SPECIAL NEEDS PLANNING CHECKLIST
Special Needs Planning for Today and Tomorrow
Special needs planning can be easier if you start with a checklist (Check the end of the document for a link to download this as a PDF).
Diagnoses and Dates:
Doctors, Other Care Providers and Case Manager:
Current Government Benefits:
Past Government Benefits:
Government Benefits Waiting Lists:
Representative Payee, if any:
Guardian (Conservator) of Your Money, if any:
Guardian of Your Person, if any:
Modified Adjusted Gross Income:
Are prescription drug costs being met?
Is Medicaid providing non-medical or quasi-medical services such as cognitive behavioral therapy, long term care, home health care services educational support services, institutional care, group home support services or services provided under Medicaid waivers?
Does the Medicaid formulary cover the necessary drugs and treatments?
How much money is Medicaid spending on care?
Is there an Affordable Care Act policy which will cover current and anticipated needs?
How does the Medicaid payback provision apply?
Does the quality and availability of health care where you live/travel/plan to move vary significantly between Medicaid and private health insurance?
Education (School? 504? IEP?):
Hobbies and Interests:
Work History, if any:
Training, Support and Employment:
Preferred Living Arrangements:
What Supported Housing or Assistance is Desired?
What Assistance is Needed with
Manipulating Objectives (wheelchair, computer, doors, telephone, etc.):
Bathing and Dressing:
Nutrition or Medication Management:
Life Insurance Policy:
Own Health and Disability Insurance Policies:
Parents’ Health and Disability Insurance Policies:
Your Long-Term Care Insurance or Other Arrangements for Later in Life:
Parents’ Health and Disability Insurance:
Parents’ Long-Term Care Insurance or Other Arrangements for Later in Life:
How Much Equity in Your Home, if any:
How Much Equity in Your Parents’ Home, if any:
What Retirement Funds? 401(k)____ Traditional IRA_____ Roth IRA_____
Your Parents’ Retirement Funds? 401(k)_____ Trad’l IRA_____ Roth IRA_____
Are You a Veteran?_____ If so, What Branch?_____ Dates?_____
Is Either of Your Parents a Veteran? If so, Who?
What Branch? Dates?
Are Your or Either of Your Parents a Federal, State or Local Government Employee? If so, Who?
Which? Years of Service?
What are Your Parents’ Social Security Retirement Benefit Amounts?
Is a Parent Disabled, Retired or Deceased?
Any Other Source of Funds?
Do You Have a Funeral or Burial Insurance Policy?
If so, What is the Amount?
People Who Currently Assist You, Their Relationships, Ages and Contact
Information [Please include any social worker, accountant or financial planner]:
Current Medical Concerns:
Current Social Concerns:
Current Emotional Concerns:
Possible Needs for Future Assistance:
Please Describe Your Current Day-to-Day Life:
What Are Your Goals for the Future?
What Would Be the Best Life for You?
Who Are You Closest To?
Is There Anything Else You Would Like Others to Know?
Document Checklist [please write “have” or “want” or “do not need”]:
Special Education Power of Attorney:
Supported Decision Making Agreement:
Family Caregiver Agreement:
Application to Serve as Social Security Representative Payee:
Application for Guardian of the Estate [money]:
Application for Guardian of the Person:
Special Needs Trust:
Family Trust with Special Needs Sub-trust:
Directions Correctly Naming Beneficiaries Named on Insurance Policies, Bank or Brokerage or Retirement Accounts:
HIPAA Medical Release Forms for You:_____Parents:_____
Medical Power of Attorney for You:_____ Parents:____
Attached Letter with wishes for You:_____ Parents:____
Mental Health Directive for You:_____ Parents:____
Financial Powers of Attorney for You:_____ Parents:____
Declaration of Guardian in Case of Need for You:_____ Parents:____
Last Will and Testament for You:_____ Parents:____