For purposes of
this chapter, unless the context otherwise requires:
1. “Available monthly income” means in reference to a medical assistance income trust beneficiary, any income received directly by the beneficiary, not
from the trust, that counts as income in determining eligibility for medical assistance and any amounts paid to or otherwise
made available to the beneficiary by the trustee pursuant to section 633C.3, subsection 1, paragraph “b”, or section 633C.3, subsection 2, paragraph “b”.
2. “Beneficiary” means the original beneficiary of a medical assistance special needs trust or medical assistance income trust, whose assets
funded the trust.
3. “Department” means the department of health and human services.
4. “Institutionalized individual” means an individual receiving nursing facility services, a level of care in any institution equivalent to nursing facility
services, or home and community-based services under the medical assistance home and community-based services waiver program.
5. “Maximum monthly medical assistance payment rate for services in an intermediate care facility for persons with an intellectual
disability” means the allowable rate established by the department and as published in the Iowa administrative bulletin.
6. “Medical assistance” means medical assistance as defined in section 249A.2.
7. “Medical assistance income trust” means a trust or similar legal instrument or device that meets the criteria of 42 U.S.C. §1396p(d)(4)(B)(i)-(ii).
8. “Medical assistance special needs trust” means a trust or similar legal instrument or device that meets the criteria of 42 U.S.C. §1396p(d)(4)(A) or (C).
9. “Statewide average charge for nursing facility services” means the statewide average charge for such care, excluding charges by Medicare-certified, skilled nursing facilities, as
calculated by the department and as published in the Iowa administrative bulletin.
10. “Statewide average charge for state mental health institute care” means the statewide average charge for such care as calculated by the department and as published in the Iowa administrative
bulletin.
11. “Statewide average charge to private-pay patients for psychiatric medical institutions for children care” means the statewide average charge for such care as calculated by the department and as published in the Iowa administrative
bulletin.
12. “Total monthly income” means in reference to a medical assistance income trust beneficiary, income received directly by the beneficiary, not from
the trust, that counts as income in determining eligibility for medical assistance, income of the beneficiary received by
the trust that would otherwise count as income in determining the beneficiary’s eligibility for medical assistance, and income
or earnings of the trust received by the trust.
C95, §633.707
96 Acts, ch 1129, §106; 2004 Acts, ch 1086, §99; 2004 Acts, ch 1166, §1; 2005 Acts, ch 38, §52, 53, 55
CS2005, §633C.1
633C.2 Disposition of medical assistance special needs trusts.
Any income or assets added to or received by and any income or principal retained in a medical assistance special needs trust
shall be used in accordance with a standard that is no more restrictive than specified under federal law. All distributions
from a medical assistance special needs trust shall be for the sole benefit of the beneficiary to enhance the quality of life
of the beneficiary, and the trustee shall have sole discretion regarding such disbursements to ensure compliance with beneficiary
eligibility requirements. Any funds retained in the medical assistance special needs trust of a beneficiary who is also a
designated beneficiary as defined in
section 12I.1 may be transferred to the Iowa ABLE savings plan trust account of the designated beneficiary in accordance with
this chapter and
chapter 12I. Any distinct disbursement in excess of one thousand dollars shall be subject to review by the district court sitting in
probate. The department shall adopt rules pursuant to
chapter 17A for the establishment and disposition of medical assistance special needs trusts in accordance with
this section.
C95, §633.708
CS2005, §633C.2
633C.3 Disposition of medical assistance income trusts.
1. Regardless of the terms of a medical assistance income trust, if the beneficiary’s total monthly income is less than one hundred
twenty-five percent of the average statewide charge for nursing facility services to a private-pay resident of a nursing facility,
then, during the life of the beneficiary, any property received or held by the trust shall be expended only as follows, as
applicable, and in the following order of priority: a. A reasonable amount may be paid or set aside each month for necessary expenses of the trust, not to exceed ten dollars per
month without court approval.
b. From the remaining principal or income of the trust, amounts may be paid for expenses that qualify as required deductions
from income pursuant to 42 C.F.R. §435.725(c) or 435.726(c) for purposes of determining the amount by which medical assistance payments under chapter 249A for institutional services or for home and community-based services provided under a federal waiver will be reduced based
on the beneficiary’s income.
c. If the beneficiary is an institutionalized individual or receiving home and community-based services provided under a federal
waiver, the remaining principal or income of the trust shall be paid directly to the provider of institutional care or home
and community-based services, on a monthly basis, for any cost not paid under paragraph “b”, to reduce any amount paid as medical assistance under chapter 249A.
d. Any remaining principal or income of the trust may, at the trustee’s discretion or as directed by the terms of the trust,
be paid directly to providers of other medical care or services that would otherwise be covered by medical assistance, paid
to the state as reimbursement for medical assistance paid on behalf of the beneficiary, or retained by the trust.
2. Regardless of the terms of a medical assistance income trust, if the beneficiary’s total monthly income is at or above one
hundred twenty-five percent of the average statewide charge for nursing facility services to a private-pay resident, then,
during the life of the beneficiary, any property received or held by the trust shall be expended only as follows, as applicable,
in the following order of priority: a. A reasonable amount may be paid or set aside each month for necessary expenses of the trust, not to exceed ten dollars per
month without court approval.
b. All remaining property received or held by the trust shall be paid to or otherwise made available to the beneficiary on a
monthly basis, to be counted as income or a resource in determining eligibility for medical assistance under chapter 249A.
3. Subsections 1 and 2 shall apply to the following beneficiaries; however, the following amounts indicated shall be applied in lieu of the statewide
average charge for nursing facility services: a. For a beneficiary who meets the medical assistance level of care requirements for services in an intermediate care facility
for persons with an intellectual disability and who either resides in an intermediate care facility for persons with an intellectual
disability or is eligible for services under the medical assistance home and community-based services waiver except that the
beneficiary’s income exceeds the allowable maximum, the applicable rate is the maximum monthly medical assistance payment
rate for services in an intermediate care facility for persons with an intellectual disability.
b. For a beneficiary who meets the medical assistance level of care requirements for services in a psychiatric medical institution
for children and who resides in a psychiatric medical institution for children, the applicable rate is the statewide average
charge to private-pay patients for psychiatric medical institution for children care.
c. For a beneficiary who meets the medical assistance level of care requirements for services in a state mental health institute
and who either resides in a state mental health institute or is eligible for services under a medical assistance home and
community-based services waiver except that the beneficiary’s income exceeds the allowable maximum, the applicable rate is
the statewide average charge for state mental health institute care.
d. For a beneficiary who meets the medical assistance level of care requirements for services in a nursing facility and is receiving
care or is receiving specialized care such as an adult receiving Alzheimer’s care, a child receiving skilled nursing facility
care, or an adult or child receiving skilled nursing facility care for neurological disorders, the applicable rate is the
statewide average charge for nursing facility services for the services or specialized services provided.
C95, §633.709
CS2005, §633C.3