First-Party Special Needs Trust (d)(4)(A)

FIRST-PARTY SPECIAL NEEDS TRUST FOR [BENEFICIARY NAME]

PRELIMINARY STATEMENT

This Trust is established under 42 U.S.C. § 1396p(d)(4)(A), commonly known as a First-Party Special Needs Trust (or "Self-Settled Special Needs Trust," "Supplemental Needs Trust," or "(d)(4)(A) Trust"). This trust is designed to:

• Hold and manage assets belonging to a person with a disability
• Preserve eligibility for means-tested public benefits (SSI, Medicaid, SSDI, public housing)
• Supplement public benefits with trustee-directed distributions for disability-related expenses
• Provide long-term financial security without jeopardizing government assistance

This trust is irrevocable and may only be modified or terminated by order of a court of competent jurisdiction.

PARTIES

Settlor / Grantor

The person establishing this trust is:

☐ [BENEFICIARY NAME] (the Beneficiary establishes the trust on their own behalf, authorized under 21st Century Cures Act § 5007)

☐ [PARENT/GUARDIAN NAME], parent of the Beneficiary

☐ [PARENT/GUARDIAN NAME], grandparent of the Beneficiary

☐ [GUARDIAN/REPRESENTATIVE NAME], court-appointed legal guardian of the Beneficiary

☐ [COURT/PROBATE COURT], by order of [STATE] [COUNTY] Court dated [__/__/____]

Beneficiary

[BENEFICIARY FULL LEGAL NAME], born [__/__/____], age [____], and all persons claiming through or under the Beneficiary. The Beneficiary is a person with a disability as defined by the Social Security Administration under 42 U.S.C. § 1382c(a)(3) or § 416(i)(1).

Trustee

Initial Trustee: [TRUSTEE NAME], address [________________________________]

By accepting this position, the Initial Trustee agrees to manage trust assets in accordance with this instrument and applicable law.

Successor Trustee(s):

1. [SUCCESSOR TRUSTEE 1 NAME]
2. [SUCCESSOR TRUSTEE 2 NAME]
3. [SUCCESSOR TRUSTEE 3 NAME]

Trust Protector (Optional)

[PROTECTOR NAME], address [________________________________], is appointed as Trust Protector with authority to: monitor compliance with SSA/Medicaid rules, review trustee distributions for sole-benefit compliance, and recommend trustee removal if necessary.

ARTICLE 1: NAME, ESTABLISHMENT, AND IRREVOCABILITY

1.1 This trust shall be known as the "Special Needs Trust for [BENEFICIARY NAME]" established on [__/__/____].

1.2 This trust is established with assets listed in Exhibit A (Initial Funding Schedule). Title to such assets shall be transferred into the name of this trust as follows:

[TRUSTEE NAME], Trustee of the Special Needs Trust for [BENEFICIARY NAME], 
dated [__/__/____]

1.3 This trust is irrevocable and may not be revoked, amended, or terminated except by order of a court of competent jurisdiction. No beneficiary (including the Beneficiary) shall have any right to revoke, amend, or terminate this trust.

ARTICLE 2: BENEFICIARY QUALIFICATIONS

2.1 Age Requirement: The Beneficiary must be under age 65 at the time trust assets are first funded. If the Beneficiary is 65 or older at funding, this trust does not comply with 42 U.S.C. § 1396p(d)(4)(A) and may result in ineligibility for Medicaid. Exception: This restriction applies to Medicaid eligibility only; the trust remains valid as a supplemental needs trust.

2.2 Disability Requirement: The Beneficiary must be disabled as defined by the Social Security Administration. This includes:

• Individuals who are blind or disabled under SSI rules (42 U.S.C. § 1382c(a)(3))
• Individuals who are disabled under SSDI rules (42 U.S.C. § 416(i)(1))
• Individuals with disabilities as determined by the Social Security Administration

2.3 Verification: The Trustee shall maintain current documentation of the Beneficiary's disability status, including:

• Social Security Administration determination letters
• Supplemental Security Income (SSI) award or SSDI Award statement
• Medical evidence if requested by state Medicaid agency

2.4 Notice of Ineligibility: If the Beneficiary ceases to meet disability or age requirements, the Trustee shall notify the Beneficiary and relevant government agencies within 30 days.

ARTICLE 3: SOLE BENEFIT RULE

3.1 Mandatory Compliance: Pursuant to SSA POMS SI 01120.201F and 42 U.S.C. § 1396p(d)(4)(A)(i), all distributions from this trust must be for the sole benefit of the Beneficiary. No distribution may:

• Directly or indirectly benefit any other person
• Be used to satisfy the Beneficiary's legal obligation to support another person
• Reduce or replace services owed by any government agency
• Disqualify the Beneficiary from SSI or Medicaid

3.2 Permissible Benefit: A distribution is for the sole benefit of the Beneficiary if it:

• Directly provides goods, services, or care to the Beneficiary
• Supplements (but does not supplant) government benefits
• Enhances the Beneficiary's quality of life without creating an ongoing entitlement claim against the state

3.3 Trustee Responsibility: The Trustee shall exercise sole discretion in determining whether a proposed distribution meets the sole-benefit requirement and shall deny any request that would violate this restriction.

ARTICLE 4: TRUST ASSETS — SOURCE AND IDENTIFICATION

4.1 Permissible Sources: First-party special needs trusts may be funded with assets that belong to the Beneficiary, including:

• Proceeds from a personal injury settlement or judgment ([SETTLEMENT CASE NAME], [__/__/____])
• Inheritance received by the Beneficiary ([DECEASED NAME]'s estate, [__/__/____])
• Accumulated Supplemental Security Income (SSI) savings
• Social Security back pay or retroactive benefits
• Workers' compensation award
• Life insurance death benefit payable to the Beneficiary
• Other assets owned or acquired by the Beneficiary

4.2 Initial Funding Schedule: The assets transferred to this trust are listed in Exhibit A, attached hereto and incorporated by reference.

4.3 Title Requirement: The Trustee shall cause all trust assets to be titled in the name of the Trustee, in trust capacity, to ensure trust ownership and proper administration.

ARTICLE 5: TRUSTEE DISCRETION AND DISTRIBUTIONS

5.1 Sole and Absolute Discretion: The Trustee possesses sole and absolute discretion to determine whether to make distributions from trust income or principal. The Trustee shall not be required to make distributions at any time or in any amount, and no beneficiary shall have any enforceable right to demand distribution.

5.2 Standard of Discretion: The Trustee shall exercise discretion consistently with this instrument and with the purpose of supplementing (not supplanting) government benefits while preserving Medicaid and SSI eligibility.

5.3 No Mandatory Distributions: This trust does not require the Trustee to:

• Distribute income or principal to the Beneficiary at any interval
• Provide stated amounts or percentages
• Respond to requests for distributions that would violate the sole-benefit rule or jeopardize public benefits

5.4 Trustee's Determination Final: Absent breach of trust, the Trustee's determination regarding distributions shall be final and binding on all parties.

ARTICLE 6: PURPOSE CLAUSE — SUPPLEMENTAL TO PUBLIC BENEFITS

6.1 Primary Purpose: This trust exists to supplement—not supplant or reduce—the Beneficiary's eligibility for or receipt of:

• Supplemental Security Income (SSI) under 42 U.S.C. § 1381 et seq.
• Medicaid under 42 U.S.C. § 1396 et seq.
• Social Security Disability Insurance (SSDI) under 42 U.S.C. § 401 et seq.
• Section 8 housing assistance under 42 U.S.C. § 1437f
• Medicare or other federal/state assistance programs

6.2 Trustee Obligation: The Trustee shall:

• Maintain current knowledge of SSA and Medicaid rules
• Consult with the Beneficiary's case manager or government representative before distributions that may trigger review
• Decline distributions that would reduce or terminate public benefits unless the long-term benefit to the Beneficiary justifies temporary loss

6.3 Duty to Preserve Eligibility: The Trustee shall prioritize preservation of the Beneficiary's public-benefit eligibility above all other trustee duties.

ARTICLE 7: PERMITTED DISTRIBUTIONS

7.1 Trustee Authority: The Trustee may distribute trust income and/or principal for any expense that benefits the Beneficiary, including but not limited to:

7.2 In-Kind Distributions: All distributions shall be made in the form of goods, services, or direct payment to vendors on behalf of the Beneficiary. No cash distributions to the Beneficiary are permitted except in limited circumstances with documented sole-benefit justification.

ARTICLE 8: PROHIBITED DISTRIBUTIONS

8.1 Distributions Prohibited by Law: The Trustee shall not distribute trust assets in the following manner:

• Cash to Beneficiary: Direct cash payments to the Beneficiary constitute income under SSA rules and will trigger SSI/Medicaid countable income, unless specifically requested and documented as a sole-benefit expense.
• Support Obligation: Distributions that satisfy the Beneficiary's legal obligation to support a spouse, child, or parent (unless exception applies).
• Third-Party Benefit: Distributions that directly benefit persons other than the Beneficiary.
• Government Service Replacement: Distributions intended to replace or reduce state-owed services (e.g., Medicaid personal care, state-provided therapy).
• In-Kind Support and Maintenance (ISM): Distributions for food, shelter, or utilities that would constitute ISM and reduce SSI, unless coordinated with SSA in advance under individual plan.
• Gifts or Charitable Donations: Gifts to third parties or charitable organizations.
• Payment of Third-Party Debts: Distributions to pay debts owed by the Beneficiary to third parties, unless documented as necessary for Beneficiary's benefit.

8.2 Caretaker Exception: Reasonable payments to family members or professional caregivers for services rendered to the Beneficiary are permitted if documented, reasonable, and truly for the Beneficiary's benefit.

8.3 Trustee Denial Authority: The Trustee shall deny any distribution request that violates this Article.

ARTICLE 9: MEDICAID PAYBACK PROVISION (MANDATORY)

9.1 Medicaid Payback Requirement: This article is mandatory by federal law (42 U.S.C. § 1396p(d)(4)(A)(ii)) and applies to all first-party special needs trusts. Upon the death of the Beneficiary, the trustee shall distribute trust property to the state Medicaid program(s) to the extent of Medicaid paid for the Beneficiary's care during the Beneficiary's lifetime.

9.2 Calculation of Payback Obligation: The Medicaid payback is calculated as follows:

The total amount of all medical assistance paid by any state's Medicaid program on behalf of the Beneficiary (including long-term care, acute care, behavioral health, prescriptions, and any other Medicaid services) during the Beneficiary's lifetime.

9.3 Multiple States: If the Beneficiary received Medicaid in multiple states (e.g., childhood in California, adulthood in New York), the Trustee shall:

• Identify all states that paid Medicaid on behalf of the Beneficiary
• Obtain Medicaid records from each state showing total amount paid
• Apportion the payback obligation among all states as required by their Medicaid manuals
• Make payments to each state's Medicaid program

9.4 Order of Distributions at Death: Upon the Beneficiary's death, the Trustee shall distribute trust assets in the following order:

1. Funeral and Burial Expenses: Reasonable costs not exceeding state limits (typically $3,000–$15,000 depending on state)
2. Administration Expenses: Reasonable Trustee fees, tax preparation, and legal fees incurred in administering the final distribution
3. Medicaid Payback: All remaining assets to the state(s) Medicaid program(s) in proportion to Medicaid paid by each state
4. Remainder Beneficiaries: Any assets remaining after Medicaid payback to remainder beneficiaries named below (if any)

9.5 Remainder Beneficiaries: The following person(s) or organization(s) shall receive any trust assets remaining after payment of funeral expenses, administration costs, and Medicaid payback:

[BENEFICIARY NAME OR "NONE—ALL TO STATE"]

9.6 Trustee Duty to Account: The Trustee shall obtain official Medicaid payback statements from each state Medicaid agency and maintain documentation of all amounts paid.

ARTICLE 10: ADMINISTRATIVE EXPENSES PERMITTED BEFORE PAYBACK

10.1 Priority Expenses: The following expenses may be paid from trust assets before the Medicaid payback and with priority over remainder distributions:

Funeral and Burial: Reasonable costs of funeral arrangements, body disposition, and related services, subject to state Medicaid limits. If the Beneficiary has prepaid funeral insurance or trusts, the Trustee shall use those resources first.

Trustee Fees: Reasonable compensation for Trustee services, including management of assets, investment oversight, and distribution decisions. Reasonable fee: [_____]% of assets annually or $[_____] per year.

Tax Preparation and Reporting: Fees for preparation of the Beneficiary's final income tax returns, trust income tax returns (Form 1041), and any state/local returns.

Legal Fees: Reasonable attorney fees incurred in administering the trust, including consultation with special needs planning attorneys regarding Medicaid compliance.

Investment Management: Reasonable fees for professional investment management if the Trustee engages an investment advisor.

Medicaid Application and Recertification: Reasonable fees for preparing or updating Medicaid applications and responding to state recertification requests.

10.2 Documentation: The Trustee shall maintain receipts and documentation for all administrative expenses and provide an accounting to the Beneficiary (or Beneficiary's advocate) showing all expenses.

ARTICLE 11: TRUSTEE POWERS AND DUTIES

11.1 General Powers: The Trustee shall have all powers granted by law, including:

• Authority to invest and reinvest trust assets in accordance with the Prudent Investor Rule
• Power to buy, sell, lease, mortgage, or pledge trust property
• Power to borrow money and pledge trust assets as security
• Power to conduct any business or profession on behalf of the Beneficiary
• Power to enter into contracts and settle claims
• Power to employ agents, advisors, and professionals

11.2 Prudent Investor Rule: The Trustee shall invest trust assets as a prudent investor would, considering:

• The Beneficiary's long life expectancy and need for assets to last a lifetime
• Preservation of capital and reasonable growth
• Diversification of investments to reduce risk
• Current and future needs for distributions to supplement public benefits

11.3 Prohibited Transactions:

• No Self-Dealing: The Trustee shall not enter into transactions with itself or use trust assets for personal benefit
• No Conflict of Interest: The Trustee shall avoid investments in companies in which the Trustee has a financial interest
• No Commingling: Trust assets shall be kept separate from the Trustee's personal assets
• Proper Accounting: The Trustee shall maintain clear records distinguishing trust property from personal property

11.4 Fiduciary Duty: The Trustee shall act as a fiduciary for the sole benefit of the Beneficiary and shall comply with all SSA and Medicaid rules to preserve public benefits.

ARTICLE 12: ANNUAL ACCOUNTING AND REPORTING

12.1 Beneficiary Accounting: The Trustee shall provide the Beneficiary (or Beneficiary's designated advocate) with an annual accounting showing:

• Beginning trust balance
• Receipts and income
• Distributions made, with description of purpose
• Fees and expenses paid
• Ending balance

12.2 Timing: The annual accounting shall be provided within 30 days of the trust's anniversary date or upon reasonable request.

12.3 Medicaid Agency Request: Upon request by the state Medicaid agency (typically during recertification), the Trustee shall provide:

• Current account statement showing trust assets
• List of distributions made in the past 12 months
• Certification that all distributions were made for the sole benefit of the Beneficiary
• Documentation that no cash was distributed to the Beneficiary (or explanation if it was)

12.4 Qualified Advocate Access: The Beneficiary (or the Beneficiary's legal guardian or authorized representative) shall have the right to request accounting information from the Trustee at any time.

ARTICLE 13: SUCCESSOR TRUSTEE PROVISIONS

13.1 Succession Order: If the Initial Trustee is unable or unwilling to serve, the following shall serve as Successor Trustee in the order named:

1. [SUCCESSOR TRUSTEE 1]
2. [SUCCESSOR TRUSTEE 2]
3. [SUCCESSOR TRUSTEE 3]

If none of the named successors are willing or able to serve, the Beneficiary (or Beneficiary's guardian) may petition the [STATE] court to appoint a successor trustee.

13.2 Resignation: Any Trustee may resign by giving written notice to the Beneficiary (or guardian) and the Trust Protector, effective 30 days after notice.

13.3 Removal: A Trustee may be removed by the court for:

• Breach of fiduciary duty
• Failure to comply with SSA or Medicaid rules
• Incapacity or unwillingness to serve
• Conflict of interest

The Beneficiary, guardian, or Trust Protector may petition for removal.

13.4 Trustee Acceptance: Any person accepting the position of Trustee agrees to:

• Manage assets in accordance with this trust instrument
• Comply with all SSA and Medicaid rules
• Provide annual accountings to the Beneficiary
• Act solely for the benefit of the Beneficiary
• Indemnify the prior Trustee for actions taken in good faith

ARTICLE 14: SPENDTHRIFT PROVISION

14.1 Restriction on Assignment: The interests of the Beneficiary in this trust—including income, principal, and distributions—may not be:

• Assigned, transferred, pledged, or hypothecated
• Reached by creditors through garnishment, levy, or judgment
• Subject to the claims of creditors or third parties
• Used to satisfy the Beneficiary's legal support obligations

14.2 Creditor Protection: Notwithstanding any other provision, neither the Beneficiary nor any creditor of the Beneficiary may compel distributions from this trust. The spendthrift provision does not, however, prevent:

• Payment of reasonable trustee, legal, and tax preparation fees
• Distributions that the Trustee determines are appropriate
• Court order for medical support (child support, spousal support) in limited circumstances

14.3 Government Claim Exception: This spendthrift provision shall not restrict claims by the federal or state government for:

• Medicaid payback under 42 U.S.C. § 1396p(d)(4)(A)(ii)
• Taxes owed by the Beneficiary
• Court-ordered support for the Beneficiary's minor children

ARTICLE 15: GOVERNING LAW

15.1 Choice of Law: This trust shall be governed by the laws of [STATE], without regard to conflicts of law principles.

15.2 Federal Law Supremacy: To the extent any state law conflicts with 42 U.S.C. § 1396p(d)(4)(A) or other federal law governing special needs trusts, federal law shall control.

15.3 Interpretation: This trust shall be interpreted to preserve the Beneficiary's eligibility for federal and state means-tested public benefits, including SSI and Medicaid.

ARTICLE 16: INCOME TAX TREATMENT

16.1 Grantor Trust Status (if Beneficiary-Established): If the Beneficiary established this trust using their own assets, the trust is generally a grantor trust for federal income tax purposes. The Beneficiary shall be deemed the owner of the trust for tax purposes, and:

• The Beneficiary reports all trust income on their personal federal income tax return (Form 1040)
• The trust does not file a separate Form 1041
• The Beneficiary bears income tax liability

16.2 Alternative: Non-Grantor Trust (if Parent-Established): If a parent, guardian, or court established the trust with the Beneficiary's assets, the trust may be a non-grantor trust, in which case:

• The trust files a Form 1041 (U.S. Fiduciary Income Tax Return)
• The trustee reports trust income and makes quarterly estimated tax payments
• Income is allocated to the Beneficiary (Form K-1) or retained in the trust

16.3 Tax Identification Number: The Trustee shall:

• Obtain an EIN (Employer Identification Number) from the IRS on Form SS-4 if the trust is a non-grantor trust
• Use the Beneficiary's Social Security Number if the trust is a grantor trust
• Provide the appropriate taxpayer ID to banks and investment firms

16.4 Coordination with SSI: The Trustee shall coordinate with the SSA regarding tax treatment to avoid creating excess countable income that would disqualify the Beneficiary from SSI.

ARTICLE 17: COURT APPROVAL (IF APPLICABLE)

17.1 Probate or Personal Injury Settlement: If this trust is funded from:

• Probate settlement: The Beneficiary's share of a decedent's estate
• Personal injury or workers' compensation settlement: Settlement proceeds awarded to a minor or incompetent person

Then a [STATE] probate court or special needs trust judge must approve this trust instrument before distribution of settlement funds.

17.2 Court Petition: The Trustee or legal representative shall file a petition in [STATE] [COUNTY] [Court Name] requesting approval, including:

• A copy of this trust instrument
• Proof that the Beneficiary is disabled under SSA rules
• Certification that the trust meets 42 U.S.C. § 1396p(d)(4)(A) requirements
• Accounting of settlement proceeds to be deposited

17.3 Court Order: The court shall issue an order approving the trust. Upon approval, the settlement funds shall be deposited to the trust, titled in the Trustee's name.

17.4 Guardianship Coordination: If the Beneficiary has a court-appointed guardian or conservator, the Trustee shall coordinate with the guardian and provide accountings as required by court order.

ARTICLE 18: STRUCTURED SETTLEMENT INTEGRATION (IF APPLICABLE)

18.1 Structured Settlement Payment Assignment: If this trust is funded in whole or part with a structured settlement (periodic annuity payments), the structured settlement shall be assigned to the trust as follows:

• Annuity Issuer: [________________________________]
• Annuity Policy Number: [________________________________]
• Monthly/Periodic Payment: $[____] beginning [__/__/____]
• Term: [____] years or lifetime

18.2 Trustee Authority over Periodic Payments: The Trustee shall:

• Receive all periodic payments directly from the annuity issuer
• Deposit payments to the trust account
• Account separately for structured settlement income
• Use structured settlement payments to make distributions consistent with this trust

18.3 Non-Assignability Limitation: If the structured settlement agreement prohibits assignment or requires consent, the Trustee shall:

• Obtain all necessary consents from the payor and annuity issuer
• Maintain copies of consent documents
• Request beneficiary designation change to the trust if permitted

18.4 Tax Reporting: Structured settlement periodic payments assigned to the trust shall be reported on:

• Form 1099-MISC (if issued)
• The Beneficiary's income tax return (grantor trust) or the trust's Form 1041 (non-grantor trust)

ARTICLE 19: MISCELLANEOUS PROVISIONS

19.1 Severability: If any provision of this trust is found to be invalid, the remaining provisions shall remain in effect, and the invalid provision shall be reformed to the extent permitted by law to achieve the Beneficiary's benefit.

19.2 Amendment Restrictions: This trust may not be amended or modified except by order of a court of competent jurisdiction. No oral amendments are valid.

19.3 Entire Agreement: This trust instrument, together with Exhibit A (Initial Funding Schedule), constitutes the entire agreement and supersedes all prior negotiations, representations, or agreements.

19.4 Captions: Headings and captions are for reference only and do not affect interpretation.

19.5 Notices: All notices under this trust shall be in writing and delivered personally or by certified mail to the addresses listed in the signature blocks below.

19.6 Perpetual Trust: This trust shall continue during the Beneficiary's lifetime and shall terminate only upon the Beneficiary's death, at which time the Trustee shall distribute assets as provided in Article 9 (Medicaid Payback).

19.7 No Contest Clause: The Beneficiary and all other parties acknowledge that challenging this trust in court will result in [OPTIONAL: forfeiture of the challenger's share OR attorney's fees paid by the challenger].

SIGNATURE BLOCKS

IN WITNESS WHEREOF, the Settlor(s) and Trustee have executed this trust instrument on the date(s) below:

SETTLOR

[SETTLOR NAME], Settlor

Signature: _____________________________ Date: __/__/____

Printed Name: _______________________________

TRUSTEE ACCEPTANCE

[TRUSTEE NAME], as Trustee of the Special Needs Trust for [BENEFICIARY NAME]

Signature: _____________________________ Date: __/__/____

Printed Name: _______________________________

By signing above, the Trustee accepts the position and agrees to comply with this trust instrument and all applicable law.

NOTARIZATION (IF REQUIRED BY STATE)

State of [____________]
County of [____________]

Subscribed and sworn to before me this [____] day of [________________], 20[____].

Notary Signature: ____________________________

Notary Printed Name: _______________________________

Notary Public Commission Expires: __/__/____

COURT APPROVAL BLOCK (IF APPLICABLE)

ORDER APPROVING SPECIAL NEEDS TRUST

The [STATE] [COUNTY] [COURT NAME] hereby approves this Special Needs Trust as compliant with 42 U.S.C. § 1396p(d)(4)(A) and orders that settlement proceeds in the amount of $[_____________] be deposited to the trust.

Signed this [____] day of [________________], 20[____].

___________________________
Judge or Court Representative

EXHIBIT A: INITIAL FUNDING SCHEDULE

Trust Name: Special Needs Trust for [BENEFICIARY NAME]

Trustee: [TRUSTEE NAME]

Date Established: [__/__/____]

Cash/Bank Account: Deposits to [BANK NAME], Account [_________________]

Real Property (if applicable): [Legal description and county recorder information]

Securities/Investments (if applicable): [CUSIP, description, account number]

Structured Settlement Annuity (if applicable): See Article 18

SOURCES AND REFERENCES

Federal Statutory Authority:

• 42 U.S.C. § 1396p(d)(4)(A) — First-Party Special Needs Trust Medicaid eligibility and payback requirement
• 42 U.S.C. § 1396p(d)(4)(C) — Pooled Special Needs Trust (alternative)
• 42 U.S.C. § 1382c(a)(3) — SSA disability definition for SSI purposes
• 42 U.S.C. § 416(i)(1) — SSA disability definition for SSDI purposes
• 21st Century Cures Act § 5007 (2016) — Beneficiary authority to establish self-settled SNT

Social Security Administration Resources:

• SSA POMS SI 01120.201F — Sole Benefit Rule and distribution restrictions
• SSA POMS SI 01120.203 — Beneficiary authority to establish special needs trust
• SSA POMS SI 01110.500 — Availability and excludability of trust distributions
• SSA POMS VB 02201.030 — Work incentive programs and trusts

Medicaid Resources:

• State Medicaid Agency Manual — Special Needs Trust requirements (varies by state)
• CMS-2296-U — Medicaid eligibility and special needs trusts
• Your state's Medicaid manual § [___] — [State-specific SNT provisions]

Professional References:

• Academy of Special Needs Planners — Special Needs Trust Best Practices
• Special Needs Alliance (www.specialneedsalliance.org) — Resource Center
• Your state's bar association — Special Needs Trust ethics opinions

DISCLAIMER: This template is for informational purposes only and does not constitute legal advice. The preparation and execution of a first-party special needs trust requires coordination with:

• A qualified special needs planning attorney in your state
• The Beneficiary's case manager or representative
• The state Medicaid agency
• A tax professional or CPA familiar with special needs trusts
• An independent financial advisor

Federal law (42 U.S.C. § 1396p(d)(4)(A)) and state Medicaid rules are complex and subject to change. Any error in trust preparation or funding can jeopardize the Beneficiary's eligibility for SSI, Medicaid, or other critical benefits. Consult a qualified attorney before execution.