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 deter Free access — add to your briefcase to read the full text and ask questions with AI
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
3 MEDICAL ASSISTANCE TRUSTS, §633C.5
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
rateisthemaximummonthlymedicalassistancepaymentrateforservicesinanintermediate
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.