Massachusetts Estate Planning and Elder Law

Planning for a Child with Special Needs

Planning for a child with special needs requires more than just making sure that you leave some money for them. Many times, children (including adult children) are receiving Medicaid or other government benefits due to their disability.  This is true even if they have private health insurance as well, since private health insurance doesn't cover everything. 

A Special Needs Trust, also called a Supplemental Needs Trust, can be a good tool in planning for your disabled child, as discussed in this recent New York Times Article. (You may need to register to read it, but registration is free.)  A special needs trust will allow your disabled child to continue to receive the necessary benefits under Medicaid or Social Security, while having money set aside to pay for those items and services that are necessary, but not otherwise covered. 

In general, the funds in a Special Needs Trust cannot be used to pay for food or shelter, since that is what Social Security Disability Insurance pays for, but they can be used to pay for things such as travel, clothing, classes, transportation, hobbies, vacations, haircuts,  TV's, DVD's, etc. In addition, because the funds are from a third party, meaning they did not belong to the beneficiary, the Trust does not compromise the beneficiary's government benefits. 

It is not just wealthy families who set up Special Needs Trusts.  A Special Needs Trust can be funded with bequests from the parent's (0r even grandparent's) Wills, and life insurance policies.  You can look out for your child while you are alive, and a Special Needs Trusts can help you provide for your child after you are gone. 

Health Insurance Appeals

You spend a lot of money on health insurance, and expect it to cover those things you need. Well, if you've read your benefit booklet (and who hasn't?), you know that there are plenty of things that are not covered, and more things that are only covered in certain circumstances. It can be frustrating and scary to have your health insurance deny coverage of an item or service your doctor is recommending to you or a loved one.
If the times comes when you need to file an appeal with your health insurance company to obtain coverage of a needed item or service, here are some guidelines for doing so:
1. Find your member handbook. If you don't have it, request a current one from your employer or call the health insurance company for a copy.

2. Read the member handbook. Review the section on what is covered, and then the section on what is not covered and see if you can find a mention of the item or service you need. Finally, read the section on filing Appeals. Find out how many levels of appeal there are, and if there is an external appeal option to an outside agency.  If you don't understand something about the appeal process, call your health insurance company and ask them to explain it.