August 8

Remand to Determine Whether Temporary Misuse of Special Needs Trust Bars Trust From Being Exempt Asset

For a period of time Susan Elias had direct access to her irrevocable first-party special needs trust (SNT) through the use of a debit card. This direct access ended when the trusteeship changed. The Social Security Administration determined Susan’s access rendered the trust a countable resource and discontinued her Supplemental Security Income (SSI) benefits, as well as requested recoupment of $18,137 for incorrectly paid benefits. An administrative law judge (ALJ) upheld the Administration’s decision. Susan appealed, arguing the ALJ erred in holding the trust was not a proper SNT and thus not an exempt asset, and that her benefits should have only been suspended during the period of misuse.

The district court held that if an individual can direct the use of the trust’s corpus, the trust should be considered a countable resource for SSI eligibility purposes. Susan’s use of a debit card freely to make purchases is substantial evidence of misuse of the trust rendering it a countable resource. But it said that held the Program Operations Manual does not fully address, nor did the ALJ adequately discuss on the record, whether the temporary misuse of a properly created SNT forever bars consideration of the trust as an exempt asset once the misuse is rectified. The court remanded for further consideration of the issue.

Elias v. Colvin, 2015 WL 4529877 (M.D. Pa. July 27, 2015)

August 6

Most Americans Want Medicare to Negotiate Drug Prices

A vast majority of Americans say the Medicare health program for the elderly should be able to negotiate with drug companies to set lower medication prices, a practice currently prohibited by law, according to a survey released on Friday. The poll conducted by the Kaiser Family Foundation found that 87 percent of people surveyed want Medicare to have the authority to press drug makers for greater discounts. The skyrocketing prices for crucial medicines have hit both health insurers and consumers, who are being asked to cover a higher proportion of their medications’ cost. Efforts to allow Medicare to negotiate drug prices have not been successful, due to opposition over government interference in the marketplace. Drug manufacturers say their prices reflect the billions of dollars they spend in research and development, both for treatments that are approved and the many more that fail. Previous Kaiser polls underlined other frustrations over drug costs. A top priority for Americans in April was making drugs affordable for people with chronic conditions like diabetes. In a June poll, 73 percent of participants thought prescription drug prices were unreasonable. Over three-quarters of those people said it was because manufacturers set prices too high.

For the article from Reuters, click here.

August 3

Medicare at 50: Much Accomplished, More to Do

When Medicare was enacted in 1965, more than half of Americans over 65 had no health insurance. The fact that Medicare provided affordable, basic health insurance was a huge boon for older Americans and their families (and eventually, people with disabilities, who were added to the program in 1972). But, despite the tremendous successes of the program over the past 50 years, Medicare can do more to safeguard older people and those with disabilities. While major strides have been made in providing coverage for medications and preventive services, Medicare still lacks coverage in three important areas — eye care, hearing aids, and dental care — no matter how extreme the need. These are all key to health and well-being. Oral health and dental care are particularly important for older people and people with disabilities, who are often more vulnerable to infection, malnutrition, and serious illness. Unfortunately, efforts to clarify and expand Medicare’s coverage of dental services have been stymied. At best, non-routine dental services are only sometimes covered — when they are coupled with exacerbating medical conditions and generally only after lengthy appeals. Medicare contractors regularly deny coverage for nearly any care that has to do with the jaw or mouth. This was not the intent of the law. The Center for Medicare Advocacy frequently hears from beneficiaries with urgent health issues who cannot obtain even extraordinarily complex dental and oral health services due to inappropriately broad Medicare denials.

For the article from The Hill, click here.