BTHE BARATELLI INSTITUTE · Mentoring at Scale
FOR FAMILIES FACING A MAJOR PEDIATRIC MEDICAL CONDITION

The estate work the diagnosis triggers — and the questions no one warns you about.

Guardianship if something happens to both parents. A Special Needs Trust if lifetime support is needed (and which one — first-party self-settled or third-party gift). An ABLE account if the diagnosis came before age 26. Term life insurance that should never lapse. Beneficiary designations that need to route around the child to avoid disqualifying public benefits. This tool maps the four to seven structures the family probably needs and the dollar-magnitude on each.

Vehicles
Recommended
Magnitude
Dollar guidance
Action list
90-day priorities
No advice
Honest scoping
YOUR PLAN
1
Child & diagnosis
2
Family financial
3
Current docs
4
Insurance picture
5
Vehicles & checklist
STAGE 1 OF 5

Child and diagnosis

Defaults reflect a 9-year-old child with a moderate-severity diagnosis requiring lifetime support but not full incapacity. The tool's logic adjusts to the diagnosis category and the expected support trajectory.

Age now. Drives ABLE eligibility (onset before 26 required), guardianship trigger age (18 in most states), and life-expectancy planning.
Broad category. Specifics matter for benefits eligibility but the planning logic divides into these buckets.
Realistic care-team assessment. Drives whether SNT planning is essential vs precautionary.
CRITICAL for ABLE eligibility. ABLE accounts (529A) require disability onset before age 26 (raising to 46 starting 2026 under ABLE Age Adjustment Act).
Drives guardianship law, SNT statutory framework, and ABLE state-plan choice (you can use any state's ABLE).
Read before you start. This tool is a triage. It tells you which structures the family probably needs and the dollar magnitudes to plan around. It does NOT replace an estate-planning attorney with disability/special-needs expertise. Most families need 3-7 working sessions with counsel over 4-6 months. Best output of this tool: walk into the attorney meeting knowing what to ask, what costs roughly, and what the priority order is.
STAGE 2 OF 5

Family financial picture

Net-worth thresholds change which SNT structure is right and whether life insurance is term or permanent.

Liquid + investment assets. Drives SNT funding logic and whether estate-tax planning enters the conversation (federal threshold $13.99M/individual 2026; sunsets 2026).
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Tracked separately. Some states protect homestead from Medicaid recovery; others don't.
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Drives life-insurance need calculation and supports the income-replacement framing for SNT trust funding.
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Siblings affect SNT structuring (3rd-party trust often funded through siblings' inheritance) and life-insurance need.
Critical for SNT planning. A grandparent leaving money directly to the child can disqualify benefits unless routed through a 3rd-party SNT.
$
If there's a malpractice settlement, accident settlement, or assets titled to the child — first-party (self-settled) SNT may be required to preserve benefits eligibility.
$
STAGE 3 OF 5

Current estate documents

What's already in place and what needs to be updated. Pediatric diagnosis is the single most common trigger for estate-document overhaul.

Probate-avoidance + privacy. In states with cumbersome probate (FL, CA) often a default. Not the same as Special Needs Trust.
529A account. Up to $19,000/year in contributions (2026 cap). Onset of disability before 26 required (raising to 46 in 2026).
Both parents should have current durable POA + healthcare proxy. Critical if one parent is the primary caregiver and the other becomes incapacitated.
STAGE 4 OF 5

Insurance and beneficiary picture

Life insurance is the funding mechanism for the SNT. A lapsed term policy on the wrong parent destroys the plan. Beneficiary designations on retirement accounts override the will.

Term is much cheaper per dollar of coverage. For SNT funding, the typical guideline is 10-15x household income.
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Both parents should have coverage. The non-earning or lower-earning parent is often dramatically under-insured.
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For a disabled-child plan, permanent insurance has a real use case: it never expires. The trade-off is much higher premium per dollar of face value. Avoid lapse at all costs.
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If the current term expires in less than 20 years and the child needs lifetime support, plan for either a level-conversion or a new permanent layer.
Long-term disability covering the earning parent is part of the SNT funding plan. Group LTD typically covers 60% of pay; private supplement to 70-80% is common in families with a disabled child.
CRITICAL. Beneficiary designations on 401(k), IRA, life insurance override the will. A direct designation to a disabled child wipes out benefits eligibility. Should route to the 3rd-party SNT instead.
STAGE 5 OF 5

Recommended vehicles & 90-day action checklist

The structures, the magnitudes, and the order to take them.

WANT THE METHODOLOGY BEHIND THIS TOOL?
Read more in the Estate Planning Decoded.
The tool gives you the answer. The guide gives you the argument — the case law, the worked examples, the negotiation playbook, the cross-check tables, the exception cases.
The methodology behind this calculator is in Special needs of the reference guide.
Read more in the Estate Planning Decoded → Browse all 22 guides
Educational references and tools — not legal, tax, accounting, or investment advice, and not a recommendation to buy or sell any security. Consult a qualified professional about your specific situation. © 2026 The Baratelli Institute.