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Title 8: Medicaid Page 69 Iowa Department of Health and Human Services Employees’ Manual Chapter D: Resources Trusts Revised September 13, 2024 Trusts Established After August 10, 1993 Special Needs Trust for Persons Under 65 Years Old Legal reference: 441 IAC 75.24(3)“a,” Iowa Code 633C.1, 633C.2 A special needs trust for persons under 65 years old must meet the following conditions:  The trust is an irrevocable trust.  The trust is established after August 10, 1993.  The trust is created with the assets of a person who is under the age of 65 and is disabled as defined by the Social Security Administration.  The trust is established for the benefit of the beneficiary by a parent, grandparent, legal guardian of the beneficiary, or a court.  The trust provides that the state of Iowa will receive all amounts remaining in the trust upon the death of the beneficiary, up to an amount equal to the total Medicaid paid on behalf of the beneficiary. When the Social Security Administration or the Railroad Retirement Board has not determined a person disabled, the Department must determine disability for this policy to apply. Send a referral to the Disability Determination Services Bureau. See 8-C, When the Department Determines Disability. The principal of a special needs trust is not a countable resource. Income paid into the trust is not countable. Count only the income paid from the trust or made available to the member as income. Payments from the trust follow the same rules as described in 8-E, Medical Assistance Income Trusts (MAITs). When a member with a special needs trust reaches age 65, the trust retains its exempt status. However, any additions to the trust after the member reaches age 65 (other than those generated by the preexisting trust assets) are countable assets. Also:  The income generated by any such additions is countable income.  These additions will be considered a transfer of assets for less than fair market value.