the phone listings section or visit www.dhs.state.mn.us.
*Services NOT covered under Medicare include personal assistants, institutional services, dental care/dentures, hearing aids, eye care/glasses, routine foot care, some screening tests, bathroom grab bars, etc. Call 800-633-4227 for more information about Medicare coverage.
Medicare Advantage Plan and Prescription Drug Coverage (Part C and Part D)
In 2006, the federal government instituted a change for Medicare recipients, which provides a new outpatient prescription drug benefit. Beneficiaries can now remain in traditional Medicare and enroll separately in private prescription drug plans or enroll in a Medicare Advantage Plan (Part C) that also covers prescription drugs. Up until this point, drug coverage was not part of Medicare. Individuals who are Medicaid eligible automatically are enrolled in a plan. Almost one in three people with Medicare qualify for these extra benefits.
With the Medicare Advantage Plan, Medicare will pay for almost all of the drug costs. You will have to pay the monthly Medicare Part B premium and you also may have to pay a monthly premium for the extra Medicare Advantage Plan benefits. There is extra help available for people with limited income and resources. For more information, call the Linkage Line at 866-333-2466 or go to www.medicare.gov.
This term describes individuals that are eligible for both Medicare and Medicaid (Medical Assistance in Minnesota) due to low income and are either age 65+ or have a disability. For many people Medicaid provides a critical supplement to Medicare, filling gaps in coverage. Some specific types of drugs will still be paid for via Medicaid (check with your pharmacist).
Minnesota Family Investment Program (MFIP)
The Minnesota Family Investment Program (MFIP) is a public assistance program for low income families with children administered by the State of Minnesota. For more information, call your county social service office found in the phone listings section or visit www.dhs.state.mn.us and click on "A-Z Topics" to find the link to MFIP.
Programs for Children
For information about programs for children, call the Department of Health – Minnesota Children with Special Health Needs at 651-201-3650 or visit www.health.state.mn.us/divs/fh/mcshn/finres.htm.
Medical Assistance (Medicaid)
Some persons will be eligible for Medical Assistance (MA), known in other states as Medicaid. MA is a need based program (e.g. low income, few assets, meet immigration/residency requirements). It pays for eyeglasses, dental care, mental health services, family planning, hospice care, lab and x-ray, health centers, medical equipment, home health care, inpatient and outpatient hospital services, nursing home services, some prescribed drugs and transportation to and from medical appointments. People receiving SSI/SSDI are eligible for Medicaid. For more information, call your county social service office found in the phone listing section or visit
www.dhs.state.mn.us and click on "A-Z Topics" to find the link to MA or call 651-431-2670, 1-800-657-3739.
Waivers are a funding source for persons who need services beyond MA or their private health insurance. There are various Waivers, including the CADI, CAC, MR/RC and TBI Waivers. The Waivers provide the opportunity for individuals to live in the community rather than in nursing homes or institutionalized settings. You must be on Medical Assistance, certified disabled and eligible for nursing home or institutionalized care to qualify for Waivers. Do not worry if you have never heard of these Waivers. Ask your county social service office (see the phone listing section) to direct you to the department that does intake for Waivered services. If you have difficulty finding the intake department, call the Minnesota Brain Injury Alliance at 800-669-6442 or 612-378-2742.
Department of Veterans Affairs (VA)
The Department of Veterans Affairs (VA) is a federal program that provides benefits to eligible veterans and their dependents. An honorable or general discharge will qualify a veteran for benefits. Veterans in prison or on parole may be entitled to certain VA benefits.
Eligible veterans may receive acute rehabilitation, residential care, outpatient treatment, dental treatment, alcohol and drug treatment, prosthetic devices or mental health services. The VA has a system that prioritizes who can receive services and at what time. Since there are limited numbers of beds available in VA facilities, there are often waiting lists for services.
For more information about eligibility and services, call the VA at 612-725-2000 or contact a veteran advocate through your county, or visit www.mdva.state.mn.us. "Military One" is also source for a one-stop information center. Contact Military One at 800-342-9647 or visit www.military.onesource.com.
If you sustained a brain injury during active military status, you may be eligible for services through the Defense and Veterans Brain Injury Center. For more information, call 800-870-9244 or visit www.dvbic.org.
Workers Compensation Program is an insurance program provided by many employers at no cost to the employee. If an employee is hurt on the job or develops a disease due to conditions on the job, Workers Compensation pays all reasonable and necessary medical care related to the injury or illness.
If a brain injury happens on the job, a person or his or her family should immediately inform the employer that an injury has occurred. Many employers require that an employee report his or her injury within 24 hours.
The worker should only seek treatment at approved medical facilities. The worker must report any earnings, Social Security benefits, or unemployment compensation benefits to the insurance company. These forms of income can affect the amount of Workers Compensation benefits received. For more information, call 651-545-5005, 800-342-5354 or visit www.doli.state.mn.us/workcomp.html.
Minnesota Work Incentives Connection: How Benefits are Affected by Work
Returning to work is an important part of the rehabilitation process for many persons with brain injury. Financial programs and incentives are set up to encourage returning to work.
There are new programs that make it easier for persons with disabilities to be employed and receive medical assistance (MA). The Minnesota Work Incentives Connection will help you understand how returning to work will affect your benefits. To speak to a Minnesota Work Incentives Specialist about your specific situation, call 651-632-5113 or 800-976-6728 or visit www.mnworkincentives.com.
Continue to the next section, "Home Health Services."