This case study originally appeared in the True Link Financial whitepaper: Trends and Innovationsin the PSNT World.

While many Pooled Special Needs Trusts (PSNTs) focus strictly on providing trust administration services, for some PSNTs, providing case management services to their beneficiaries is a critical part of their strategy. The model for offering these services, however, varies significantly from organization to organization. For the PSNTs that do offer case management, on one end of the spectrum are those that lean on external resources on an as-needed basis; on the other end are those that hire full-time staff to provide case management to everyone they serve. 

Assigning a case manager to every beneficiary

The Colorado Fund for People with Disabilities (“CFPD”) is an example of a PSNT that’s developed an effective approach to providing case management services to all its beneficiaries with a team of full-time case managers on staff.

“Case management is deeply embedded in the work we do and has been from Day 1. At CFPD, we believe these services are essential for people with disabilities who have unique needs, particularly related to government benefits,” shared CFPD’s Executive Director Megan Brand, who started as a case manager at the organization.  

When a trust is funded, each beneficiary is assigned a case manager. They review the beneficiary’s profile and set up a meeting with that individual and anyone else the beneficiary wants to include in the conversation. During this meeting, several important topics are discussed, including:

• Current living situation 
• Medical needs and accessibility concerns
• How the beneficiary’s disability impacts their life
• Educational background and vocational experience
• Passions, hobbies, and other recreational interests 

In some cases, the case manager might work with the beneficiary to create a budget and discuss what the trust will cover, what the individual will pay for, etc. As Brand shared, “This way, we can refer back to this document later on and explain, ‘Your new request doesn’t align with what we talked through together; if we do approve this request, we won’t be able to purchase these others things you wanted.’” 

After this first required visit**, case management is offered on an as-needed basis. CFPD’s goal is to keep each beneficiary assigned to the same case manager to help establish a strong relationship and make it easier to detect changes in behavior or other red flags. 

“Beneficiaries can often be victims of exploitation, so visiting the home and getting to know the beneficiary really helps us identify concerning situations,” Brand said. “We had one beneficiary Aaron* (name changed) who started submitting large Costco receipts at the same time we saw his utility bills skyrocket. His case manager made a visit to the home and discovered a life-threatening situation.”

Upon arriving at Aaron's home, the case manager discovered seven other people living in the house along with a variety of illegal drugs. To make matters worse, the house had been dangerously rewired to accommodate these individuals, and one person was living in the garage with multiple space heaters. “There were several fire hazards in the home, and it was clear to our case manager that this was not a safe or healthy place for Aaron to stay,” Brand detailed. “We were able to get him out of this situation and put additional safeguards in place to help protect Aaron from being exploited again.” 

One of the major responsibilities of the case managers is to help identify and apply for public benefits for which their beneficiaries may be eligible. “Taking advantage of available benefits programs helps put less pressure on the trust to fund everything,” explained Brand. Case managers may also coordinate in-home service providers, make larger purchases, or assist in moving from one home to another. 

A unique aspect of this case management program is that individuals are not required to have a trust with CFPD to take advantage of this service. A family member trustee can contract with CFPD on a fee-for-service basis to act as another set of eyes and ears for their loved one. The PSNT also advises other trust companies or non-professional trustees, helping them with anything from conducting a short-term benefits analysis to acting as an administrative trustee and taking on disbursement management. Offering these services a la carte benefits CFPD too. After families experience CFPD’s quality of care, they often name CFPD as successor trustee, or they may even decide to make CFPD trustee. 

How CFPD makes it work

Running an in-house team to handle case management for all beneficiaries is no small feat, but CFPD has honed its approach to make it happen in a sustainable way. 

It all starts with how beneficiaries are assigned to case managers. Each manager has a caseload of 100 to 120 individuals. Some beneficiaries never make a request of their managers, some reach out occasionally for help with specific tasks, and some require more frequent support. “Based on a beneficiary’s profile and initial assessment, we can typically assess how challenging or complex their needs may be,” said Brand. “We try to spread these complex cases out, so the workload is as even as possible across our team.” 

CFPD’s team is mostly full-time and based in Denver with some contractors in places like Fort Collins and Colorado Springs. Because much of Colorado’s population is located in the greater Denver metropolitan area, full-time team members can travel to beneficiaries’ homes (when it is safe to do so). Brand notes that hiring in-house case managers can be challenging because “case managers with trust experience are nearly impossible to find.” She recommends looking for people with strong attention to detail, a desire to work with numbers, and experience working with people with Intellectual/Developmental disabilities or mental health challenges. “You can train people on the trust part of the job,” Brand said. 

Sustainably funding its case management services is also critical to the success of its program. CFPD covers these costs in a few ways:

1. All private case management services (for those not invested in a CFPD trust) are funded entirely by CFPD’s fee schedule.
2. CFPD charges each pooled trust beneficiary to cover what they view as essential services. Included in this trust fee is one hour of case management per month; if the case manager provides services above this, a low hourly fee may be charged.
3. CFPD retains 100% of any remainder funds, which are used to support the organization’s Representative Payee and PSNT programs, including the case management in the pooled trust.   

This unique composition of funding sources may seem like more trouble than it’s worth, but if you ask CFPD, it’s all worth it. As Brand emphasized, “Case management is core to what we do and has such a clear impact on the lives of our beneficiaries. We’re proud to be able to offer this service to everyone who chooses to work with us.”

**Before COVID, CFPD preferred to have these meetings in the beneficiary’s home.