Representative Matters

Representative Cases

MTS

In one of the cases I’m proudest of, I represented a thirteen-year-old girl with a unique learning disability. MTS (not her real initials) was born with an arteriovenous malformation (AVM), a deformity of the blood vessels in the head. The condition carries with it an increased risk of stroke. In fact, MTS did suffer a stroke at age ten.MTS recovered remarkably well, due to her youth and determination. When I met her, I could see no sign of disability. MTS appeared perfectly normal. However, she had a hidden disability that was absolutely unique: she could no longer recognize letters and numbers. She could no longer read. She could write, but could not read what she had written.

MTS’s vision was fine. She could see printed or written text, but could not read it. To her, it might as well have been written in an unknown alphabet. No one knew what to do to help her.

However, MTS’s speech therapist did not give up hope. After many brick walls and false starts, she reached out to the Department of Cognitive Science at Johns Hopkins University. A researcher there was studying just these kinds of problems. He agreed to lead the effort to help MTS.

After much study, trial, and error, the Johns Hopkins team developed an alphabet – a font – that MTS could recognize. The secret was to add two strikethrough lines at specific heights relative to the letters. The result was miraculous – MTS could read again. The Johns Hopkins researchers loaded this custom font onto a laptop and an iPad, both of which they provided to MTS free of charge.

This should have been the end of the story, but for MTS and her family, it was only the beginning. Yes, she could suddenly read again. The problem was that to do so, she needed all text provided to her in her special font, in advance. This gave her school district a very hard time.

The district was provided with MTS’s special font. However, converting in advance all the text she needed for school proved to be an administrative nightmare. All her textbooks had to be converted. So did all in-class handouts and homework assignments. So did any notes the teacher wrote on the blackboard. The Johns Hopkins team wrote software to convert text into MTS’s font, but it did not work perfectly. Text with graphics was especially hard to convert.

Multiply all these problems by the number of MTS’s classes, and you begin to see the scale of the district’s problem.This is when MTS’s family came to me. They had grown frustrated with the district’s inability to cope with her unique needs. MTS was struggling in school, and staying up until midnight to complete her homework. Since the district was apparently unable to convert all her text in advance, she had to rely on family members and on her own efforts to compensate. She was losing sleep and making herself ill with the effort.I filed a due process complaint against the district, arguing that it could not properly teach MTS. Although her intelligence was above average, she was falling behind. The more chances the district had to rectify the situation, the more it fell short. Effectively, MTS was being denied an appropriate education.

After a long legal battle that led us literally to the courthouse steps, the district agreed to place MTS in the private program that she and her family had settled on. This was a school that served both typical and learning disabled children, and provided one-on-one instruction. It could handle MTS’s needs. Finally, MTS was getting the appropriate education she deserved.

MTS’s ambition is to enter the medical field and help children like herself with unique disabilities. I wish her every success.

If you are interested in MTS’s story, you might like to read the attached article about her from the Johns Hopkins Gazette. It first identifies MTS simply as “the girl,” and then by the initials MTS.


AW

AW is an 88-year-old woman with two daughters. She recently sold her home and moved into a rental. Between the proceeds of the sale and her other savings, AW has almost $1 million in the bank. She has both pension and Social Security income. AW is beginning to need help around her home. She and her daughters would like to have an aide come in to help – at first part-time, and later on full-time if necessary. However, they do not want to deplete AW’s life savings to do so. Can they have Medicaid pay for the help?

At first glance, it may seem that the answer is no. AW presently has too much in assets and income to qualify for Medicaid. However, she can be made Medicaid-eligible (right away for home care, and after five years for nursing home care) with the help of a Medicaid asset protection trust. This is an irrevocable trust into which one can transfer assets in order to preserve them for the next generation. (As the term “irrevocable” suggests, it is a one-way solution. You can transfer your assets to it, but you can’t take them back out.)

I met AW and her daughters at her home, and we had a long discussion about how to address her situation. We decided to set up the Medicaid trust to hold her excess assets. One of her daughters would be the trustee, and the other daughter would be able to receive distributions of principal during AW’s lifetime. The other daughter would then be able to meet any extraordinary or unforeseen expenses by paying for them herself.

As for AW’s excess income, it would be directed to a pooled Medicaid trust. This is another kind of trust. As the name suggests, it pools the excess income of many Medicaid recipients for investment purposes. However, each recipient has his or her own account. Excess income is directed to the pooled trust, and the recipient’s monthly expenses are paid from the individual account. This is a way of reducing monthly income to the Medicaid limit, while still having the income available to pay regular expenses.

AW needed a new will, to direct any assets remaining in her name at her death to the Medicaid asset protection trust. This trust included dispositive provisions, for the distribution of assets to the following generations upon AW’s death, according to her wishes.

I drafted the trust and the will, as well as a Power of Attorney, appointing one of her daughters to handle AW’s affairs should she be incapacitated. Finally, I drafted a Health Care Proxy, appointing one of the daughters to make health care decisions for AW, should she be unable to make those decisions for herself. In each case, the other daughter was named as successor, in case the first should be unavailable, or unable to carry out her duties as agent.

This was a complex solution, with a number of moving parts. However, it achieved the goal that AW and her daughters intended. She immediately became eligible for Medicaid to pay her home care expenses. Her assets, though no longer in her name, were still available to meet unforeseen or extraordinary expenses. Her income was likewise still available to pay her ordinary monthly expenses. And she was able to direct her assets to the following generations upon her death in accordance with her wishes.