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Title 8: Medicaid Page 62 Iowa Department of Health and Human Services Employees’ Manual Chapter D: Resources Trusts Revised July 10, 2026 Treatment of Resources in a Trust 3. Eligibility policy staff will:  Review the trust for eligibility;  Respond to the Clarification Request indicating how the trust will affect eligibility; and  Upload the response to the electronic case file indicated on the Clarification Request where it will be received in the case file process list. Trusts Established with Assets Not Owned by Beneficiary Legal reference: 441 IAC 75 (Rules in Process) If the applicant or member is the beneficiary but not the grantor of a trust, Medicaid eligibility is determined by the terms of the trust. These trusts may be testamentary trusts or inter vivos trusts. Examine the terms of the trust to determine if it is countable. Under both non-MAGI and MAGI-related policy, income and resources are available to an applicant or member who is the beneficiary as follows:  Trust principal and income are countable resources and income to the beneficiary when the terms of the trust require the trustee to pay or to make available to the beneficiary trust principal and income for the beneficiary’s basic needs. (EXCEPTION: Do not count resources for MAGI-related Medicaid.)  Trust principal and income are countable income, but not a countable resource, to the beneficiary when the terms of the trust allow the trustee to make income or principal available to the beneficiary for basic needs, and the trustee makes either trust principal or income available to the beneficiary for basic needs.  Trust principal and income are countable resources and income to the beneficiary when the terms of the trust allow the beneficiary to withdraw trust principal and income for basic needs. (EXCEPTION: Do not count resources for MAGI-related Medicaid.) Income and resources are not available to the beneficiary under both non-MAGI- related and MAGI-related policy if:  The terms of the trust prohibit the trustee from making either trust principal or income available for the beneficiary’s basic needs.  The terms of the trust allow the trustee, at the trustee’s discretion, to make income or principal available to the beneficiary for basic needs, but the trustee does not make either income or resources available for basic needs.