Families in Dallas County raising a child with a disability face a planning problem with two common answers that are not interchangeable. An ABLE account and a special needs trust both hold money for a person with a disability without costing that person Supplemental Security Income and Medicaid. They operate under different bodies of law, carry different ceilings, and end very differently when the beneficiary dies.
The federal Medicaid statute is what makes a special needs trust work. Under 42 U.S.C. § 1396p(d)(4)(A), a trust holding the assets of an individual under age 65 who is disabled is treated differently from an ordinary trust, provided it was established for that individual’s benefit by a permitted person and the State is repaid at the beneficiary’s death, up to what Medicaid spent, from whatever remains. An ABLE account comes from the tax code instead, at 26 U.S.C. § 529A, and its constraints are dollar constraints rather than structural ones.



























