September 23, 2011 MOPRA Conference

 MSNT background  Special Needs Trusts  Protecting Benefits  Opening and using a SNT  MSNT Services  Questions & Discussion

 Financial planning and estate tool  Trust account for an individual with a disability  Administered by trustee/co-trustees  Protects eligibility for SSI, Medicaid & other public benefits  Trust funds can be used for supplemental needs, NOT basic support needs

 First Party or Self-Settled ◦ Typical sources of funds  Back payment from Social Security  Inheritance  Personal Injury Settlement ◦ Medicaid payback required  Third Party ◦ Family donors ◦ Typically revocable until donor’s death ◦ Does not require Medicaid payback

 Trust language protects benefits ◦ Used only to supplement benefits ◦ No distributions that negatively affect benefits  Trust “exception” allowed by Medicaid and SSI regulations  Missouri Statute exempts resource for DMH services  Funds Can Be Used for Wide Range of Living and Health Needs  No Upper Limit on Amount in Trust

Exception for Counting Trust Resources for Persons with Disabilities ◦ Federal Medicaid Regulations  Title 42 US Code Section 1396p(d)(4)(A)  Title 42 US Code Section 1396p(d)(4)(C) ◦ SSI  Section 1917(d)(4)(A) of the Social Security Act  Section 1917(d)(4)(C) of the Social Security Act 

 Trust Established with Beneficiary’s Resources (SI ) ◦ MSNT qualifies as Pooled Trust Exception [(d)(4)(C)]  No age restriction  Must be established and administered by a non-profit organization  Must be for the sole benefit of individual with a disability  May be established by the disabled individual, a parent, grandparent, legal guardian, or a court  State pay-back clause required ◦ If revocable, further criteria apply

 All Necessary Documents Available at cs/default.htm cs/default.htm ◦ Master Trust Agreement ◦ Beneficiary Background Information Form ◦ Waiver of Right to Revoke (for third party only) ◦ Enrollment Fee on Sliding Scale up to $500 ◦ Minimum Trust Deposit of $500 ◦ Add additional funds at any time  MSNT advises attorney consultation but does not require it

 Attorneys Specializing in Special Needs & Estate Planning ◦ National Association of Elder Law Attorneys  and click on pink box at right that says Find a Special Needs or Elder Law Attorney ◦ Special Needs Alliance, LLC  attorney attorney

 Distribution request form signed by co-trustee with appropriate documentation  MSNT reviews each request ◦ Must conform decision-making to fiduciary duties ◦ Must assure will not have negative effect on benefits  Processed daily ◦ Authorize bank to prepare check available on next business day ― Checks are sent by MSNT to vendor or to co-trustee ― $5 check fee  Periodic distributions can be arranged with appropriate justification

 Medical and dental care not covered by Medicaid or health insurance  Private rehabilitative training  Durable medical & rehabilitation equipment  Supplementary education  Entertainment ◦ Concerts ◦ Periodic vacations and outings  Transportation of beneficiary or family & friends to visit beneficiary

 Pre-paid burial expenses  Expenditures to foster interests, talents, hobbies  Personal property, goods and services ◦ Furnishings, telephone/cable, etc.  Personal caregiver or respite ◦ In-home support ◦ To accompany beneficiary or provide transportation  Attorney fees to create trust or other legal matters

 MSNT will not accept or hold a home in trust  Large purchases require board approval ◦ Takes time ◦ Scrutiny ◦ Example: Car  Documentation and Security agreement  Check from MSNT to vendor

Fee TypeAmount Enrollment Fee$500 Annual Asset Value Fee (includes bank admin fees) 2.04% for AV ≤$9,999 plus 1.54% for AV ≥ $10,000 Check Processing Fee$5 per check Annual Trustee Fee (only when MSNT is sole trustee) $350 Extraordinary Services Fee$50 per hour, plus mileage, if applicable Account Closure Fee$100 Charitable Trust Provision at death of life beneficiary  None if trust never used  25% of remainder balance if distributions were made

 Provide consultation on use of trust funds  Staff and board knowledgeable about SSI, Medicaid and services to PWD  Smaller amount accepted to open a trust  Reasonable administrative fees  Investments managed at no additional charge  Minimizes co-trustee burden

 Created by Missouri Statute in 1989 as Missouri Family Trust with 2011updates to authorizing statutes  Values-driven board appointed by Governor  Not for profit 501 c 3  Administer trusts for >900 individuals with disabilities in Missouri & surrounding states  Average trust at opening is about $30,000

 Missourians with disabilities with no trust may apply  Grants up to $1000 ◦ Urgent care ◦ Board review  Limitations ◦ One award per year ◦ Cannot be for medical or dental already completed ◦ Must provide a treatment plan with estimated costs from the intended provider ◦ Award must be used within 90 days ◦ Payment made directly to the vendor, not the recipient  Application online or by request ◦ Contact information on next slide ◦ Sponsor or self submission ◦ Timelines for submission

Midwest Special Needs Trust 1500 Vandiver Drive, Suite 100 Columbia, MO Phone: Fax: Web: