What the Heck is a Pooled Trust

WHAT THE HECK IS A
POOLED TRUST?

HOW YOUR ELDERLY OR DISABLED FAMILY MEMBER WITH INCOME THAT IS "TOO HIGH"
CAN STILL QUALIFY FOR MEDICAID HOME CARE (or Husky C, OR QMB) IN CONNECTICUT
(last updated:  1/21/24)


Lisa Nachmias Davis
Davis O'Sullivan & Priest LLC
59 Elm Street, Suite 540
New Haven, Connecticut 06510
203-776-4400
 davis@sharinglaw.net
www.sharinglaw.net ~ www.estate-elder.com

DISCLAIMER
    While having ASSETS over a limit is not always a problem in Connecticut, depending on the type of benefit, there are many situations where having INCOME over the limit either disqualifies you or makes you pay a big deductible before coverage kicks in.

    For instance: 

    "QMB" which pays the copays and deductibles of Medicare has a flat CAP.  One dollar over, you don't qualify.  In 2024, that's $2,563/single.

    Husky C -- which pays for the stuff Medicare does NOT pay for, as well as basic medical care and prescriptions for people not on Medicare and not eligible for "Husky D," -- doesn't have a cutoff exactly, but unless you can work, if your income is over $1128 (2024 figure), you can have a pretty big deductible.  If you need personal care assistance at home under something called "Community First Choice," this is a huge headache. 

    AND ESPECIALLY -- IF AN ELDERLY OR DISABLED PERSON NEEDS MEDICAID TO PAY FOR SO-CALLED "WAIVER SERVICES" -- such as paying for home care  that Medicare doesn't cover, such as supervision, or help with activities of daily living, INCOME MATTERS. Too much income and you don't qualify.  Period.  These "waiver" programs include:


1.      CT Home Care Program for Elders Category 3 (Medicaid Waiver) -- home care for those 65+.
2.     Acquired Brain Injury Medicaid Waiver -- services and supports for those with a brain injury, any age.
3.     Personal Care Assistance Medicaid Waiver - services and supports for those able to supervise an attendant; PCA waiver allows you to use an agency, for Community First Choice, you have to hire a person alone.. 

For these programs, if the applicant's income is more than 300% of the SSI benefit (for 2024, this means $2829), the person's income is TOO HIGH -- NOT ELIGIBLE.

       But this is crazy -- the person could have $3,000 of income and Medicaid would pay for a nursing home (after requiring almost all income to be paid towards the cost) but not if you want to stay home????

       Don't ask why. It's complicated.  The point is that Connecticut has found a solution: diverting the excess income to a POOLED TRUST.    If you put your "excess income" in this every month, the excess magically disappears, does not count, does not cause you to be denied or have a big deductible any more!  This solution was actually developed by State officials AND disability lawyers putting their heads together and looking for loopholes in the federal rules.  (THIS DOES NOT WORK FOR HUSKY D UNFORTUNATELY!!! THAT'S BASED ON TAXABLE INCOME WHICH IS A DIFFERENT THING.)

       So what is it?  What's a pooled trust?

       A "pooled trust" is a type of common fund run by a charitable organization where disabled people have "accounts" representing their contributions to the fund.  It's like a mini Special Needs Trust. (as you might have heard, a Special Needs Trust is designed for disabled individuals as a way to benefit from their own assets while not having the assets disqualify them from eligibility.)  The pooled trust was originally intended to help disabled people with excess assets where a Special Needs Trust seemed too expensive, or slow, or complicated.  Unlike a Special Needs Trust (which is only for people under 65), a pooled trust account can be created for a disabled person of any age. A person of any age can set up the account and put assets in the account .... or income.  The federal government's state medicaid manual  says that when income goes in  to a Special Needs Trust OR a Pooled Trust, the income is no longer "counted" income for eligibility purposes.

       (And to be clear -- if you are under 65, you doesn't need a pooled trust necessarily although you could use one -- a separate Special Needs Trust (for instances, with your sister as Trustee)  could also work, but only until you turn 65.)

       What if you are over 65, but were never disabled?  That's OK.  Provided the doctor will says that you are unable, due to your medical etc. condition, to WORK for 12 months or more, you ARE disabled.

       And does the money just go in and disappear?  NO. Both the Special Needs Trust and the Pooled Trust are for the "sole benefit" of the person whose money goes in.  True, there will be administrative expenses, but basically, the money left over can still be used for the person's needs.  In fact, for someone over 65, you even have to prove that the money WILL be used up for the person's needs!


       How does it work?  Let's talk about your MOM.  Her income is $3,000.  She may already get care for 20 hours a week under the so-called "state-funded" home care program.  BUT, she really need 40 hours a week of home care.  All she owns is her home and about $1,000.  To get the Medicaid waiver home care that will provide the 40 hours of care, she needs a pooled trust (or Special Needs Trust if under 65, but that won't work if she's 64 and turning 65 in a few months, will it?).   The only nonprofit in Connecticut that does this is PLAN of Connecticut (www.planofct.org).
 
PLAN will require:

DSS will require (in addition to any other application forms):       How much should go into the account?  It depends.  If Mom has $3,000 of income, and the limit for 2024 is $2,829, putting in $171/month might be enough to make her eligible for home care, BUT, unless she has other out-of-pocket medical expenses, she'd still have a deductible -- the amount by which $2829 exceeds the "allowance" the state allows, which right now, until March 1, 2024, is $2,430.  So $2829 minus $2430 is nearly $400 dollars!  (It will probably be less, effective in March.)  SO, if instead she puts in $570 per month, no copay.  THIS CAN BE TRICKY so you may need an experienced lawyer to figure it out.  If 40 hours won't cut it and she'll be spending out of pocket for additional help, or she is keeping her health insurance premium, etc., maybe she won't need to put in $570 per month.  This can be tricky and you'll probably need a lawyer to help with this.  PLAN does have a minimum of $75/month.
.  
     The logistics can get tricky.  As I said, what goes in has to (mostly) be used for Mom's expenses, less about $100 or so/month.  PLAN cannot send Mom her whole $570, but can probably pay the electric bill and the cable TV bill-- something like that.  If the condo fee is due the first of the month, it may not work to have PLAN pay that.

       What happens when Mom dies?  Everything left in the account goes to the State, or to PLAN's Charitable Trust. NOTHING COMES BACK AFTER MOM DIES.  If she were to die soon after her income went to PLAN, PLAN could not pay the bills it would usually pay.  Everything STOPS and the money goes to the State.

       Hope this helps!

       P.S.  -- is it worth it? what will it mean?  You SHOULD know that if the person getting benefits dies (you, mom, whoever), owning a house, the state is NOT going to come after the estate for reimbursement of Community First Choice and SHOULD NOT be able to come after the estate for that state-funded home care. Or QMB  ONLY for the Medicaid waiver (or nursing home care).  So there might be times when it makes more sense for a family member to pitch in. OR -- see a lawyer.

 
  Disclaimer:  This information is maintained to benefit the elderly in Connecticut and nationwide by providing a resource to
attorneys, caregivers, and others assisting the elderly.   This is not legal advice,
and establishes no attorney-client relationship.  Accuracy and currency are not guaranteed.
The law changes often; this may be out of date. USE AT YOUR OWN RISK.
Please report changes, errors, and suggestions to Lisa Davis.