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NADD U.S. Policy Update (from the NADD Bulletin Volume VII Number 3)Complete listing
Understanding Supplemental Needs Trusts
by DiAnn Davies Baxley, MAR, and Anna Zendell, MSW, Center on
Developmental Disabilities, University at Albany, School of Social
Welfare, New York
The federal Omnibus Act of 1993, also called the OBRA-93 Act, is
federal legislation that affects how people with disabilities,
including dual diagnoses, can have supplemental, also called special,
needs trusts and still qualify for Medicaid benefits. The Foster Care
Independence Act of 1999 is federal legislation affecting how people
with disabilities can have trusts and still qualify for Supplemental
Security Income (SSI).
Defining Supplemental Needs Trusts
A supplemental needs trust (SNT) is a legal document that provides a
supplemental source of funds for individuals with disabilities.
Trusts enable individuals to remain eligible for need-based
government benefits, including SSI or Medicaid. An SNT is not counted
as a resource for SSI and Medicaid's purposes. Specific trust wording
precludes beneficiaries from any legal say in how the money is spent.
Trustees manage the SNT's and decide how to spend the money to meet
the person's needs. Trustees should understand SNT policy, money
management, have a qualified attorney to consult with, and hold
beneficiaries' best interests paramount.
Purpose of Trusts
The purpose of an SNT is to enhance the quality of life of
individuals with disabilities. The trust can purchase additional
support services, therapies, private health insurance, and care not
(or inadequately) covered by Medicaid, but that are important to the
beneficiary's well-being. Additionally, an SNT can pay for anything
beyond food, clothing and shelter such as vacations, magazine
subscriptions, and recreation. As of 1999, SSI allows for home
ownership purchases through a trust to be executed under certain
circumstances provided the trustee holds the title to the home (POMS
SI 01120.200). However, as with any phase of setting up a trust, one
should not proceed without consulting an attorney specializing in
SSI/Medicaid/estate law.
Three Types of Trusts
A Third Party or Escher SNT is set up and funded by a donor/grantor
who may be a parent or other person with no legal duty to support the
disabled individual. Once a trust is established, anyone can gift or
leave money for the benefit of the person to the trust
(Davies-Baxley, 2001).
An OBRA-93 Payback SNT is a trust established by a parent,
grandparent, legal guardian or court, but which is funded with the
assets of a beneficiary under age 65. When the beneficiary dies, the
State has a right to be "paid back" out of the remainderman
of the trust for Medicaid expenditures given to the beneficiary
(Davies-Baxley, 2001).
Pooled Trusts are trusts that, by law, are established and maintained
by a not-for-profit organization. These trusts allow families to pool
their resources with other families to maximize the investment and
streamline management of the trust. Beneficiaries of these trusts
usually receive earnings based on their share of the principal. A
"sponsor" (the person who creates the trust) signs a
sponsor agreement with the not-for-profit establishing an individual
trust account. There are two basic forms of pooled SNT's, OBRA-93
Trusts (first party trusts) and Third Party Trusts. Check state laws
and a qualified attorney regarding payback of State Medicaid and
pooled trusts (Davies-Baxley, 2001).
Importance of Trusts
Individuals with dual diagnoses are living well into retirement years
and are much more involved in the community. Government benefits and
entitlements cover only basic needs. Families provide so many of the
extras that bring meaning and quality to the lives of their child
with disabilities. The best way to ensure that these
"extras" and any other future needs are met is for families
to set up a trust and start saving. Agencies and providers can be
pivotal in assisting families in this endeavor.
References
Davies-Baxley, D., ed. (2001). Frequently asked questions about
supplemental needs trusts. New York: New York State Trust Task Force.
Social Security Administration. (2004). Program Operation Manual. SI
01120.200 Trusts Established Prior to 1/1/00, Trusts Established by
Third Parties and Trusts Not Subject to Section 1613(e) of the Social
Security Act. Retrieved from: http://policy.ssa.gov/poms.nsf/36f3b2ee954f0075852568c100630558/ae1777ed62e2fd6d85256e310077d992/
The ARC of the United States. (2002). Pooled trust programs for
people with disabilities: a guide for families. Silver Springs, MD:
The ARC of the United States.
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Upcoming Conferences:
September
Ohio State 10th Annual MI/DD Conference , Mental Health Aspects
–Treatment & Support (September 18 & September 19, 2012)
Columbus, Ohio
October
NADD 29th Conference & Exhibit Show, (October 17 - 19, 2012)
Denver, Colorado
October 2013
NADD 30th Conference & Exhibit Show, Baltimore MD (October 23 -
October 25, 2013)
Complete Calendar |
New Educational Products:
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 Intellectual
Disability and Mental Health: A Training Manual in Dual Diagnosis
Sharon McGilvery, Ph.D. and Darlene Sweetland, Ph.D.
With the release of this book, Drs. McGilvery and Sweetland share
decades of experience working with individuals diagnosed with an
intellectual disability and co-occurring psychiatric disorders. Their
well-practiced approach takes into account the extremely complex
nature of working with dual-diagnosis. The authors provide
in-depth information about the diagnostic process, hands-on treatment
considerations, and their experience training thousands of people to
work passionately with these individuals. An important
contribution is their approach to addressing complicating factors in
identifying appropriate psychiatric diagnoses, as well as the problem
of the underreporting of psychiatric symptoms and disorders. Finally,
those working in a variety of contexts with these individuals will
benefit from the innovative approaches of looking at treatment and
intervention strategies that can be immediately implemented. 264 pages
Details:
ST11-053B
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 A
PRACTICAL GUIDE to Assessing Medical Issues Associated with
Behavior/ Psychiatric Problems in Persons with Intellectual
Disability – Revised in 2011
Ann R. Poindexter, M.D.
This book discusses medical/medication issues which may present as
behavioral/ psychiatric problems in individuals with intellectual
disability. Three self-directed instructional courses and
several illustrative case histories are included. 110 pages\
Details:
DA05-021BR
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Psychotherapy for Individuals with Intellectual Disability
Edited by: Robert J. Fletcher, DSW, ACSW
This book provides the reader with insightful and useful ways to
provide psychotherapy treatment for individuals who have intellectual
disability (ID). It brings together all three modalities
(individual, couple, and group), and a variety of theoretical models
and techniques are discussed. The first section, Individual
Therapy, offers a variety of approaches and techniques including
dialectical behavioral therapy, positive psychology,
mindfulness-based practice, and relaxation training. Also included in
this section are chapters on specialty populations including victims
of abuse, people who have Autism Spectrum Disorder, and people in
mourning. The second section is a chapter on group therapy addressing
trauma issues. The third section is on family and couple therapy. The
fourth section covers chapters on research, ethics, and
training. The individual authors are respected authorities in
the field of providing psychotherapy treatment for persons with ID
and all have contributed to the professional literature.
This book is a major contribution to the effort to make psychotherapy
available to individuals who have ID and should serve to further
stimulate interest in the provision of psychotherapy treatment for
individuals who have ID co-occurring with significant mental health problems.
NADD # CT11-051B Details
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 Comprehensive
Competence-Based Parenting Assessment for Parents with Learning
Dificulties and Their Children
Maurice Feldman, PhD, Marjorie Aunos, PhD
This book presents an innovative, empirically-supported approach to
assessing parenting capacity of parents with learning difficulties
that can lead to more humane, fair and accurate child custody
decisions. The authors are leading researchers and
practitioners in this field haing worked with hundred of these
families. Many professionals working with these families
recognize that the current parenting capacity assessment approaches
are based on outdatd and invalid assumptions and methods. This
book addresses the unique assessment needs of these families and
includes detailed background information, rationales and methods.
NADD # DA10-050B Details
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 Working
with People with Challeging Behaviors: A Guide for Maintaining
Positive Relation
Nathan Ory
The material in this book introduces general practices
and specific solutions to behavior problems that will work with
people who display difficult and challenging behaviors regardless of
who they are. It is especially suitable for working with
individuals who have developmental or intellectual disabilities
coupled with a behavior disorder. The methods also apply to the
person with emotional or psychiatric disturbances, or another serious
mental health problem. Finally, they are helpful in providing
support to elderly individuals who display challenging behavior.
NADD # ST10-049B Details
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Human Needs and Intellectual Disabilities: Applications for Person
Centered Planning, Dual Diagnosis, and Crisis Intervention
Steven Reiss, Ph.D.
Human Needs and Intellectual Disabilities identifies the 12 human
needs most relevant to the lives of people with intellectual
disabilities, autism and related developmental disabilities. It
includes detailed, practical suggestions for caregivers or parents
interested in the happiness, quality of life, and self-determintion
of their loved ones or consumers. The book includes detailed,
practical suggestions for reducing episodes of challenging behavior
and psychiatric symptoms in people with a dual diagnosis
(intellectual disabilities and mental illness). It shows how to
substitute the language of individuality (e.g., "friendly
person") for the language of disability (e.g., "person with
disability"). It also reduces the tendency of planners to
confuse their own value system for that of the consumer. The
book includes scholarly reviews of dual diagnosis literature on
mental illness, prevalence, and assessment.
NADD # DA10-048B Details
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Positive Identity Development
Author: Karyn Harvey, PhD
Positive Identity Development is an exciting new approach to
treatment for individuals with intellectual disabilities. This
book provides a new theoretical perspective on treatment along with a
variety of innovative tools. It rejects reducing adults with
intellectual disabilities to a mere compilation of their behaviors
and promotes the use of a positive, therapeutic approach to each
unique individual. Psychologists, social workers and therapists
should be able to use the tools presented in this book to directly
enhance the effectiveness of the treatment they provide to adults
with intellectual disabilities. This book promotes well-being on
every level and explores a broad range of issues relevant to the life
and mental health of adults with intellectual disabilities
Mbr Price: $34.95
Non-Mbr: $39.95
NADD #CT09-047B Details |
 Down
Syndrome: When to Worry about Mental Health and What to Do About It
Robin Friedlander, M.D. & Peter Johnson, Ph.D.
NADD # FI09-044B Details |
 Working
with People who have Intellectual Disability and Behavioral
Problems: A Self-Study Guide for Interdisciplinary Team Members
Ann R. Poindexter, M.D. & Paul D. Kolstoe, Ph.D.
NADD # ST09-045B Details |
Multi-Media CDs of NADD 25th Annual Conference Presentations
Presentations recorded at NADD 25th Annual Conference are available
as multi-media CDs. These CDs contain the video and Power Point
from conference presentations and are a great tool for training
yourself and your staff. To order, or for additional
information, click here.
Community Networks of Specialized Care: Building Community
Capacity through Training and Education Lisa Holmes, Liz
Froese, MSW, Rosanne Stein, LLB, BSc, Sandi Bricker
NADD Competency-Based Dual Diagnosis Certification Program Robert
Fletcher, DSW, ACSW, FAAIDD; Donna McNelis, PhD; John McGonigle,
PhD; Kathleen Olson, PhD; Jarrett Barnhill, MD
Autism Spectrum Disorders: Separating the Data from the
Myths Ann R. Poindexter, MD
Diagnostic Systems for Use with People with ID Luis
Salvador-Carulla, MD, PhD, Robert J. Fletcher, DSW, ACSW, FAAIDD,
Sally-Ann Cooper, MD
The price for the above multimedia is: Member:
$49.95 Non-member: $59.95
To order, or for additional information, click
here.
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