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 chargefor nursing facility services to a private-pay resident of a nursing facility, then, during thelife of the beneficiary, any property received or held by the trust shall be expended only asfollows, 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 paymentsunder chapter 249A for institutional services or for home and community-based servicesprovided 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 ided 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 orincome of the trust shall be paid directly to the provider of institutional care or home andcommunity-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 careor services that would otherwise be covered by medical assistance, paid to the state asreimbursement for medical assistance paid on behalf of the beneficiary, or retained by thetrust. 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 statewidecharge for nursing facility services to a private-pay resident, then, during the life of thebeneficiary, any property received or held by the trust shall be expended only cent of the average statewidecharge for nursing facility services to a private-pay resident, then, during the life of thebeneficiary, any property received or held by the trust shall be expended only as follows, asapplicable, 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 indetermining 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 facilityservices: 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 whoeither resides in an intermediate care facility for persons with an intellectual disability oris eligible for services under the medical assistance home and ons with an intellectual disability and whoeither resides in an intermediate care facility for persons with an intellectual disability oris eligible for services under the medical assistance home and community-based serviceswaiver except that the beneficiary’s income exceeds the allowable maximum, the applicablerate is the maximum monthly medical assistance payment rate for services in an intermediatecare 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 psychiatricmedical institution for children, the applicable rate is the statewide average charge toprivate-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 healthinstitute or is eligible for services under a medical assistance home and community-basedservices waiver except that the beneficiary’s income exceeds the allowable maximum, theapplicable rate is the statewide average ligible for services under a medical assistance home and community-basedservices waiver except that the beneficiary’s income exceeds the allowable maximum, theapplicable 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 anadult receiving Alzheimer’s care, a child receiving skilled nursing facility care, or an adult Sat Dec 23 12:17:10 2023 Iowa Code 2024, Section 633C.3 (22, 0) §633C.3, MEDICAL ASSISTANCE TRUSTS 2 or child receiving skilled nursing facility care for neurological disorders, the applicable rateis the statewide average charge for nursing facility services for the services or specializedservices provided. 94 Acts, ch 1120, §5C95, §633.70996 Acts, ch 1129, §113; 2004 Acts, ch 1086, §100; 2004 Acts, ch 1166, §2; 2005 Acts, ch 38, §53 CS2005, §633C.32007 Acts, ch 136, §1; 2012 Acts, ch 1019, §140; 2014 Acts, ch 1084, §1 – 3Referred to in §249A.3, 633C.1, 633C.4, 633C.5 Sat Dec 23 12:17:10 2023 Iowa Code 2024, Section 633C.3 (22, 0)
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