How to Protect an Adult Child With a Disability in Maryland Without Guardianship

If you need to protect your adult child with a disability in Maryland without going through Circuit Court, the approach that works for most families is layering three legal tools: a Supported Decision-Making Agreement for day-to-day support, a Power of Attorney for financial transactions that require signature authority, and an Advance Directive for medical decisions. This combination preserves your child's full civil rights — including the right to vote, marry, and enter contracts — while giving you structured support and, through the POA and Advance Directive, authority in the financial and health-care areas those documents cover. Maryland's 2022 SDMA statute and the 2025 Pughsley appellate ruling have made this layered approach consistent with the state's least-restrictive-alternative framework.

The Three-Document Framework

Each document covers a different domain. Together, they close the gaps that push most families toward guardianship.

1. Supported Decision-Making Agreement (SDMA)

Under Title 18 of the Estates and Trusts Article, your child names one or more supporters who help them understand information, weigh options, and communicate decisions. The supporter helps — they don't decide. Your child keeps full legal capacity.

What it covers: attending appointments, explaining documents, helping evaluate choices, communicating decisions to third parties.

What it doesn't cover: signing documents on your child's behalf, making medical decisions, or managing money independently. That's what the next two documents handle.

The SDMA is free to create, requires two adult witnesses (who can't be named supporters or their employees or agents), and can be revoked at any time orally, in writing, or by another act expressing the adult's specific intent to revoke. No court filing, no clinical assessment, no attorney required.

2. Power of Attorney (POA)

Under Title 17 of the Estates and Trusts Article, a durable POA gives your child's designated agent the legal authority to handle financial transactions: banking, bill payment, insurance claims, government benefits applications, and property management.

The key word is durable — under Maryland law, a written POA is presumed durable unless its terms provide otherwise, so the agent's authority can continue even if your child later becomes incapacitated.

Your child must have sufficient capacity to understand the document's purpose, the powers granted, and the affected property.

3. Advance Directive

Under Title 5, Subtitle 6 of the Health-General Article, an Advance Directive designates a healthcare agent who can make medical decisions when the attending physician and a second independent physician certify that your child is incapable of making an informed health-care decision; a second physician is not required if your child is unconscious. It also documents your child's preferences for end-of-life care, organ donation, and specific medical interventions.

This is the document that addresses the fear every parent carries: being locked out of the emergency room, unable to access medical records or authorize treatment, because your child turned 18 and you have no legal standing.

A properly executed Advance Directive, paired with a HIPAA authorization, gives you both decision-making authority and records access. No court required.

Why This Works Better Than Guardianship for Most Families

A guardianship can transfer specified decision-making powers to a court-appointed guardian; a full guardianship can significantly restrict the adult's rights. The three-document framework can provide practical support and authority in the areas covered by the documents without that rights restriction.

The practical difference matters most in how your child experiences adult life. Under guardianship, a 19-year-old may need guardian involvement for decisions within the guardian's authority, while a limited order can preserve other decision-making rights. Under the three-document framework, your child retains the freedom to handle what they can handle while having documented support for what they cannot.

The Pieces People Forget

HIPAA Authorization

An Advance Directive gives your healthcare agent decision-making authority, but HIPAA privacy rules separately control access to medical records. Your child should sign a HIPAA authorization form naming you (and any other relevant family members) as authorized recipients of their health information. Most hospitals and clinics provide their own HIPAA release forms.

Representative Payee (for SSI Recipients)

If your child receives Supplemental Security Income, the Social Security Administration does not recognize a Power of Attorney or even a court-appointed guardian as automatically authorized to manage benefits. The SSA has its own Representative Payee program with its own application process and investigation. Apply through SSA directly — the POA won't substitute.

DDA and DORS Service Agreements

If your child accesses services through the Maryland Developmental Disabilities Administration or the Division of Rehabilitation Services, those agencies require their own authorization forms. An SDMA supporter can help your child understand and sign service agreements, but the agencies need their own documentation on file.

Banking Institutional Pushback

Some banks are unfamiliar with Maryland's SDMA statute and may initially refuse to recognize it. Title 18 includes third-party liability protection — institutions that rely on a valid SDMA are shielded from legal liability. Having the statute citation ready (Estates and Trusts Article, Title 18) and presenting a properly executed agreement resolves most disputes. If a bank still refuses, escalate to their compliance department or file a complaint with Maryland's Commissioner of Financial Regulation.

Who This Is For

• Parents whose child is turning 18 and who want to maintain practical authority without removing their child's civil rights
• Families whose child can participate in decision-making with support — even if that participation is limited to expressing preferences about who they trust
• Parents who've been told "you need guardianship" by a doctor, school, or bank and want to verify whether that's actually true under current Maryland law
• Families already navigating guardianship who want to explore whether the 2022 SDMA statute opens a less restrictive path

Who This Is NOT For

• Parents whose child genuinely cannot participate in any decision-making, even with support — if your child cannot understand or communicate preferences about who should help them, the SDMA's foundational requirement isn't met, and guardianship may be necessary
• Families facing immediate safety threats (financial exploitation, medical neglect, unsafe living conditions) where emergency court intervention is needed right now
• Parents whose child is under 18 — these documents are executed by adults; plan and prepare, but you can't sign until your child's 18th birthday

The Education Exception Most Families Don't Know About

One of the most common reasons parents seek guardianship is to maintain authority over IEP decisions after their child turns 18. In Maryland, this concern is unnecessary.

Under Education Article § 8-412.1, parents retain educational decision-making rights even after the student turns 18. If the student has not been adjudged incompetent under state law, rights transfer only when there is documentation of a statutory condition, including parental unavailability or unknown status with the student's request, a year of nonparticipation after repeated school attempts, written rejection, specified prolonged illness or extraordinary circumstances with parental consent, or the student living outside the parental home without another public agency's care. In all other cases, you remain the educational decision-maker through graduation or exit, generally until the end of the school year in which your child turns 21.

If a school administrator tells you that you need guardianship to attend IEP meetings after your child turns 18, they are misinformed. The statute citation above is the correction.

Getting Started

The execution order matters. Start with the SDMA — it's the simplest to create and establishes the support relationship. Then execute the POA and Advance Directive, ideally on the same day. Finally, handle the ancillary authorizations (HIPAA, Representative Payee application, agency-specific forms).

The Maryland Adult Guardianship & Alternatives Guide walks through the execution requirements for each document, including the witness rules, capacity thresholds, and the statutory requirements and third-party reliance protections that apply to them.

Frequently Asked Questions

What if my child can't sign their name?

Each document has its own execution requirements: an SDMA requires signatures witnessed by two adults, a POA requires notarization and two adult witnesses, and an Advance Directive requires two adult witnesses. If your child cannot sign in the usual way, confirm an alternative method for that specific document before signing.

Can my child revoke these documents?

Yes. The adult may revoke an SDMA at any time orally, in writing, or by another act showing specific intent to revoke. POAs and Advance Directives have their own revocation requirements, so follow the document and applicable Maryland law.

What if we try this approach and it doesn't work?

The three-document framework doesn't prevent you from pursuing guardianship later. In fact, documenting why less restrictive alternatives were insufficient strengthens a guardianship petition — Circuit Court judges want evidence that you explored other options first. If the SDMA, POA, and Advance Directive prove insufficient, you'll have documented evidence for your petition.

Does this approach work for managing my child's SSI benefits?

Not directly. The Social Security Administration requires its own Representative Payee arrangement to manage SSI benefits — neither a POA nor guardianship automatically qualifies you. However, the POA covers non-SSI financial management (banking, bills, insurance), and the SDMA supports your child in understanding their benefits and making informed decisions about spending.

How do I handle the age-18 SSI redetermination?

The SSI redetermination evaluates your child's eligibility under adult disability standards. You can support your child through this process as their SDMA supporter and handle the paperwork through the Representative Payee arrangement. The Maryland Guardianship & Alternatives Guide covers the redetermination timeline, what to expect, and how to prepare documentation.

See more Maryland guides →