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Title 8: Medicaid Page 60 Iowa Department of Health and Human Services Employees’ Manual Chapter D: Resources Trusts Revised July 10, 2026 Treatment of Resources in a Trust  Identify marital status.  Indicate what program the client is applying for or is eligible under (MAGI, non- MAGI, Food Assistance, or FIP).  Indicate whether this referral concerns a trust for third-party liability for medical expenses.  Attach a copy of the legal document or trust agreement to the request. Trust Program staff will first review each submitted document to determine whether it is a “pay-back” trust (defined as a special needs trust, an income trust, or a pooled trust).  Trusts that are not “pay-back” trusts are returned to the eligibility policy staff for review. (See procedures below.)  “Pay-back” trusts are kept for review by trust program staff. Of these, income trusts will be the priority for review. Review procedure for income trusts: 1. The Trust Program will:  Determine whether the document meets the criteria for a medical assistance income trust; and  Send a response indicating whether the trust was approved or denied directly to the scanning center indicated on the Clarification Request. (If the request does not contain a case number, the response will be emailed to the requesting worker.) 2. When the trust is approved, the worker issues form 470-4488, Medical Assistance Income Trust, to the client or the payee. 3. When the trust is denied, the Trust Program will:  Prepare a checklist indicating why the trust does not meet the criteria; and  Email the checklist to the scanning center indicated on the Clarification Request where it will be received in the electronic case file process list.