Elder Law Firm of Marshall & Associates

Supplemental Security Income (SSI) is a Federal income supplement program administered by the Social Security Administration but funded by general tax revenues (not Social Security taxes). It is designed to help aged, blind, and disabled people who have low income and resources by providing cash to meet basic needs for food, clothing, and shelter, with related Medicaid coverage providing for health care.

SSI provides payments to aged, blind and disabled individuals and couples based on uniform Federal eligibility standards and a national base payment level. The Federal SSI benefit rate for 2005 is $579 monthly per individual and $869 per couple.

Since the national standards do not account for variations in living costs that exist from one state to another, Congress gave states the option to provide additional payments to supplement the basic Federal SSI payment. Pennsylvania has chosen to provide its SSI beneficiaries with such a state supplementary payment (SSP). About 300,000 Pennsylvania residents receive state SSP payments. The current supplement amounts are listed below.

If an aged, blind or disabled individual or couple meets all SSI requirements other than income, and if countable income does not exceed the combined Federal Benefit Rate and applicable SSP, the individual or couple is eligible to receive the state SSP-Only. Of particular significance is that an individual or each member of the couple that is eligible for SSP-Only is also eligible for Medicaid. However, if the individual or couple receiving SSI is living in a medical care facility where a substantial portion (more than 50%) of the cost of care is paid by Medicaid, the individual or couple is ineligible for the SSP.

Until this year, the Federal Social Security Administration (SSA) has administered the SSP for Pennsylvania and included it with the Federal SSI payment made to beneficiaries. SSA charges Pennsylvania over $8 per check to handle the Pennsylvania SSP. In an effort to save money, Pennsylvania has decided to take over the administration of its SSP for most SSI beneficiaries. (The Federal Government will continue to make Federal SSI payments and will also pay Pennsylvania 's SSP for individuals and couples living in personal care homes or domiciliary care homes.)

Initial reports reveal the change from Federal operation to Pennsylvania operation of the SSP portion of SSI payments has not been particularly smooth. However, Pennsylvania expects to save approximately $10 million in the first year and over $15 million per year thereafter as a result of the changeover.

In conjunction with this change in administration of some SSP payments, Pennsylvania has revised and updated its SSI SSP regulations. Pennsylvania 's new regulations will become Chapter 297 of Title 55 of the Pennsylvania Code. They are available online at http://www.pabulletin.com/secure/data/vol35/35-10/418.html.

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While everyone knew that most Americans were concerned about increasing medical costs and high prescription drug prices, it was not clear what Americans wanted done about these costs. In September 2004, the Civil Society Institute ("CSI") conducted a telephone survey* of 1,020 American adults. According to the September 16, 2004 edition of the Long Island Newsday, Pam Solo, president of CSI, explained that "[w]hat this survey shows is a nation in the grips of a health care crisis. Americans are now prepared to embrace some tough ideas." The survey revealed the following about Americans:

78% support government regulated health care agreeing that it is as necessary as water, gas and electricity, and government regulation will ensure accountability, price fairness, quality and equal access

67% support a health care "guarantee" like

Canada

and other nations have where citizens have health insurance on the job, through government programs or a nonprofit source

56% of adults with insurance have had coverage cut (7%) or prices increased (37%) or both (13%)

- 34% are already buying or planning to buy lower cost drugs from pharmacies in Canada or other countries.

-18% say they skip medicine or reduce the dosage to make their medicine last because of high prescription costs. According to the survey, this percentage translates to more than 20 million adults "playing a form of Russian roulette with their medications."

-83% say U.S. should but prescription drugs on a bulk basis to help control the cost.

There appears to be little faith in health insurers to control costs. For example, not even two in ten (19%) surveyed are willing to give "HMOs the power to reject more medical procedures ordered by doctors as 'medically necessary'" as a method of cost control.

Seventy-nine (79%) of adults believe that everyone should have access to the same type of health insurance available to most federal employees. Similarly, 81% think that children's health care should be a priority.

Three quarters of Americans feel that a patient's legal rights should not be dependent upon where they get their health insurance. When asked, "Should patients who get HMO or other medical coverage on the job in the private sector have FEWER legal rights than people who get their health care benefits from a government job or through Medicare or Medicaid?" 75% surveyed answered "no." This view crosses the political divide with 71% of conservatives agreeing with nearly 80% or moderates and liberals.

* The full survey may be found through this link: http://www.resultsforamerica.org/calendar/files/RFA%20CSI%20Healthcare%20FINAL.pd f

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So wrote 19^th Century poet William Ernest Henley, expressing a human desire that may be harder to attain in the 21^stCentury. Life expectancies have soared over the past 100 years. But, as we live longer, we face a higher risk that an accident or illness may some day require us to seek help making financial and health care decisions. It is a risk we all face.

In the event you are ever unable to make financial or medical decisions for yourself, who will decide for you? Will you remain the master of your fate?

Fortunately, there are legal tools that can help ensure that you will always have as much control as possible over your financial affairs, your personal decisions, and your health care no matter what may happen to you physically or mentally. The most important of these tools is the power of attorney.

With a power of attorney you give someone you trust the authority to be your advocate and make decisions for you when you are unable to make them for yourself. The person you authorize is called your "agent."

Your power of attorney is so important that you should not rely on a simple or standard document. It should be carefully crafted to meet your individual situation, preferences and goals.

Your agent will only be able to act in ways that are authorized in the document. For example, if you want a family member to have access to your medical information in the event of a health care crisis, your power of attorney should grant that authority.

Many people want their family to be able to protect their assets from loss to health care costs in the event of a long term illness. If the document does not contain the proper language, your family may be at risk of financial devastation.

Here are some critical issues you should consider for your power of attorney.

1. Asset Protection. Do you want to authorize your agent to protect your assets from health care costs? If so, your agent may need to transfer ownership of your assets to your spouse or children. This authority must be clearly stated in the document or your agent may not have the ability to protect your assets for your family. A standard power of attorney won't include this power, so you may need to raise this issue with your lawyer.

2. Authorization as Health Care Representative. A power of attorney can help ensure that you will always receive the types of medical treatment you desire, avoid unwanted procedures, limit your pain, and be treated with care, dignity and respect. To achieve these goals, your document should express your values and philosophy about health care and empower a trusted person to serve as health care agent to advocate for you.

Appointment of a health care agent with broad authority to act for you has become even more important as a result of the recent federal privacy regulations referred to as HIPAA. These federal rules may cause health care providers to deny your family access to your health information and participation in your care. The inclusion of appropriate language in your health care power of attorney will authorize your agent to get the information needed and make the best informed decisions on your behalf.

3. Avoiding Abuse. In the wrong hands, a power of attorney can be an instrument of financial abuse and exploitation. The danger of abuse is particularly acute when the document includes the authorization to make transfers of your assets. Your power of attorney needs to walk the fine line between protecting the financial security of your loved ones and ensuring that you will always be able to receive the care you need.

4. Naming Successor Agents. Just as you may someday be unable to make financial and health care decisions, there is always a possibility that the person you choose as your agent may become unavailable or unwilling to serve. Make sure you deal with this possibility by appointing a back-up agent.

Conclusion. The power of attorney may someday become your most important legal document. It may be invaluable to you and your family. But, an ill-considered power of attorney can lead to disaster. This is one document where you don't want to cut corners. You and your family could someday pay a heavy price.

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In the Community.

The professional staff of Marshall and Associates will be presenting to the following groups and organizations over the next couple of weeks. Many of these events are open to the public. If you would like more information or would like to schedule someone to speak at your group, please contact Melissa at 321-9008 or at mbottorf@paelderlaw.com

-Attorney Kevin Grebas will be talking about The Elder Law Firm of Marshall & Associates' Services to Leadership Hazleton on March 10^th at 10:00 AM . The presentation will be held at Mountain City Nursing Home.

-Planning Specialist Perry Landon will make a presentation for the Cancer Support Group at their monthly meeting. It will be held at Susque-View in Lock Haven on March 10^th at 7:30PM .

-The Luzerne- Wyoming Area Agency on Aging is providing an in-service for caseworkers on March 11^th at 9:15AM . Attorney Marshall will present Legal Considerations When Qualifying for Waiver.

-Planning Specialist Perry Landon will participate in a Paying for Long Term Care forum at Maria Joseph Manor in Danville on March 11^th from 1:00-2:00PM .

-Attorney Matthew Parker will be providing an-in-service on Advanced Directives and Guardianships to the caseworkers at the Columbia Montour Snyder Union (CMSU) Developmental Supports & Services on March 31^st.

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Marshall & Associates Now Offering FREE In-Office Workshops

Marshall & Associates is now offering free workshops for seniors, their families and professionals who want to know more about paying and planning for long term care. The workshops are held in our Williamsport and Wilkes-Barre offices and last about an hour. These informal discussions with our planning experts are a great opportunity to learn about the options available to pay for care.

Reservations are suggested, but not required. SIGN UP ONLINE or call 1-800-401-4552 for more information or to reserve your spot.

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*Attorney Marshall is certified as an Elder Law Attorney by the National Elder Law Foundation under authorization from the Pennsylvania Supreme Court.

1-800-401-4552

www.paelderlaw.com

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