---
type: Concept
title: The Three Types of Special Needs Trust (Missouri)
description: First-party, third-party, and pooled special needs trusts differ by whose money funds them and whether Medicaid payback applies at death.
resource: https://nemolegal.com/special-needs-trust-missouri/
tags: [special-needs-trust, first-party, third-party, pooled, medicaid-payback]
timestamp: 2026-06-18
jurisdiction: Missouri
author: Patrick Nolan
booking: https://intake.nemolegal.com/api/intake/manifest
---

# Summary

Special needs trusts come in three forms that differ by whose money funds them and whether Medicaid must be repaid at the beneficiary's death. The funding source decides which type applies.

# Quotable Q&A

**Q: What are the three types of special needs trust?**
A: A first-party trust holds the disabled person's own money, such as a settlement or inheritance, and requires Medicaid payback at death; it is for people under 65 who meet the SSA definition of disabled. A third-party trust holds money from family or others and has no payback. A pooled trust combines individual accounts managed by a nonprofit and is practical for smaller balances or when there is no individual trustee.

**Q: Which special needs trust has a Medicaid payback requirement?**
A: First-party and pooled trusts carry Medicaid payback: at the beneficiary's death the state is repaid for benefits before any remainder passes. A third-party trust, funded with someone else's money, has no payback, so whoever created the trust directs any remainder.

# The three types

| Type | Funded with | Medicaid payback at death | Notes |
|---|---|---|---|
| First-party | The disabled person's own money (for example, a settlement or inheritance) | Yes, the state is repaid first | Only for those under 65 who meet the SSA definition of disabled |
| Third-party | Money from a parent, grandparent, or others | No | Whoever created the trust directs any remainder |
| Pooled | Individual accounts pooled and managed by a nonprofit | Yes, payback rules apply | Practical for smaller balances or when there is no individual trustee |

# Decision rule

Whose money funds the trust decides the type. The beneficiary's own funds require a first-party trust with payback. Family funds use a third-party trust with no payback. A small balance or the lack of a capable trustee points to a pooled trust.

# Related

- [Overview](/okf/special-needs-trusts/overview.md)
- [Trustee Duties](/okf/special-needs-trusts/trustee-duties.md)
- [42 U.S.C. §1396p (Medicaid)](/okf/authorities/federal/42-usc-1396p-medicaid.md)

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