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What’s the Difference Between “Supplemental” and “Special” Needs Trusts?


You may have heard the terms “special” needs trust and “supplemental” needs trust and wondered what the difference is. The short answer is that there’s no difference. Here’s the long answer.

When the field of special needs planning began some four decades ago, we generally called the trusts we created for people with disabilities “supplemental” needs trusts. Our thinking was that the purpose of the trusts was to supplement the assistance provided by Medicaid, Medicare, Social Security, Supplemental Security Income and other public benefits programs whose level of support is meager at best.

With passage of legislation in 1993 authorizing the creation of self-settled trusts under 42 USC §1396p(d)(4)(A), some practitioners called for distinguishing between these new trusts and third-party trusts often created by a parent, by calling the former “special” needs trusts and continuing to call the latter trusts “supplemental” needs trusts. But this approach never really caught on.

Instead, over time, both types of trusts have come under the rubric of “special” needs trusts and the term “supplemental” needs trust has fallen away. The term “special” needs trust refers to the purpose of the trust to pay for the beneficiary’s unique or special needs. In short, the title is focused more on the beneficiary, while the name “supplemental” needs trust addresses the shortfalls of our public benefits programs.

Special needs trusts now encompass both traditional “third-party” trusts and those under under the statutory safe harbor for sheltering the beneficiary’s own funds. The latter are often referred to as “(d)(4)(A)” trusts, which refers to the statute, as a “pay-back” trusts, focusing on the feature that any funds remaining in the trust at the beneficiary’s death must be used to reimburse the state Medicaid agency, or as “self-settled” trusts referring to the fact that these trusts are created with the Medicaid beneficiary’s own funds.

Special needs trusts, created with someone else’s funds — a parent, grandparent, or someone else, are often referred to as “third-party” special needs trusts.

In short, the reference to the trusts as “supplemental” needs trusts rather than “special” needs trusts is something of a survival. But what’s in a name? Whether “supplemental” or “special,” the trusts serve the same purpose — helping meet the needs of individuals with disabilities while still permitting them to qualify for vital public benefits programs.

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