Workers’ Compensation

Ca. Workers' Comp. Quarterly 2019, Vol. 32, No. 3

The Interplay Between Medicare and Medicaid for Injured Workers

Jason D. Lazarus, J.D., LL.M., CSSC, MSSC Orlando, Florida

This article discusses dual eligibility for injured workers. It addresses exactly what it is and how Medicaid (in California, Medi-Cal) coordinates with Medicare for those who are eligible for both programs. It takes a look at Medicare Set-Asides (MSAs) and Special Needs Trusts (SNPs) and techniques to preserve Medicaid and Medicare. Finally, it examines the intersection of these two public benefit preservation trusts.

Some individuals are "dual eligible," meaning they qualify for both Medicaid and Medicare. In certain cases a Medicare Set-Aside/Special Needs Trust (SNT) or pooled Special Needs Trust may be necessary to preserve the claimant’s dual eligibility. A Medicare Set-Aside Trust is a device used to preserve future Medicare eligibility. An SNT or pooled Special Needs Trust is appropriate for claimants receiving Supplemental Security Income (SSI) and/or Medicaid benefits. Federal law allows creation of either an SNT or a pooled SNT to preserve eligibility for needs-based benefits, such as SSI and Medicaid, post settlement of a workers’ compensation claim.

Dual Eligibility

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