A supplemental needs trust designed to benefit a person with a disability without disqualifying them from Medicaid, SSI, or other means-tested public benefits. Covers both third-party and self-settled (d)(4)(A) variants.
The Special Needs Trust Agreement is a ready-to-use legal & compliance template you can send for signature in minutes. It is written for 2 signers (grantor and trustee) and, by default, expires 30 days after it is sent if left unsigned. It covers trust, special needs, disability, medicaid. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Special Needs Trust Agreement This Special Needs Trust Agreement ("Agreement") is entered into as of the date last signed below, by and between: **Grantor:** ___________, residing at ___________ ("Grantor"); and **Trustee:** ___________, residing at ___________ ("Trustee"). --- ## Article I — Name, Type, and Purpose 1.1 **Trust Name.** This trust shall be known as the ___________ ("Trust"). 1.2 **Trust Type.** This Trust is established as a: ___________ 1.3 **Beneficiary.** The primary beneficiary of this Trust is: **Name:** ___________ **Date of Birth:** ___________ **Disability Description:** ___________ (Describe the nature of the disability, diagnosis if known, and the public benefit programs upon which the beneficiary currently relies or may in the future rely, including Medicaid, Supplemental Security Income (SSI), Section 8 housing assistance, vocational rehabilitation, or other means-tested programs.) 1.4 **Purpose — Supplemental Needs.** The sole purpose of this Trust is to supplement, not supplant, public benefits available to the beneficiary. All distributions from this Trust shall be used exclusively for goods, services, and opportunities that are not available from any governmental or public benefit source, and that improve the beneficiary's quality of life, independence, and well-being. Nothing in this Trust shall be construed to make the Trust Estate available to any public agency or to otherwise disqualify the beneficiary from receiving public benefits to which the beneficiary is entitled. 1.5 **Governing Law.** This Trust shall be governed by the laws of the State of ___________, without regard to conflict-of-law principles. --- ## Article II — Trust Estate 2.1 **Initial Funding.** The Grantor hereby transfers, assigns, and conveys to the Trustee the following property to be held in trust pursuant to this Agreement (the "Trust Estate"): ___________