If you have a client who is both a Medicaid and Medicare recipient, extra planning may be in order. If it is determined that an MSA is appropriate, it raises some issues with continued Medicaid eligibility. An MSA account is considered an available resource for purposes of needs-based benefits such as SSI/Medicaid. If the MSA account is not set up inside a special needs trust, the client will lose Medicaid/SSI eligibility. Therefore, in order for someone with dual eligibility to maintain his Medicaid/SSI benefits the MSA must be put inside a special needs trust. In this instance you would have a hybrid trust that addresses both Medicaid and Medicare. It is a complicated planning tool but one that is essential when you have those with dual eligibility.
