This chapter evaluates the operation of Midwest Special Needs Trust (MSNT), an organisation created to establish and administer special needs trusts. A special needs trust is used as a fiduciary tool to serve persons with disabilities so that their assets do not affect the eligibility of means-tested social benefits. It starts with an account of the history of MSNT, and then examines the specific definitions and requirements of MSNT trust accounts, the roles and responsibilities of the Trustee and co-trustees, and the merits of MSNT. This chapter also considers important aspects of the administration of MSNT, such as the establishment and termination of trust accounts, staffing, fees and expenses, data management, and investment policy. Real-life cases are discussed throughout to show how MSNT helps to improve the quality of life of the disabled. This chapter concludes with thoughts on the future development of special needs trusts, including MSNT service enhancements and other financial tools, to assist the population with disabilities.