Medicaid Supplemental Needs Trusts

Filling a Growing Space

By Dr. David Edward Marcinko; MBA, CPHQ™, CMP™

By Thomas A. Muldowney; MSFS, CLU, ChFC, CFP® CMP™

By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™dhimc-book2

Some states now allow family and friends (not the individual Medicaid applicant) of a disabled individual to establish a trust, either inter vivos or testamentary, that permits distributions of income or principal without jeopardizing the beneficiary’s right to Medicaid, Supplemental Security Income, and other public benefits.

Of Trusts and Trustees

The trust allows the trustee discretion to make payments directly to the provider of goods and services for the beneficiary’s benefit to supplement public benefits. The beneficiary may be a disabled person of any age who is expected to have long-term needs (medical, social, psychological, and so on).

The Limits

There are no limits on the amount of income or principal that otherwise may be expended on the beneficiary’s behalf. After the disabled beneficiary’s death, the state has no right of recovery against the funds remaining in the trust because the trust was funded with the assets of someone other than the disabled beneficiary. The trust is truly supplemental; its assets may pay for lifestyle comforts, but not for any expense covered under Medicaid.

Assessment

Thus, a son or daughter could establish such a trust to provide additional comforts to a parent in a Medicaid-paid nursing home without jeopardizing that parent’s right to continuing Medicaid support. Upon the death of the parent, the trust remainder can then revert to the child.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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Disclosures Lacking in Drug Studies

New – Dark Alley – Report on Drug Studies

Staff Reportersdark-alley

A report in Bloomberg News, January 13, says that drug regulators haven’t done enough to force disclosure of financial conflicts among the researchers who conduct clinical trials of medications and medical devices.

 

Quid-pro-Quo

Financial connections between companies that make drugs and devices, and the doctors and other researchers who test them on humans, may compromise the safety of patients in studies and the integrity of the results.

According to the report, lawmakers led by Senator Charles Grassley [Republican from Iowa] have raised concern that conflicts of interest among doctors and manufacturers may influence prescribing decisions.

Assessment

Furthermore, the report said the “FDA should ensure that sponsors submit complete financial information for all clinical investigators.”  Is this a new or novel idea?

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is this entire “pay-2-play” or “quid-pro-quo” idea another dark-alley of drug research and development; or not?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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UnitedHealth Group Shenanigans

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Ingenix’s Lack of Independence Cited

[By Dr. David Edward Marcinko; MBA]

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According to Melissa Dahl, Jeff Rossen and Robert Powell of msnbc.com on Jan. 13th, 2009, UnitedHealth Group agreed to pay $50 million in a settlement after being accused of over charging millions of Americans for health care.

The Investigation

An investigation was launched after receiving hundreds of complaints about Oxford Insurance and its parent company, which claims to rely on “independent research from across the health care industry” to determine reimbursement rates.

Faux Independence

In actuality though, it relies on the well known firm, Ingenix, a research arm owned by UnitedHealth Group. The allegations are that Ingenix has been manipulating the numbers so insurance companies pay less.

Other Insurers under Investigation

Although UnitedHealth Group and Oxford Insurance were the only entities investigated, other major insurers use Ingenix, including Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield.

CEO Bill McGuire

The $50 million UnitedHealth Group will pay as the settlement will be used to create a nonprofit organization that will determine reimbursement rates for patients. William W. McGuire MD was the CEO of United from 1992 until his ignominious resignation in 2006, because of his involvement in an employee stock options scandal. Hence, rise of the insider moniker; “Useless Healthcare.”

Assessment

According to blogger Robert Laszewski,

“The big losers here are the docs. The result is going to be about the same and their medical societies will now have less reason to challenge the customary and reasonable system than they did before.”

As a medical practitioner, I eschewed contracts with this company a decade ago. Relative to peers, I was never so happy! Some companies just can’t seem to learn, or change their culture. But, the more important question to ask: is this indicative of an isolated rogue company, or the entire health insurance industry?

Conclusion

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