The Affordable Care Act (ACA) is certainly a hot topic lately.

For families with special needs children, Medicaid has been the only viable option for health care coverage. Private insurance costs were exorbitant and unattainable because of “pre-existing” conditions (i.e disability). The new Affordable Care Act will make private insurance an option.

There are pros and cons of Medicaid and private insurance, and families have two big questions:

1. Will their child need Medicaid or Supplemental Security Income (SSI)?
2. Will their child need a special needs trust?

The answer to both these questions is “probably.”

Before all ties with Medicaid are cut, families should compare what Medicaid provides versus private insurance. For example, many doctors do not accept Medicaid, and with insurance coverage you might have access to more doctors. This can also provide parents with access to more doctors who “specialize” in certain areas who may not be available through Medicaid.

Insurance will have to cover benefits that are essential and for special needs children, those benefits might include physical therapy, occupational therapy, autism services and speech therapy if your state mandates such coverage by insurance companies. Sometimes parents are wait-listed for months trying to get these same services from Medicaid.

Private insurance might not pay for some medical equipment such as hospital beds, lift chairs, some wheelchairs and other items that a person with special needs might deem necessary. Medicaid might be necessary for these items.

Private insurance will not cover services that people with special needs require that enables them to be a member of the community and improve their quality of life. These services are important, but might not be considered medical care. Examples include certain types of day-care, in-home services such as an aid or assistance with some activities of daily living, such as preparing meals, dressing, shopping or doing laundry. Private insurance will not cover these needs.

A special needs trust might be the right tool to fill in some of those gaps. If a loved one with a disability needs Medicaid or SSI, then having a special needs trust should be an essential part of future planning.

How A Special Needs Trust Can Help:

You want your child to live as contentedly as possible, with loving guardians and you want him/her engaged in activities that will bring them peace and pleasure.  This dream cannot be achieved on the limited assets that Medicaid recipients are allowed to have without losing their government benefits.  By having a special needs trust, responsible parents can safely leave an inheritance to their special needs child.  Not all parents are aware of the benefits of a special needs trust  or how easy it can be to create one.  It gives your child the funds that are needed beyond the basic living expenses provided by SSI or Medicaid.

A special needs trust is not a document that can be found in a software package or created from a standard trust template.  The needs of your child are unique, and should be treated as such.  If your family could benefit from a special needs trust, please contact our office for more information.