‘‘(E) Except as provided in paragraph (4) 
or (5) of subsection (c), in the case that the 
designated beneficiary dies or ceases to be an 
individual with a disability, all amounts remain-
ing in the trust not in excess of the amount 
equal to the total medical assistance paid for 
the designated beneficiary after the establish-
ment of the trust under any State Medicaid 
plan established under title XIX of the Social 
Security Act shall be distributed to such State. 
‘‘(2) QUALIFIED DISABILITY EXPENSES.— 
‘‘(A) IN
GENERAL.—The term ‘qualified 
disability 
expenses’ 
means 
any 
expenses 
which— 
‘‘(i) are made for the benefit of an in-
dividual with a disability who is a des-
ignated beneficiary of the trust, and 
‘‘(ii) approved under regulations es-
tablished by the Secretary. 
‘‘(B) EXPENSES
INCLUDED.—The fol-
lowing expenses shall, to the extent provided 
under regulations established by the Secretary, 
be qualified disability expenses if made for the 
benefit of an individual with a disability who is 
a designated beneficiary of the trust: 
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‘‘(i) EDUCATION.—Expenses for edu-
cation, including tuition for preschool thru 
post-secondary education, books, supplies, 
and educational materials related to such 
education, tutors, and special education 
services. 
‘‘(ii) HOUSING.—Expenses for hous-
ing, including rent, mortgage payments, 
home improvements and modifications, 
maintenance and repairs, real property 
taxes, and utility charges. 
‘‘(iii) 
TRANSPORTATION.—Expenses 
for transportation, including the use of 
mass transit, the purchase or modification 
of vehicles, and moving expenses. 
‘‘(iv) EMPLOYMENT
SUPPORT.—Ex-
penses related to obtaining and maintain-
ing 
employment, 
including 
job-related 
training, assistive technology, and personal 
assistance supports. 
‘‘(v) 
HEALTH, 
PREVENTION, 
AND 
WELLNESS.—Expenses for the health and 
wellness, including premiums for health in-
surance, medical, vision, and dental ex-
penses, habilitation and rehabilitation serv-
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ices, durable medical equipment, therapy, 
respite care, long term services and sup-
ports, and nutritional management. 
‘‘(vi) LIFE
NECESSITIES.—Expenses 
for life necessities, including clothing, ac-
tivities which are religious, cultural, or rec-
reational, supplies and equipment for per-
sonal care, community-based supports, 
communication services and devices, adapt-
ive equipment, assistive technology, per-
sonal assistance supports, financial man-
agement and administrative services, ex-
penses for oversight, monitoring, or advo-
cacy, funeral and burial expenses. 
‘‘(vii) 
OTHER
APPROVED
EX-
PENSES.—Any other expenses which are 
approved by the Secretary under regula-
tions and consistent with the purposes of 
this section. 
‘‘(viii) ASSISTIVE
TECHNOLOGY
AND 
PERSONAL SUPPORT SERVICES.—Expenses 
for assistive technology and personal sup-
port with respect to any item described in 
clauses (i) through (vii). 
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‘‘(3) INDIVIDUAL WITH A DISABILITY.—An in-
dividual is an individual with a disability if such in-
dividual— 
‘‘(A) would be eligible to receive supple-
mental security income benefits due to blind-
ness or disability under title XVI of the Social 
Security Act, or disability benefits under Title 
II of the Social Security Act, notwithstanding— 
‘‘(i) the income and assets tests and 
substantial gainful activity test required 
for eligibility for such benefits, and 
‘‘(ii) whether a determination has 
been made that such individual is blind or 
disabled, or 
‘‘(B) is eligible to receive or is deemed to 
be receiving supplemental security income bene-
fits due to blindness or disability under title 
XVI of the Social Security Act, or disability 
benefits under title II of the Social Security 
Act. 
‘‘(4) RULES RELATING TO ESTATE AND GIFT 
TAX.—Rules similar to the rules of paragraphs (2), 
(4), and (5) of section 529(c) shall apply for pur-
poses of this section. 
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