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After a brain injury, many people face financial struggles and challenges that may be overwhelming. This section provides a background of financial planning and discusses different government financial resources and options for a person with brain injury.
Brain injury can greatly affect the financial situation of the person with the brain injury and their family members/dependents. There may be a change in earning potential and the projected income from salary/wages. Income from government benefits, legal settlements and other sources may become necessary. Change in expenses, such as housing, transportation, and personal care, may also affect finances.
Although it can seem like a lower priority when the brain injury has occurred, it is imperative to take time to develop a comprehensive plan for meeting current and future financial needs. This information needs to be revisited frequently, because it is an important step in making sure you are able to continue to have the adequate needs met to live in the community. A social worker in the hospital or county employee in the financial services setting can help you make plans for this and discuss some future financial plans for you as well as assist in finding the additional financial resources you may require.
A couple other things that are important while financial plans are being considered is to check with your employer if you have short term and long term disability benefits, whether the injury happened at work or not.
Special Needs Trusts
To maintain eligibility for benefits and leave assets to an individual with brain injury, a Special Needs Trust needs to be set up. Special Needs Trusts (SNT) are designed specifically to supplement, not replace, benefits to ensure expenses are covered. Some of these expenses include but are not limited to out-of-pocket medical expenses, insurance, hobby materials, entertainment, personal care, or essential dietary needs.
Money from the SNT cannot be distributed to the person with the disability; it must be distributed directly to a third party. Trust assets are not held in the name of the person with the disability. Family members can become the beneficiary of the trust assets. The laws governing a trust are complex so it is important to be advised by a qualified attorney.
Government Financial Resources
There are public benefits available to persons with disabilities. Some of these resources place limits on income and certain types of assets but in order to find out more about how to qualify it is always good to reach out to your county human services department and ask questions to see if these resources are available to you. All government financial programs also have an appeals process for individuals who have been denied benefits. If you believe that you should be eligible, you have the right to appeal the decision.
Social Security Disability Insurance (SSDI)
To qualify for Social Security Disability Insurance (SSDI), a person must have a physical or mental impairment that is expected to keep him or her from doing any substantial work for at least one year, or a condition that is expected to result in death. The amount of a person's SSDI payment depends upon how much he or she has worked and how much he or she has paid into the Social Security system through taxes. Some people who have SSDI may also be eligible for Minnesota Supplemental Aid (MSA).
It is advised that you apply for SSDI benefits as soon as possible due to a six month waiting period. If a person has qualified for SSDI, benefits begin on the sixth full month after the application is accepted. It is important to understand how complex the application process for SSDI can be. A disability attorney can help you apply for SSDI or appeal an initial denial. The social security office reports denial rates for first time applicants for disability are as high as 65 percent. The appeal process is part of the application process and is your right. Disability attorneys generally complete a complimentary consult on your case and only collect payment after you have been awarded disability benefits. To apply call your local Social Security Administration (SSA) office found in the resource section of this book.
Supplemental Security Income (SSI)
Supplemental Security Income (SSI) is a strictly need-based federal financial assistance program for persons with disabilities who have limited resources. The program is intended to guarantee a minimum monthly income to person with disabilities who have little or no income and resources.
Persons with disabilities can be eligible for SSI even if they have never worked. Age is not a factor. If a person is eligible for SSI, he or she is automatically eligible for Medicaid. People receiving SSI must meet certain income and resource/asset limitations to be eligible. Insurance policy payments, court settlements, worker's compensation and other financial resources may limit your eligibility for SSI.
Medicare is a federal health insurance plan that provides for people with disabilities that are determined to be eligible for SSDI due to disability. People will qualify for Medicare two years after being awarded SSDI benefits. Medicare is not based on income. Medicare has four components: hospital insurance (Part A), medical insurance (Part B), Medicare Advantage Plan (Part C) and Prescription Coverage (Part D). Local Social Security Administration officers process applications and provide information about the program.
Medical Assistance (Medicaid)
Some people will be eligible for Medical Assistance (MA), known in other states and by the federal government as Medicaid. MA can pay for eyeglasses, dental care, mental health services, family planning, hospice care, lab and x-ray, health centers, medical equipment, home health care, inpatient and outpatient hospital rehabilitation services, nursing home services, some prescribed medications and transportation to and from medical appointments.
Home and Community Based Services Waivers Waivers are a funding source for individuals who need services beyond MA or their private health insurance. The goal of the waiver is for an individual to continue living in the community with the resources available through the waivers instead of living in a nursing home or an institution. There are various waivers, including the CADI (Community Alternatives for Disabled Individuals), CAC (Community Alternative Care), DD (Developmentally Disabled), EW (Elderly Waiver), and BI (Brain Injury). You must be on MA, certified disabled and eligible for nursing home level of care. Contact your local county human services to talk to the social worker where the person who wants the services is residing.
Department of Veterans Affairs (VA) Benefits
The Department of Veterans Affairs (VA) is a federal program that provides benefits to eligible veterans and their dependents. An honorable or general discharge will qualify a veteran for benefits. Veterans in prison or on parole may be entitled to certain VA benefits. The VA has a system that prioritizes who can receive services and at what time. Since there are limited numbers of beds available in VA facilities, there are often waiting lists for services. For more information please contact your local VA for services available to you or your family member. You may also contact a veteran advocate through your county.
The Workers Compensation Program is an insurance program provided by many employers at no cost to the employee. If an employee is hurt on the job or develops a disease due to the conditions on the job, Workers Compensation may pay all reasonable and necessary medical care related to the injury or illness.
If a brain injury happens on the job, a person or his or her family should immediately inform the employer that an injury has occurred. Many employers require that an employee report his or her injury within 24 hours of the injury occurring.
The worker should only seek treatment at approved medical facilities. The worker must report any earnings, Social Security benefits, or unemployment compensation benefits to the insurance company. These forms of income can affect the amount of Workers Compensation benefits received.