Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 103 - Resources › Chapter 5 - Trust Provisions › Rule 23-103-5.17 - Income Trusts

Current through June 25, 2024
A. The purpose of
				an Income Trust is to allow an individual with excess income who has exhausted
				all available resources to become eligible for Medicaid. The trust may be used
				only for income belonging to the individual. No resources (assets) may be used
				to establish or augment the trust. Inclusion of resources voids the trust
				exception. It is intended to assist individuals with excess recurring monthly
				income who have income that exceeds the Medicaid institutional limit in effect
				at the time eligibility is requested but have insufficient income to pay the
				private cost of institutional care. Individuals with income above the private
				pay rate for the facility in which the individual resides will not be eligible
				for Medicaid under the Income Trust provision.
B. This type of trust established for the
				benefit of the individual is limited to institutionalized individuals, not
				those in an acute care hospital setting. Persons participating in the home and
				community-based services (HCBS) waiver may also utilize an Income Trust for
				eligibility purposes.
C. An Income
				Trust must meet all the following requirements:
1. The trust is composed only of the
				pension(s), Social Security, and other income due the individual from all
				sources, including accumulated interest in the trust. Total income does not
				include income that is not countable under Medicaid rules, such as payments
				from the Veterans' Administration for Aid and Attendance (A&A) and payments
				for unreimbursed medical expenses.
2. Income Trusts, once accepted by the
				Division of Medicaid, cannot be modified without the Division of Medicaid's
				approval. An Income Trust must specify that the trust will terminate at the
				individual's death, when Medicaid eligibility is terminated, when the trust is
				no longer necessary or in the event the trust is otherwise terminated. Trusts
				may need to be terminated prior to an individual's death due to changes in the
				individual's income or changes in Medicaid policy regarding how certain income
				must be counted or in the event the individual is discharged from the nursing
				facility.
3. A portion of the
				individual's income may be protected in the month of entry into a nursing
				facility. When income protection is applicable, there is no cost of care
				payable to the nursing facility for beneficiaries whose income is less than the
				institutional income limit. However, income above the amount that is one dollar
				($1.00) less than the Medicaid institutional limit is payable to the Division
				of Medicaid for beneficiaries eligible under an Income Trust within thirty (30)
				days after receipt of the notice approving eligibility issued by the Division
				of Medicaid. The approval notice informs the Trustee of the amount payable for
				the month of entry.
4. For all
				subsequent month(s), if income of the individual is less than the individual's
				cost of care at the nursing facility, all income of the individual, less
				authorized deductions, must be paid directly to the nursing facility. In that
				case no funds will be retained in the trust. If the income of the individual
				exceeds the cost of care at the nursing facility in any month the individual is
				eligible under an Income Trust, the trust must retain the income in excess of
				the cost of care until such time that payment of the accumulated Income Trust
				fund is requested by the Division of Medicaid.
5. Income Trusts for HCBS Waiver enrollees
				require that the trust must distribute to the individual, or for his/her
				benefit, an amount equal to not more than one dollar ($1.00) less than the then
				current Medicaid income limit as approved by the Division of Medicaid. The
				trust should not specify the amount of the individual's income as this amount
				may change each year and the amount to be released from the trust will change
				to an amount equal to one dollar ($1.00) less than the current Medicaid income
				limit.
6. At the dissolution or
				termination of an Income Trust, the death of the individual, loss of the
				individual's Medicaid eligibility or in the event that the individual's income
				no longer exceeds the current Medicaid income limits, the trust agreement must
				provide that all amounts remaining in the trust up to an amount equal to the
				total medical assistance paid by the Division of Medicaid on behalf of the
				individual that has not previously been repaid will be paid to the Division of
				Medicaid.
7. The trust agreement
				must provide that at the time of each review of the individual's Medicaid
				eligibility (at least annually) while this trust is in existence, when notified
				by the Division of Medicaid, the Trustee must pay to the Division of Medicaid
				the amount that should be accumulated in the trust up to the amount expended by
				the Division of Medicaid on behalf of the individual that has not previously
				been repaid. Failure to make the requested payments will result in the loss of
				Medicaid eligibility for the individual.
8. The trust agreement must provide for an
				accounting of all receipts and disbursements of the trust during the prior
				calendar year when requested by the Division of Medicaid.
9. No fees are allowed to be paid to the
				Trustee for their service. In the event funds are retained in the trust,
				administrative fees are limited to ten dollars ($10.00) per month and are
				intended to cover any bank charges required to maintain the trust account.
10. Any disbursements not approved
				by the Division of Medicaid or provided for by the trust agreement will result
				in a loss of the trust exemption.
11. The trust agreement must specify an
				effective date. Unless the applicant is requesting retroactive eligibility of
				up to ninety (90) days, which will require that the applicant have the funds
				necessary to fund the trust for that period, the effective date will be the
				date of execution. If a retroactive date is being sought, the effective date
				will be determined through consultation with the Division of Medicaid's
				Regional Office. In that case the Regional Office should be consulted to
				determine the effective date prior to execution of the agreement.