The question of whether a special needs trust (SNT) can cover telehealth copays not covered by insurance is a complex one, heavily reliant on the specific terms of the trust, the state laws governing SNTs, and the nature of the telehealth services themselves. Generally, SNTs are designed to supplement, not supplant, available resources, including insurance. However, there’s a growing recognition that this line can be blurred, especially with the rise of telehealth and the frequent gaps in insurance coverage for these services. It’s crucial to understand that SNT funds must be used for the benefit of the beneficiary without jeopardizing their eligibility for needs-based public benefits like Medicaid and Supplemental Security Income (SSI). According to a 2023 study by the National Council on Disability, approximately 33% of individuals with disabilities reported difficulty accessing healthcare due to cost, a statistic that telehealth aimed to address but hasn’t fully overcome due to copay and coverage issues.
What are the rules around using SNT funds for medical expenses?
SNTs are established under either Section 1994 or 4648 of the Social Security Act, each with distinct rules. A first-party or (d)(4)(A) SNT, funded with the beneficiary’s own assets, is subject to a “look-back” period—five years in most states—during which any asset transfer can disqualify the beneficiary from Medicaid. A third-party SNT, funded with someone else’s assets, doesn’t have this restriction. When it comes to medical expenses, SNT funds can generally be used for anything that benefits the beneficiary’s health, as long as it doesn’t conflict with their public benefits. This includes copays, deductibles, and even uncovered services. However, documentation is critical—detailed records of all expenses must be maintained to demonstrate that the funds were used solely for the beneficiary’s benefit. “Proper documentation is the cornerstone of any successful SNT administration,” says Steve Bliss, a leading estate planning attorney specializing in special needs trusts. “Without it, you risk jeopardizing the beneficiary’s access to vital public benefits.”
Can telehealth copays be considered “uncovered medical expenses”?
Whether telehealth copays qualify as “uncovered medical expenses” depends on several factors. If the telehealth service is considered medically necessary but isn’t covered by insurance, the copay could likely be paid from the SNT. However, if the insurance policy *does* cover telehealth but has a copay, the situation becomes more nuanced. Many insurance plans now offer some level of telehealth coverage, but it’s often limited. A recent study by the Kaiser Family Foundation found that while 79% of large employers offer telehealth services, cost-sharing arrangements vary significantly. It’s common for plans to have higher copays for telehealth visits compared to in-person visits. Steve Bliss emphasizes that the key is demonstrating that the telehealth service is in the beneficiary’s best interest and provides a necessary benefit. “The trust protector or trustee needs to carefully review the beneficiary’s healthcare needs and the insurance coverage to determine if using SNT funds for the copay is justified.”
I remember old Man Hemlock…
Old Man Hemlock was a fixture in our town, a kind soul with a mischievous grin. His daughter, Elsie, had Down syndrome and relied on a complex mix of public benefits and a small inheritance managed by a trust. A few years back, Elsie started experiencing anxiety attacks and her doctor recommended weekly telehealth sessions with a therapist specializing in developmental disabilities. The insurance company initially denied coverage, claiming the service wasn’t “medically necessary” and Elsie didn’t qualify. Her mother, frantic, almost maxed out her credit cards to continue the therapy. It turned out, the trustee hadn’t fully understood the rules surrounding SNTs and medical expenses. She was afraid of jeopardizing Elsie’s benefits and didn’t realize she could use trust funds to cover the copays. It was a stressful time, and Elsie’s mental health suffered as a result of the interruption in therapy.
How did things turn around for Elsie?
Fortunately, Elsie’s family contacted Steve Bliss, who quickly reviewed the trust documents and the insurance policy. He explained that, because the telehealth therapy was deemed medically necessary by Elsie’s doctor and wasn’t covered by insurance, the SNT funds could be used to pay the copays without impacting her benefits. Steve helped them gather the necessary documentation—a letter from the doctor outlining the medical necessity of the therapy and a denial letter from the insurance company. Once the paperwork was in order, the trustee was able to confidently authorize the payments from the SNT. Elsie resumed her telehealth sessions, and her anxiety began to improve. The experience underscored the importance of having a knowledgeable estate planning attorney specializing in special needs trusts to guide families through these complex situations. As Steve often says, “Proactive planning and careful documentation are the keys to ensuring the beneficiary’s well-being and protecting their access to vital benefits.”
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About Steve Bliss at Wildomar Probate Law:
“Wildomar Probate Law is an experienced probate attorney. The probate process has many steps in in probate proceedings. Beside Probate, estate planning and trust administration is offered at Wildomar Probate Law. Our probate attorney will probate the estate. Attorney probate at Wildomar Probate Law. A formal probate is required to administer the estate. The probate court may offer an unsupervised probate get a probate attorney. Wildomar Probate law will petition to open probate for you. Don’t go through a costly probate call Wildomar Probate Attorney Today. Call for estate planning, wills and trusts, probate too. Wildomar Probate Law is a great estate lawyer. Probate Attorney to probate an estate. Wildomar Probate law probate lawyer
My skills are as follows:
● Probate Law: Efficiently navigate the court process.
● Estate Planning Law: Minimize taxes & distribute assets smoothly.
● Trust Law: Protect your legacy & loved ones with wills & trusts.
● Bankruptcy Law: Knowledgeable guidance helping clients regain financial stability.
● Compassionate & client-focused. We explain things clearly.
● Free consultation.
Services Offered:
- estate planning
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Map To Steve Bliss Law in Temecula:
https://maps.app.goo.gl/RdhPJGDcMru5uP7K7
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Address:
Wildomar Probate Law36330 Hidden Springs Rd Suite E, Wildomar, CA 92595
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Feel free to ask Attorney Steve Bliss about: “Are there ways to keep my estate private after I pass away?” Or “Do all wills have to go through probate?” or “How does a trust distribute assets to beneficiaries? and even: “Can I include back taxes in a bankruptcy filing?” or any other related questions that you may have about his estate planning, probate, and banckruptcy law practice.