Medicare Set-Asides, Pooled Trusts, and Public Benefits: A Practical Guide for Attorneys

Representing individuals with disabilities, minors, or vulnerable adults adds an additional layer of complexity to counsel's fiduciary and ethical responsibilities. Challenges arise when clients receive lump-sum awards without proper planning, including disqualification from benefits, misuse of funds, and exposure to fraud or mismanagement.

Counsel must be able to evaluate trust options, select administrators, and audit institutional safeguards to prevent client exploitation or trust insolvency, an urgent concern in light of recent high-profile trust failures.

Listen as our expert panel shares their insight on designing coordinated post-settlement plans to protect vulnerable clients and comply with benefit rules. The panel will provide an overview of PSNTs and examine when and how an MSA should be used in tandem with a trust. The panelists will explore coordinating ABLE accounts and other benefit-preserving tools, and how to evaluate pooled trust organizations. 

I. Introduction and case study

A. Structured settlements, MSAs, and PSNTs

B. Case overview

II. Overview of government benefits

A. Means-tested benefits: SSI and Medicaid

B. Earned benefits: SSDI and Medicare

C. Understanding dual eligibility and benefit coordination

III. PSNTs: fundamentals

IV. Selecting a pooled trust

V. Integrating MSAs and structured settlements

A. When to use an MSA arrangement

B. Coordinating MSAs with pooled trusts to preserve benefits

VI. Trust administration: client expectations

A. Administrator roles and responsibilities

B. Distribution process and sole benefit rule

VII. ABLE accounts and alternate tools

The panel will review these and other important issues:

• Preserving Medicaid and SSI eligibility after a settlement or judgment
• PSNTs versus individual trusts
• MSAs: use and trust coordination
• Evaluating trust administrators
• Navigating disbursement rules and sole benefit requirements
• Using ABLE accounts with trusts