Medical Assistance Income Trust for Long-term Care

What is a Medical Assistance Income Trust (MAIT)?

People with income in excess of 300 percent of the Supplemental Security Income (SSI) benefit for one person may qualify for Medicaid payment LTSS care using a medical assistance income trust (MAIT). 

A person with such a trust qualifies for LTSS payment only if the person's total gross monthly income does not exceed 125 percent of the statewide average change for the type of facility or level of care the person meets.

Rates & Types of Care

Appropriate Use for Income Trusts

These types of payback trusts provide for the health care needs of the beneficiary including those medical expenses that are covered by Medicaid, such as:

• Long term care, such as skilled nursing or assisted living
• Home health care
• Prescriptions for medicine
• Doctors
• Other medical providers

Establishing a Trust

A MAIT (also referred to as a Miller Trust) is a trust set up by a person who has income that exceeds the eligibility limit for Medicaid long-term care assistance. 

By establishing a MAIT, your countable income is reduced when you divert all or some of your income into the trust. Income assigned and paid to the trust is not countable income to you when determining your Medicaid eligibility. 

However, any money available to you from the trust for basic needs is countable as unearned income in the month it is available to you. This does not include money paid from the trust for your medical expenses or facility care.

Any income that remains in the MAIT each month must be retained in the trust. Upon your death, the state will receive all amounts remaining in the trust, up to the amount equal to the total medical assistance paid on your behalf.

Learn more about the Iowa Medicaid Trust Program.

Guidelines

Iowa Code section 633C.3(1) requires trustees of MAITs to make specific payments from any income received or held by the trust. A trustee may make monthly payments from the trust in the following order:

1. A reasonable amount not to exceed $10.00 (without court order) for necessary expenses of the trust.
2. An amount for the personal needs allowance of the trust beneficiary.
3. An amount for the maintenance needs allowance of a spouse and/or dependents.
4. An amount for unmet medical needs.
5. Any remaining amount, up to the Medicaid rate, is paid directly to the provider of medical services.
6. At the trustee’s option, any remainder may be paid directly to:
   1. Other medical providers that would otherwise be covered by medical assistance,
   2. The state as reimbursement for medical assistance paid on behalf of the beneficiary, or
   3. Kept in the trust.