Nurse Case Management for Children with Cerebral Palsy

Many times, children with cerebral palsy receive nurse case management either through a public agency serving individuals with developmental disabilities, an insurance company or health maintenance organization, or voluntary agencies in the community. Other children receive case management services through a Special Needs Trust (SNT). A SNT is a legal arrangement that preserves the child's eligibility for government benefits, while setting aside assets that will meet his or her supplemental needs.

A SNT is often established to maintain the child's eligibility for both Medicaid (a federal program that pays for medical care for the child) and Supplemental Security Income (SSI, a federal program that pays cash benefits to cover the costs of food, shelter, and clothing). Parents, grandparents, or legal guardians may contribute money to a SNT during their lifetime to provide assets for the child's future. Trust funds may also come from probate distributions, a living trust, life insurance, pension plans, or other identified sources.

In some cases, SNT funds come from tort claim awards and settlements that arise from a lawsuit over medical malpractice, involving the mother's prenatal care, birth-related injuries, or early childhood diseases such as meningitis. Tort claim awards and settlements may be paid by the responsible party in lump sum payments, a structured settlement that provides for periodic payments that may be funded by an annuity, or a combination of lump sum and periodic payments. It's important for nurse case managers to have a general idea of the payment structure, and the funds available, in order to make realistic recommendations for expenditures from the Special Needs Trust.

The SNT is designed to meet the supplemental needs of an individual with special needs. Supplemental needs are the person's needs that are not met by Medicaid, SSI, and other government benefits. Some examples of these expenditures include the following:

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The SNT can be used to pay for recreational activities for a child with CP.

Nurses who are familiar with SNT law can serve as valuable resources to the family, identifying and writing justifications for expenditures of SNT funds in a manner that maximizes the child's overall health, well-being, and development.