What Does The "BBB" Mean For Special Needs Planning?
- Brian Cotroneo
- Jul 21
- 3 min read
For the last few months as the “Big Beautiful Bill” has made its way through Congress, members of the Special Needs Community have waited with baited breath to see what, if any, changes would be made to benefit support programs. Now that the bill has become law, we can see the true impact - $1 Trillion in cuts over ten years, as well as changes to the eligibility requirements that make getting and keeping Medicaid more difficult.[i]
We don’t take a political view – we leave that to the pundits – but as Special Needs Planners we have to concern ourselves with the result of these policy changes on our clients and community. What follows are our thoughts and recommendations in the wake of the BBB’s passage.
Who Will Be Impacted?
The short answer to this question is “we don’t know,” and neither does anyone else. The text of the bill (all 330 pages of it) doesn’t specify. The best guesses so far suggest services that states are not required to provide – things like home and community-based services – are the most likely to suffer. These services are often a lifeline to individuals with disabilities, assisting with the functions of daily life (eating, dressing, mobility) they are unable to perform themselves. More importantly they are used by some families as the foundation of long-term special needs care planning.[ii]
Obtaining Medicaid Coverage Will Become Harder
A large part of the change to Medicaid services are the changes to eligibility requirements, specifically related to an individual’s ability to work. While we have no information to suggest that the standards of work eligibility will be changing, the mere requirement for additional screening will result in longer wait times and additional scrutiny of Medicaid applicants.
Maintaining Eligibility Will Be More Difficult
Similar to the above, the BBB instructs states to increase the frequency of work eligibility screening for current Medicaid recipients. This requirement will further stress an already overburdened Agency for Health Care Administration (the government agency running Medicaid) and can result in improper “disenrollments” – similar to the horror stories of seniors being removed from Social Security due to administrative errors. At the very least the AHCA is being asked to do more with fewer resources, which is rarely a recipe for success.
Existing Special Needs Plans Will Need Adjustment
As dedicated special needs planners, we’ve seen countless families make the decision to rely on Medicaid to support their loved one with a disability. It is time to reevaluate that decision. As we mentioned above – we don’t know who will be affected by the changes or to what degree, but someone will be. Continuing to make Medicaid support a cornerstone of lifetime financial support might not be feasible going forward, especially for individuals whose disabilities are not as pronounced or limiting. You should consider the options available to provide supplemental support as quickly as possible.
New Special Needs Plans Will Be Different
Individuals who have yet to start the special needs planning process – especially those not already enrolled in Medicaid – are likely to find themselves in unknown territory. We can’t continue with the traditional assumption that “Medicaid will provide a foundation” because the rules have changed; instead, we’ll have to start somewhere else. Lifetime income planning, estate bequests, and supplemental trusts are poised to go from supporting actors to star of the show under this new policy.
Professional Trustees & Benefit Managers Are Now Crucial
Most special needs trusts are written with family (parents & siblings) acting as trustees, and without any implicit provision for hiring a benefit manager. That should be changing. While family undoubtedly has the best interest of the special needs individual in mind, they are likely to be overwhelmed with the complicated and shifting eligibility requirements. Hiring a team of individuals to manage these concerns – especially once parents have passed – is crucially important.
While its hard to find a silver lining the BBB passage, its important to realize you aren’t alone trying to navigate the future. For all the issues raised above, there is a planning solution or referral available. For more information on creating or revising a special needs plan please reach out to jcg@moorscabot.com. Put “Special Needs Planning” in the title and we’ll make sure you are contacted by our Chartered Special Needs Consultant (ChSNC) to get the conversation started.
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