1. Securing the Future for Loved Ones with A Disability
Robert P. Mascali, Esq NAMI of Cape Cod November 15, 2017 Hampton Inn, Route 28 West Yarmouth, MA

2. The Statistics…
Studies show that Persons with Disabilities face many barriers to good health
Have poorer overall health
Have less access to adequate health care
Have limited or no access to health insurance
Skip medical care because of cost
Engage in risky health behaviors, including physical inactivity
Having a disability does not mean a person can't be healthy and live productive lives
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

3. What Is Special Needs Planning?
Provides for a individual with a disability; personally, legally and financially
Considers needs of the individual and the individual’s family
Plans can be made by the individual and/or the loved ones of the individual
Child of any age
Sibling
Spouse
Parent
Other relative or friend
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

4. Goals of Special Needs Planning
Balance the family’s present and future needs with the individual with special need’s present and future needs
Create and implement personal care, financial, and legal plans
Communicate such plans to all relevant persons
Review and revise plans as circumstances change
Provide peace of mind and family harmony
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

5. Risks of Not Planning Ahead
Possible Appointment of a Guardian
The state will determine how much of the estate will be inherited by each family member
Assets may pass outright to an individual with a disability
The money might run out
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

6. Planning Steps You Need To:
Create and implement a current personal care plan for your child
Create a transition Future Care Plan for continued personal care as circumstances change
Create and execute a legal plan for yourselves and your loved one(s)
Create and implement a financial plan
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

7. Create and Implement a Personal Care Plan
Who will provide care?
Parents and/or other family members or friends
Full or part-time professional
Where will the individual with special needs live now and in the future?
With parents or another family member or friend
At home, independently
Assisted-living arrangement
Alternative housing options
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 201 The Centers

8. Create and Implement a Personal Care Plan
What care is needed?
Household chores and other daily tasks
Washing and dressing
Preparing meals
Transportation
Medical
Safety/Emergency plan
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2016 The Centers

9. Create a Transition Plan
Continuity of care and supervision
Choosing alternate people and services to replace those in original plan if needed
Anticipate and prepare for future life events
Answer “what if” questions
What if the parent(s) die unexpectedly?
What if the parent(s) can no longer care for their child with special needs?
What if the individual with special needs becomes unable to make his/her own medical/financial decisions?
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

10. Create and Execute a Legal Plan
Ensure that legal precautions are in place:
Power of Attorney (POA)
Health Care Proxy (HCP) - Medical directives
Living Will
Will
Revocable Trust
Manage Assets During Life
Avoid Probate at Death
Beneficiary Designations
Letter of intent or instruction (not legally binding)
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017The Centers

11. Special Needs Planning Techniques
Certain techniques are permitted by federal and state law to maximize available resources
Government benefits are available to all families regardless of their means
Families can use their personal resources to provide for non-basic needs
Family’s personal resources serve as a secondary source of support
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

12. Federal Benefits: Not Based on Financial Need
Medicare
Social Security Disability Income (SSDI)
Other benefits
Special education
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

13. Federal Benefits: Need-based
Medicaid
Joint federal and state program that helps with medical costs for some people with low incomes and limited resources
Supplemental Social Security Income (SSI)
Provides monthly income to people age 65 or older, or who are blind or disabled, and who have limited income and financial resources
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

14. Needs Based Programs Supplemental Security Income
Income $ with state supplement
Resources $2,000
Mass Health-Different Plans and Services
Income
Resources
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

15. Supplemental Needs Trusts
Supplemental or Special Needs Trusts (SNTs)
Provide a supplemental source of funds for people with disabilities
Because of certain legal limitations on these trusts, individuals can remain eligible for government benefits that are based on need, such as SSI and Medicaid
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

16. Supplemental Needs Trusts
Purpose of a SNT: to enhance the quality of life of the person with the disability
Trust can purchase additional support services, therapy and care that are not covered by Government Benefits
Additional medical treatment or insurance
Individualized therapy
Special medical equipment
Case management
Recreational activities / Hobbies
Other goods, services and activities
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

17. SNTs and Government Benefits
A properly drafted supplemental needs trust is not counted as a beneficiary’s resources
For purposes of SSI and Medicaid, the trust is not “actually available” to the beneficiary because he or she has no right to demand that the trust pay for any good or services
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2016 The Centers

18. SNTs and Government Benefits
Trust distributions are made at the sole discretion of the trustee
Distributions must be made directly to providers of goods and services to the beneficiary
Any money paid directly to the beneficiary will be counted for purposes of eligibility for SSI and Medicaid
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

19. SNTs and Government Benefits
In-Kind donations of food or shelter – that is, when someone (including a parent) gives the disabled individual a place to live for free or at a reduced rate - will generally reduce SSI payments by up to one-third
CASH-Never
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

20. Types of SNTs Self-settled or First-Party SNT Pooled SNT
Third-party SNT
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2016 The Centers

21. Self-Settled or First-Party SNT
Created for sole benefit of individual with disability under age 65
Created by parent, grandparent, guardian, or by the court
Can now be created by the individual with disability
Representative payees??
Individual with disability can fund the trust
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

22. Self-Settled or First-Party SNT
Avoids Medicaid and SSI “look-back” provisions
Assets in trust will not be countable as resources for eligibility purposes
Upon death, any money or assets remaining in the trust must be used to reimburse the government for Medicaid benefits extended to the individual during his/her lifetime
Payback provisions
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

23. Self-Settled or First-Party SNT
First Party Trusts are typically set up when an individual receives a lump sum, including an inheritance or the proceeds from a lawsuit or settlement
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

24. Pooled SNT Managed by a nonprofit organization
Funds are pooled for investment purposes
Sub-accounts maintained for each disabled beneficiary
Can be created by the individual with disability for himself/herself or parent etc.
Pay back to Medicaid or help disabled individuals, depending on state law
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

25. Pooled Trusts
Can be used for lump sum amounts that are received by an individual on Medicaid or planning to be on Medicaid
Exempt resource
Proposed regulations in Massachusetts for individuals 65 and older
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

26. Third-Party SNT
Created by parent / grandparent of individual with a disability or other involved third-party
No payback requirement
Creator of trust must not have a duty to support the beneficiary
Beneficiary does not need to be under age 65
May or may not trigger Medicaid or SSI penalty period
Other relatives or friends may also want to contribute to the trust
Life Insurance proceeds can be a source of funds
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

27. THE ABLE ACT Achieving a Better Life Experience
Federal law enacted in 2014
Required state law enactment
Massachusetts enacted as of May 10, 2017
The Attainable Savings Plan
Administered by Fidelity
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

28. THE ABLE ACT PARTICULARS
$14K Limit per year-$15K as of 1/1/2018 Total
529 Limits $400,000 in Massachusetts
Disability before age 26
Only one account permitted
Payment allowed for qualified expenses related to the disability
$100K total limit for SSI
SSI suspended if >$100K
Medicaid payback required for First and Third party funding
Favorable treatment for rent payments
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

29. Thank You!
QUESTIONS
The materials contained herein are not to be considered legal advice but informational in nature.
Copyright 2017 The Centers

30. Contact Information
Robert P. Mascali, Esq
Admitted in Massachusetts and New York
Bourget Law Group, LLC
194 Old Main Road 765 West Main Street
North Falmouth, MA Hyannis, MA 20601

31. Robert P. Mascali, Esq. : Robert.Mascali@centersmail.com
194 Old County Road
North Falmouth, MA
Robert P. Mascali, Esq. :