What Every Estate Planning Attorney Needs to Know About Medicaid Planning

Session 5: Pooled Special Needs Trusts (D4C Trusts)

By: Ed Biggin, CELA from Lansman Law Group & Yolanda Mazik of Shared Horizon
April 2,  2026

Ed Biggin and Yolanda Mazik delivered a practical, real-world discussion of pooled special needs trusts (PSNTs) as a critical tool in Medicaid planning—particularly for crisis or near-crisis eligibility situations. They explained how pooled trusts function as pre-established, nonprofit-managed vehicles that allow practitioners to quickly convert excess resources into non-countable assets while preserving funds for a beneficiary’s supplemental needs.

• Pooled Trust Structure: nonprofit-managed master trust with individual sub-accounts; beneficiaries join via a joinder agreement rather than drafting a new trust, allowing for rapid implementation.
• Core Eligibility Benefit: properly funded pooled trusts create a safe-harbor where assets are treated as non-countable for Medicaid eligibility purposes.
• Critical Distinction – Whose Money Is It: first-party funds (beneficiary’s own assets) require Medicaid payback or retention; third-party funds do not and are used for traditional planning.
• Sole Benefit Rule: trust assets must be used exclusively for the beneficiary; funds cannot support family members or others.
• Speed & Efficiency: emphasized as one of the fastest Medicaid planning tools—accounts can be established and funded within days, making them ideal for end-of-month eligibility planning.
• Use Cases: particularly effective for inheritances, personal injury recoveries, excess resources, and conservatorship or guardianship planning.
• Advantages Over Other Tools: no drafting required, no minimum funding thresholds, professional management, and access to pooled investment strategies for smaller accounts.
• ABLE Account Comparison: pooled trusts allow unlimited funding, while ABLE accounts are capped; the two tools can be used together strategically.
• Maryland & D.C. Distinctions: Maryland provides clear statutory authority and no transfer penalties for pooled trusts at any age; D.C. relies more on regulatory guidance and may require court approval in conservatorship contexts.
• Retirement Account Treatment: highlighted key jurisdictional difference—retirement accounts are exempt in D.C. but countable in Maryland, significantly impacting planning decisions.
• Provider Evaluation Criteria: attorneys should assess trustee structure, accounting systems, transparency of fees, audit history, investment management, and beneficiary support services.
• Operational Best Practices: strong providers offer onboarding, budgeting, beneficiary portals, debit card access, and a person-centered approach to distributions.

Their presentation emphasized that pooled special needs trusts are not merely a fallback option, but a primary and highly effective tool for achieving Medicaid eligibility while preserving assets—especially when timing, simplicity, and professional administration are critical.