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519 (07/2026) Chapter 2:Eligibility • Section 10: Long-Term Care (LTC) services For changes in medical deductions that reduce liability: • For both ongoing and one-time expenses, the change is effective the first of the month the change occurred, if reported timely. • For ongoing expenses that are not reported timely, the change is effective the first of the month the change is reported. • One-time expenses that have been paid in full but not reported timely will not be used. For changes in marital status or number of eligible dependents that reduce liability: • The change is effective the first of the month the change occurred, if reported timely. • The change is effective the first of the month the change was reported or discovered if not reported timely. For changes in service setting that decrease liability, the effective date is the date the individual moves into the new service setting. If a change in income and service setting occur in the same month, the effective date is the day the individual moves into the new service setting. Income cap trust (ICT) The effective date for an income cap trust is the first day of the month in which the trust document is signed, the trust account is set up, and income is assigned to the trust. People may choose to establish the ICT immediately or wait until service eligibility is determined. Individuals should be advised that waiting to establish the trust may cause a delay in eligibility. The individual or trustee must make a good faith effort to set up the account and assign income to the trust. Exceptions may be approved by local office leadership on a case-by-case basis if the individual or trustee experience barriers outside their control preventing them from setting up the account and funding the trust. If the individual or trustee is experiencing barriers to establishing the trust account or funding the trust that are outside of their control, OSIPM may be opened in the meantime with a soft pend due in 90 days. If verification the trust has been funded is not received within 90 days, OSIPM must be closed with timely notice. Funding the ICT ICTs must be funded using the individual’s income, not resources. Resources cannot be transferred into the ICT account. Assume the trust has initially been funded with the individual’s income unless the individual or their trustee report otherwise. Direct deposit is a convenient method for ensuring income is deposited into the ICT account each month. Direct deposit is not a requirement. Trustees may also choose to deposit income manually each month. If choosing to deposit income manually, it is important this is done in the month in which the income is received. Income from a prior month cannot be deposited into the ICT account because it is now a resource, and resources cannot be deposited into the ICT account. If resources are transferred into the ICT account, the ICT is invalidated and the transferred amount remains countable. If resources are transferred in error, the trustee can reverse the transfer.