The ABLE Act of 2014 The able act, which was signed into law December 19, 2014, attempted to ease financial strain faced by individuals with disabilities by making tax-free savings accounts available to cover qualified expenses such as education, housing, and transportation. The Achieving a Better Life Experience (ABLE) Act of 2013 (S. 313/ H.R. 647) was introduced in the 113th Congress with bipartisan support from Rep. Ander Crenshaw (R-FL) and Sen. Robert Casey (D PA). The ABLE Act would amend Section 529 of the IRS Code of 1986 to create tax-free savings accounts for individuals with disabilities. The bill aims to ease financial strains faced by individuals with disabilities by making tax-free savings accounts available to cover qualified expenses. This bill would supplement, but not supplant, benefits provided through private insurances, the Medicaid program, the supplemental security income program, the beneficiary’s employment, and other sources. Purpose To encourage and assist individuals and families in saving private funds for the purpose of supporting individuals with disabilities to maintain health, independence, and a better quality of life. Covered Qualified Expenses Education – including tuition for preschool thru post-secondary education, books, supplies, and educational materials related to such education, tutors, and special education 6 services. Housing – Expenses for a primary residence, including rent, purchase of a primary residence or an interest in a primary residence, mortgage payments, home improvements and modifications, maintenance and repairs, real property taxes, and utility charges. Transportation – Expenses for transportation, including the use of mass transit, the purchase or modification of vehicles, and moving expenses. Employment Support – Expenses related to obtaining and maintaining employment, including job-related training, assistive technology, and personal assistance supports. Health Prevention and Wellness – Expenses for health and wellness, including premiums for health insurance, mental health, medical, vision, and dental expenses, habilitation and rehabilitation services, durable medical equipment, therapy, respite care, long term services and supports, nutritional management, communication services and devices, adaptive equipment, assistive technology, and personal assistance. How to Qualify for an ABLE Account: Any individual who is receiving, deemed to be, or treated as receiving supplemental security income benefits or disability benefits under Title II of the Social Security Act. OR Any individual who has a medically determined physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 month or is blind, and provides a copy of their diagnosis signed by a physician. No one who qualifies for an ABLE account is able to use that eligibility to secure supplemental security income benefits or Medicaid. Federal Treatment of ABLE Account under Supplemental Security Income Program: When the assets in an ABLE account reach $100,000, if the beneficiary is receiving Supplemental Security Income (SSI) benefits, any monthly SSI benefits will be placed in suspension If the assets in the ABLE account drop back below $100,000, the SSI benefit suspension ceases and any SSI benefit resumes The beneficiary will not have to reapply for SSI benefits once the account drops back below the $100,000 threshold No Impact on Medicaid Eligibility: Under no circumstance will anyone with an ABLE account who is currently receiving Medicaid benefits lose their benefits –even if their SSI benefits are suspended The beneficiary will never lose their eligibility for Medicaid based on the assets held in their ABLE account Medicaid Payback Provision: In the event the qualified beneficiary dies (or ceases to be an individual with a disability) with remaining assets in an ABLE account: The assets in the ABLE Account are first distributed to any State Medicaid plan that provided medical assistance to the designated beneficiary. The amount of any such Medicaid payback is calculated based on amounts paid by Medicaid after the creation of the ABLE Account.

2015 SNT National Conference at Stetson University Too Old for a Pooled SNT – Megan Brand Transfers to Pooled Trust Sub-Accounts by Persons Over 65 Under Medicaid Statute Glossary of Public Benefit Terms and Resources Able Accounts & More – Stephen Dale The Able Act – John Ariale The Planner's Evolving – Mary O'Byrne Veterans Benefits and the Person w Specail Needs – Kelly Thompson

Official Information: The Americans with Disabilities Act (ADA) is the most comprehensive federal civil-rights statute protecting the rights of people with disabilities. ADA Act of 1990 – (U.S. Code) Current text of the Americans with Disabilities Act of 1990, as amended. ADA Home Page – (U.S. Department of Justice website) Information and technical assistance on the Americans With Disabilities Act.

Adult Home Help Services (“AHHS”) are those characterized as unskilled and non-specialized activities, including personal care, essential to the care of the client and maintenance of the home. AHHS assists aged, blind, disabled and other functionally-limited individuals with necessary daily activities, which they cannot perform without assistance. The goal of this service is to maintain the recipient in his/her home and avoid a placement into an alternative care facility, that is, a nursing home or adult foster care arrangement. This goal is accomplished by identifying the client’s natural support system and strengthening it whenever possible. Who is Eligible? The individual needing services must have MEDICAID eligibility, require home help personal care, and must be living in an unlicensed setting. What Services are Available? * (A copy of the “Definitions & Rankings” of each ADL and IADL and a more detailed explanation of the AHHS program is available by calling The Arc of Oakland County office at: 248-816-1900) Activities of Daily Living (ADL) such as Eating and feeding, Toileting, Bathing, Grooming, Dressing, Transferring and Mobility. Exceptions to these seven ADL’s are possible only for those with “complex care needs.” The local DHS office is not allowed to grant any exceptions. An appeal must be made through your local DHS Adult Services Worker to the Michigan Department of Community Health’s Long-Term Care Systems Development Section in Lansing, Michigan. Instrumental Activities of Daily Living (IADL) Taking medication. Meal preparation and clean-up [maximum 25 hours allowed each month]. Shopping and for food and other necessities of daily living [maximum 5 hours allowed each month]. Laundry [maximum 7 hours allowed each month]. Housework [maximum 6 hours allowed each month]. What Adult Home Health Care does NOT Include Supervision, teaching or therapy. Medical services. Professional contracting or repair services that require services be performed by a certified or licensed provider (i.e., an electrical wiring repair, which requires an electrician). Public transportation (e.g., buses, cabs, subways, etc.). Transporting for medical reasons (e.g., visits to doctors, pharmacies, hospitals). Activities normally performed by other members of the residential unit or family without charge. Services provided to persons other than the client. If a provider performs activities for other persons, AHHS may be authorized only for that portion of the service time and cost that is attributable to services rendered specifically to, or for, the client (e.g., meal preparation, shopping, and/or general household cleaning). Who Provides These Services? Individuals choose their own providers from available persons, or public or private agencies. All providers must meet minimum qualification requirements and complete a monthly listing of services rendered to the client. Providers cannot be a ”Responsible Relative,” that is, a spouse or dependent child under the age of 18. How Much is Paid for These Services? Based on an evaluation of specific services needed, time required, and special circumstances, payment is negotiated between the client and provider. The AHHS “maximum” benefit that a local DHS worker can agree to is $549 or less; the local office DHS supervisor can authorize $1299 or less; all amounts in excess of $1300 must be approved through the DHS main office in Lansing. Home Help payment rates vary by county – Medical Services Administration Bulletin 09-59 dated, 12/31/2009. The most recent rates are effective 11/1/2009 (see download below for more information on rates). The possibility exists to receive the higher payment level of AHHS, but only in very special cases. This benefit is called an “exception to home help services.” This occurs in all requests that exceed $549 per month. These “exceptions” are essentially for situations where the functional limitations of the person are “so severe” that $549 will not allow for the provision of the necessary assistance to maintain someone in his/her own home. In other words, the person’s care requirements far exceed the regular, normal levels. Again, this higher payment level is not for general nursing services or supervision. Such “exception” claims must be processed by a DHS worker within 45 days of the request. If an exception is denied, there is an administrative law appeals procedure. How is Payment Made? AHHS payment is made jointly to the client and provider and mailed directly to the client. The payment is received the first week after the completion of the previous month following the provision of services. Are These Benefits Taxable? Yes! This is taxable income to all providers of services, even parents. However, parents may not be liable for the FICA (“Social Security Tax”) payments. Starting with calendar year 2010, IRS form-1099’s will be issued to all entities not receiving a W-2, which would include parents and some agency providers. A parent may choose to have FICA withheld from the check by notifying their DHS Adult Services worker of this request; the system is not setup to automatically withhold FICA from a parent.How are Services Obtained ? Application is made through the local county DHS office. A worker contacts the individual, [REMEMBER, the consumer must have already established MEDICAID eligibility], and conducts a thorough client needs assessment using the current 1-5 scale. Next, the DHS worker develops a services plan jointly with the client, assists with locating providers, and authorizes services as appropriate. Next, the DHS worker develops a service plan jointly with the consumer, assists with locating providers, and authorizes services as appropriate. A physician certification (form DHS-54A) is required documenting the consumer’s need for services. Only in an “Expanded Home Help” case involving “complex care” or where the payment will exceed $1300 is there also a review by a registered nurse from the Department of Community Health. Before applying for AHHS it is suggested that the client or client’s family thoroughly review the ADL/IADL definitions and ranks, along with the worksheet scale. Please note that rankings of “1? or “2? will most likely NOT result in any AHHS benefit, since a person in either of those two levels is fairly independent. Keep a diary of daily services provided and also list services that are provided on an irregular basis — as long as such services are covered under the Adult Home Help program. This advanced planning can prove quite useful when the DHS services worker visits the home to do the “needs assessment.” If asked, providers should indicate that they expect the minimum established rate in their county for the work they do — more if a special skill or task is involved short of a certification or license. Finally, the DHS worker may ask a family if they would provide or continue to provide services if they were not paid. Families need to know that if they answer in the affirmative (i.e., “Yes”), the DHS probably will not pay for the AHHS even though the client is clearly eligible. So, families who wish to receive compensation for this valuable and important work should tell the DHS worker (if they are asked) that they cannot continue services without compensation. Home Help Services for Minor Children The same type of funding is available for children if the following conditions exist: The child must not qualify for the Children’s Waiver Program. If a child in need of services is a recipient of SSI or MEDICAID, there is no income test for the responsible relative(s). The child is automatically eligible. Payment can only be authorized for personal care services, not for supervision. The child’s condition must be such that care requirements exceed the “age-appropriate” demands that would normally be placed on the parent(s). An example of this would be: changing diapers for an infant is considered an age-appropriate responsibility of parents, but changing diapers for a 10-year-old with a disability is personal care under this program. Parents cannot be personal care providers. Siblings, however, can be providers; also, grandparents, and so on. If the need for specific Adult Home Help care services is based on the parent’s need to be away from the actual home (e.g., for education and training), then such services can only be authorized during the actual hours that the parent must be away. Remember, AHHS only pays for hands-on care and NOT for supervision time! 5. There are also provisions covering parents who are physically disabled and unable to care for their child. Again, only for hands-on care — supervision is NOT a covered service.

Information and Resources The Patient Protection and Affordable Care Act Text of H.R. 3590 (Now P.L. 111-148) Health Care and Reconciliation Act of 2010 Text of H.R. 4872 (Now P.L. 111-152) Section 2401 C – Community First Choice Option Sec 2402 – HCBS changes to 1915i Section 2406 – Sense of the Senate Regarding Long-Term Care