BERNARD M. RAICHE, ED.D., LCSW-C EXECUTIVE DIRECTOR PLAN OF MARYLAND-D.C., INC. 604 S. FREDERICK AVE., SUITE 411 GAITHERSBURG, MD TEL: X 222 FAX: Planning for the Future of a Family Member Who has a Disability

PLAN of Maryland – D.C., Inc. Family Founded Family Directed  Board of Directors  Personal Plan Review Committee  Trust Committee

PLAN’s Services Include Case Management Budgeting / Bill Payment Trust Management Cognitive Enhancement Therapy Housing

Preparing so others can carry on your work

What direct support are you providing Emotional support – Social contacts Lodging (and keeping it clean) Food Transportation Applying for benefits / Maintaining eligibility Spending cash Problem solving Resolving crisis situations Make a list – Expand it as you recognize additional things that you are doing

What support are you facilitating? Finding doctors/therapists – Making appointments Finding resources (housing – activities) Helping providers communicate with each other Make a list – Add to it as you recognize more things that you are facilitating

Who is going to provide that support when you are no longer able to? Siblings  Are they willing to step into that role  Will their brother or sister be receptive to receiving help from them  What effect with it have on sibling relationships Other family members Family friends Social workers affiliated with programs Professional case managers PLAN of Maryland-D.C.

Planning for the future -First Step Identify the services and support your family member needs now and / or will need in the future Identify who provides those services or that support now Identify who will provide those services or that support later, when you or other key caretakers are no longer able to do so.

Get a Commitment to Help Talk to all those on your helper list and ask them to commit to helping. Make sure they understand what you are asking them to do. Do not assume that they are willing or able to help.

How PLAN Can Help With Case Management PLAN can provide case management services, and can coordinate and monitor other services provided.  All of our case managers are licensed social workers or licensed professional counselors PLAN can help with budgeting and bill payment PLAN can supplement the work of others who have agreed to step in and help, and/or can be in place as a successor.

Planning for Financial Security Key Elements  Supplemental Security Income (SSI) and/or SSDI  Medical Assistance or Medicare  Trusts

Two Types of Special Needs Trusts Self Settled Trusts  (d)(4)(A)  (d)(4)(C) Third Party Trusts

Self-Settled Trusts – (d)(4)(A) First Party – “Self Settled” trusts – 42 USC & 1396p“(d)(4)(a)” Trusts Funded with the assets of the individual with a disability who is under age 65 Exempt if created by a parent, guardian, or a court Must reimburse the State for Medical Assistance costs Amounts in excess of the state’s reimbursement can be passed on to contingent beneficiaries

Self Settled Trust – (d)(4)(C) 42 U.S.C. & 1396p(d)(4)(C) Established and managed by a nonprofit agency Pooled accounts Accounts established by individual, parents, grandparents, guardian or court State may be reimbursed, or trust may retain balance after death of beneficiary

Special Needs Trusts Third Party Trusts “(c)(2)(B)(iii or iv) Established by parent or other individual for the benefit of a individual with a disability who is under 65 For the sole benefit of the disabled person Must be spent down on an actuarially sound basis Amounts left in the trust at the death of the primary beneficiary can be passed on to a contingent beneficiary.

Benefit of Special Needs Trusts Allow family to provide financial resources for an individual with a disability without making that individual ineligible for means tested government benefits such as SSI and Medical Assistance. Allow an individual with a disability who comes into assets (such as an SSI lump sum payment, unplanned inheritance, or a litigation award) to preserve those assets without becoming ineligible for means tested government benefits.

Who can create a Special Needs Trust Attorney who has the specialized knowledge regarding special needs trusts Joining an existing First Party or Third Party discretionary trust

Implementing Your Plan Through Creating A Trust Selecting a Trustee  Family member or trusted friend  Make sure Trustee has required skills Knowledge of Trust regulations and procedures Knowledge of SSI / Medical Assistance / Other means tested benefits Understanding of the unique needs of the beneficiary Resources to provide the care needed  Make sure Trustee is willing to serve  Attorney – Make sure the attorney has  Understands the unique needs of the beneficiary  Resources to provide the care beyond financial management  Institutional Trustee

Things to Consider When Selecting a Non-Family Member Trustee Minimum size of the trust they will accept Fees for trustee services Understanding and ability to work with the individual who has a disability Flexibility in responding to emergency situations Ability to provide or coordinate the services which will be needed.

Funding the Trust A trust can funded at the time it is created, or it can be created prior to the time when it will be funded Trusts generally become irrevocable at the time when they are funded. Future funding of a trust can be provided as a provision in a will Future funding can be provided through a life insurance policy Future funding (with some limitations) can be provided through retirement benefits

PLAN of Maryland-D.C., Inc. as an Institutional Trustee PLAN operates a third party discretionary trust that families can join  PLAN may be willing to serve as Trustee of a pre-existing third party trust Under some circumstances PLAN will accept the role of trustee for (d)(4)(A) self settled trusts  The terms of the trust must be satisfactory to the PLAN Trust Committee.

PLAN of Maryland-D.C., Inc. Master Discretionary Trust Families can join PLAN’s existing Master Discretionary Trust Trustees are family members who understand the importance of the service they perform Trust office is operated by people who understand and are committed to helping individuals with disabilities No predetermined minimum corpus required No minimum trustee fee Coordinated services  Communication and planning between the trust office and case management services  Coordination between the trust office and bill payment services  Flexibility to respond to beneficiaries needs  Flexibility to respond to crisis

How Do I Register for PLAN Services Any PLAN Services  Become a member of PLAN – Annual Membership $130  Call Bernie Raiche at x 222 Case Management / Budget – Financial Management  Sign a contract for Case Management Services  Complete PLAN’s Clinical Information Form  Complete other required forms (HIPAA, etc.)  Participate in the completion of the Personal Plan of Care  Work with Case Manager to determine which specific services you would like PLAN to perform

How do I Register for PLAN Services – Cont. Trust Services  Complete steps for Case Management services  All trust clients receive at least minimal case management services  Complete Trust Application  Provide all relevant documents  Meet with PLAN’s Trust Committee  Communicate your concerns and desires regarding how the trust is to be used  Sign a Joinder Agreement, or complete forms to make PLAN the trustee of your existing trust  Fund your trust

When Planning Also Consider Statutory durable power of attorney  For yourself and for your loved one with a disability Health care agent / Advanced Directives  m m  For yourself and for your loved one with a disability Advance Directives for Mental Health Treatment 

For More Information Visit our website:  Write or fax us:  PLAN of Maryland-D.C., Inc.  604 S. Frederick Avenue, Suite 411  Gaithersburg, MD  Tel:  Fax: Call or us:  Bernie Raiche   Telephone X 222