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MISSISSIPPI DIVISION OF MEDICAID HOME & COMMUNITY BASED SERVICES WAIVER INCOME TRUST – HELP SHEET HCBS Income Trust Help Sheet, Revised June 2020 Page 2

Income Trust Requirements (Continued) – Please read carefully:

A bank account that is separate from the account used for the individual’s living expenses must be established for income that must fund the trust. The account does not have to be styled as a trust account; it only has to be a separate account for accumulated funding that will be electronically verified by the Division of Medicaid for compliance with the Income Trust provision. If electronic verification is not possible, the individual must verify the separate account and account balance at the time of application and at each annual review.

7. A letter specifying the payment due from accumulated trust funds will be issued at each review of the individual’s Medicaid eligibility, which is at least annually, while the HCBS Income Trust is in existence. Failure by the Trustee to make the payment by the due date specified in the letter will result in the loss of Medicaid eligibility for the individual.

8. When requested, the Trustee must provide an accounting to the Division of Medicaid to show all receipts and disbursements of the Income Trust during the prior calendar year. Any disbursements not approved by the Division of Medicaid or provided for by the Income Trust will result in the loss of Medicaid eligibility for the individual. Completing the Income Trust: 9. The Division of Medicaid provides a model HCBS Income Trust agreement for individuals in need of an Income Trust. The only change to this legally binding document that is acceptable is to add a successor Trustee or Co-Trustee. Any changes must be approved by the Division of Medicaid prior to execution of the trust. Once approved and accepted by the Division of Medicaid, the document cannot be modified without prior approval by the Division of Medicaid.

10. The individual requesting eligibility under an Income Trust is referred to as the “Settlor” in the Income Trust document. The Trustee is the individual or entity (such as a bank) that manages the trust and has fiduciary responsibilities. The Settlor and Trustee cannot be the same person. Income Trust Restrictions: 11. An HCBS Income Trust is used only for income belonging to the individual. No resources (assets) may be used to establish or augment the Income Trust as this will void the trust exception, resulting in the loss of Medicaid eligibility.

12. No fees are allowed to be paid to the Trustee for their service. In the event funds are retained in the trust, administrative fees are limited to $10 per month are intended to cover any bank charges required to maintain an Income Trust bank account.