Authority: IC 12-13-5-3; IC 12-15-1-10

Affected: IC 12-15-2-17; IC 12-15-3

Sec. 22. (a) This section:

1. (1) governs the treatment of trusts when determining eligibility of an applicant or member of Medicaid; and
2. (2) applies to trusts established by an applicant or member of Medicaid as defined in subsection (e).

As used in this section, "individual" means an applicant or member of Medicaid.

(b) A revocable trust established by an applicant or member shall be considered as follows:

1. (1) The corpus of the trust shall be considered resources available to the individual.
2. (2) Payments from the trust to or for the benefit of the individual shall be considered income of the individual.
3. (3) Any other payments from the trust shall be considered assets disposed of by the individual for purposes of section 1.1 of this rule.

(c) An irrevocable trust established by an applicant or member shall be considered as follows:

1. (1) If there are any circumstances under which payment from the trust could be made to or for the benefit of the individual, the portion of the corpus or income from which payment to the individual could be made shall be considered resources available to the individual. Payments from that portion of the corpus or income shall be counted as follows:

   1. (A) Payments to or for the benefit of the individual shall be considered income of the individual.
   2. (B) Payments for any other purpose shall be considered assets disposed of by the individual subject to section 1.1 of this rule.

2. (2) If there are no circumstances under which payment from a portion of the trust could be made to or for the benefit of the individual, the portion of the corpus or income from which no payment to the individual could be made shall be considered to be assets disposed of by the individual for purposes of section 1.1 of this rule. For purposes of section 1.1 of this rule, the following shall apply:

   1. (A) The assets shall be considered disposed of as of the date:

      1. (i) of establishment of the trust; or
      2. (ii) on which payment to the individual was foreclosed;
   2. whichever is later.
   3. (B) The value of the trust shall be determined by including the amount of any payments made from that portion of the trust after the date in clause (A).

(d) As used in this section, "trust" includes, but is not limited to, any legal instrument or device that is similar to a trust. The term includes an annuity only to such extent and in such manner as allowed by regulations of the Secretary of Health and Human Services.

(e) For purposes of this section, an individual shall be considered to have established a trust if assets of the individual were used to form all or part of the corpus of the trust, and if any of the following individuals established the trust other than by will:

1. (1) The individual.
2. (2) The individual's spouse.
3. (3) A person with legal authority to act in place of or on behalf of the individual or the individual's spouse, including, but not limited to, a court or administrative body.
4. (4) A person acting at the direction or upon the request of the individual or the individual's spouse, including, but not limited to, a court or administrative body.

(f) As used in this section, "assets" includes all income and resources of the individual and of the individual's spouse, including any income or resources that the individual or the individual's spouse is entitled to but does not receive because of action by:

1. (1) the individual or the individual's spouse;
2. (2) a person with legal authority to act in place of or on behalf of the individual or the individual's spouse, including, but not limited to, a court or administrative body; or
3. (3) a person, including a court or administrative body, acting at the direction or upon the request of the individual or the individual's spouse.

(g) In the case of a trust, the corpus of which includes assets of an individual and assets of any other person or persons, this subsection shall apply to that portion of the trust attributable to the assets of the individual.

(h) Subject to subsection (i), this subsection shall apply without regard to any of the following:

1. (1) The purposes for which a trust is established.
2. (2) Whether the trustees have or exercise any discretion under the trust.
3. (3) Any restrictions on when or whether distributions may be made from the trust.
4. (4) Any restrictions on the use of distributions from the trust.

(i) This section shall not apply to any of the following trusts:

1. (1) A trust containing the assets of an individual under sixty-five (65) years of age who is disabled as defined in 42 U.S.C. 1382c(a)(3), and which is established for the benefit of the individual by a parent, grandparent, legal guardian of the individual, or a court, if the state will receive all amounts remaining in the trust upon the death of the individual up to an amount equal to the total Medicaid paid on behalf of the individual.
2. (2) A trust established under subdivision (1) on or after December 13, 2016, may be established by an individual with a disability under sixty-five (65) years of age for his or her own benefit.

3. (3) A qualified income trust composed only of:

   1. (A) pension;
   2. (B) Social Security;
   3. (C) other income of the individual; and
   4. (D) accumulated income in the trust;
4. where income of clauses (A) through (C) is delivered to the trustee of the trust, and the trust instrument provides that the state will receive all amounts remaining in the trust upon the death of the individual up to an amount equal to the total Medicaid paid on behalf of the individual. The trust cannot be allowed to terminate in any manner at any time before the death of the individual.

5. (4) A trust containing the assets of an individual who is disabled as defined in 42 U.S.C. 1382c(a)(3) that meets the following conditions:

   1. (A) The trust is established and managed by a nonprofit association.
   2. (B) A separate account is maintained for each beneficiary of the trust, but, for purposes of investment and management of funds, the trust pools these accounts.

   3. (C) Accounts in the trust are established solely for the benefit of individuals who are disabled by:

      1. (i) the parent, grandparent, or legal guardian of the individuals;
      2. (ii) the individuals; or
      3. (iii) a court.
   4. (D) To the extent that amounts remaining in the beneficiary's account upon the death of the beneficiary are not retained by the trust, the trust pays to the state from the remaining amounts in the account an amount equal to the total amount of Medicaid paid on behalf of the beneficiary.

(j) The office may waive the application of this section in cases of undue hardship, but only to the extent required by standards specified under 42 U.S.C. 1396p(d)(5) by the Secretary of Health and Human Services and section 24 of this rule.

(k) This section applies to trusts established on or after August 11, 1993. Trusts established before August 11, 1993, are governed by 42 U.S.C. 1396a(k).

(Office of the Secretary of Family and Social Services; 405 IAC 2-3-22; filed May 1, 1995, 10:45 a.m.: 18 IR 2225; errata filed Jun 9, 1995, 2:30 p.m.: 18 IR 2796; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; filed Aug 18, 2009, 11:33 a.m.: 20090916-IR-405080325FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Apr 8, 2014, 12:37 p.m.: 20140507-IR-405130533FRA; readopted filed Nov 13, 2019, 11:54 a.m.: 20191211-IR-405190487RFA; filed Jun 11, 2021, 2:35 p.m.: 20210707-IR-405190602FRA; readopted filed Oct 8, 2025, 3:16 p.m.: 20251105-IR-405240502RFA)