New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 71 - MEDICAID ONLY
Subchapter 4 - RESOURCES
Section 10:71-4.11 - Trusts
Universal Citation: NJ Admin Code 10:71-4.11
Current through Register Vol. 56, No. 18, September 16, 2024
(a) For purposes of this subchapter, effective June 18, 2001, a trust is any legal instrument, device, or arrangement which is similar to a trust, in which a grantor transfers property to an individual or entity with fiduciary obligations (considered to be a trustee for purposes of this section). The grantor transfers the property with the intention that it be held, managed, or administered by the trustee for the benefit of the grantor or others. For the purposes of this chapter, a trust shall include, but not be limited to, escrow accounts, annuities, investment accounts, and other similar devices managed by an individual or entity with fiduciary obligations.
(b) The standards set forth in this section shall apply to trusts without regard to:
1.
The purposes for which the trust is established;
2. Whether the trustee(s) has discretion or
exercises such discretion under the trust;
3. Any restrictions on when or whether
distribution can be made from the trust; or
4. Any restrictions on the use of
distributions from the trust.
(c) Definitions, for the purposes of this section, shall be as follows:
1. A grantor
shall be any individual who creates a trust. This section shall apply only to
situations in which the grantor is:
i. The
individual;
ii. The individual's
spouse;
iii. A person, including a
court or administrative body, with legal authority to act in place of, or on
behalf of, the individual or the individual's spouse; or
iv. A person, including a court or
administrative body, acting at the direction or upon the request of the
individual or the individual's spouse.
2. A revocable trust is a trust which can,
under State law, be revoked by the grantor. A trust, which provides that the
trust can be only modified or terminated by a court, is considered to be a
revocable trust, since the grantor (or his or her representative) can petition
the court to terminate the trust. Also, a trust that declares itself to be
irrevocable, but which terminates upon conditions relating to the grantor
during his or her lifetime, shall be, for the purposes of this section,
considered to be revocable. For example, a trust may require a trustee to
terminate a trust and disburse the funds to the grantor if the grantor leaves a
nursing facility. Such a trust shall be considered to be revocable.
3. An irrevocable trust is a trust which
cannot, in any way, be revoked by the grantor.
4. A beneficiary is any individual or
individuals designated in the trust instrument as benefiting in some way from
the trust. The term "beneficiary" shall not include the trustee or any other
individual whose benefit consists only of reasonable fees or payments for
managing or administering the trust. The beneficiary can be the grantor,
another individual, or individuals, or any combination of any of these
parties.
5. For purposes of this
chapter, a payment from a trust shall be any disbursal from the corpus of the
trust or from income generated by the trust which benefits the party receiving
it. A payment may include actual cash, as well as noncash or property
disbursements, such as the right to use or occupy real property.
(d) Individuals to whom the trust provisions apply shall include any individual who establishes a trust and who is an applicant or beneficiary of Medicaid. An individual shall be considered to have established a trust if any of his or her assets, regardless of the amount, were used to form part or all of the corpus of the trust and if any of the parties described as a grantor in (c)1 above established the trust, other than by will.
1. When the corpus of a trust
includes assets of another person or persons not described in (c)1 above, as
well as assets of the individual, the rules apply only to the portion of the
trust attributable to the assets of the individual. Thus, in determining
countable income and resources in the trust for eligibility and
post-eligibility purposes, the county welfare agency shall prorate any amounts
of income and resources, based on the proportion of the individual's assets in
the trust to those of other persons.
2. When the corpus of a trust includes assets
of either an institutionalized spouse as defined in
10:71-4.10(b)2
or a community spouse, this section shall apply to the portion of the trust
attributable to either spouse for the purposes of determining eligibility for
the institutionalized spouse.
(e) Treatment of trusts, for purposes of determining Medicaid eligibility, shall be dependent on the characteristics of the trust. The look-back period for evaluation of resource transfer shall be 60 months. The following are the rules for consideration of various kinds of trusts:
1. In the case of a revocable trust:
i. The entire corpus of the trust shall be
counted as a resource available to the individual;
ii. Any payments from the trust made to or
for the benefit of the individual shall be counted as income (unless otherwise
excludable, see
10:71-5.3); and
iii. Any payments from the trust which are
not made to or for the benefit of the individual shall be considered assets
disposed of for less than fair market value (see
10:71-4.10) .
2. In an irrevocable trust from which payment
can be made under the terms of the trust to or for the benefit of the
individual from all or a portion of the trust, the following shall apply to
that trust or that portion of the trust:
i.
Payments from income or from the corpus made to or for the benefit of the
individual shall be treated as income to the individual unless otherwise
excludable (see
10:71-5.3);
ii. Income on the corpus of the trust which
could be paid to or for the benefit of the individual shall be counted as a
resource available to the individual;
iii. The portion of the corpus that could be
paid to or for the benefit of the individual shall be treated as a resource
available to the individual; and
iv. Payments from income or from the corpus
that are made, but not to or for the benefit of the individual, shall be
treated as a transfer of assets for less than fair market value (see
10:71-4.10) .
3. In the case of an irrevocable trust from
which payments from all or a portion of the trust cannot, under any
circumstances, be made to or for the benefit of the individual, all of the
trust, or any such portion or income thereof, shall be treated as a transfer of
assets for less than fair market value (see
10:71-4.10) .
i. In treating these portions as a transfer
of assets, the date of transfer shall be considered to be the date the trust
was established, or, if later, the date on which the right of payment to the
individual was foreclosed.
ii. For
transfer of assets purposes, in determining the value of the portion of the
trust which cannot be paid to the individual, amounts that have been paid, for
whatever purpose, shall not be subtracted from the value of the trust on the
date the trust was created or, if later, the date that payment to the
individual was foreclosed. The value of the transferred amount shall be no less
than the value on the date the trust is established or on the date that payment
is foreclosed. If additional funds are added to this portion of the trust,
those funds shall be treated as a new transfer of assets or less than fair
market value.
4.
Payments made from a revocable or irrevocable trust to or on behalf of the
individual shall include payments of any sort, including an amount from the
corpus or income produced by the corpus, paid to another person or entity such
that the individual derives some benefit from the payment. For example, such
payments may include purchase of clothing or other items, such as a radio or
television, for the individual. Such payments may also include payment for
services the individual may require, or care, whether medical or personal, that
the individual may need. Payments to maintain a home shall also be considered
payments for the benefit of the individual.
i. When a payment to or for the benefit of
the individual is made which would not be considered income in the eligibility
process, then the payment shall not be counted as income to the individual
under this section. For example, payments made on behalf of an individual for
medical care are not counted in determining income eligibility for Medicaid,
and are therefore not counted as income under these trust provisions.
5. In determining whether payments
can or cannot be made from a trust to or for an individual, the county welfare
agency shall take into account any restrictions on payments, such as use
restrictions, exculpatory clauses or limits on trustee discretion that may be
included in the trust. Any amount in a trust for which payment can be made, no
matter how unlikely the circumstance of payment might be or how distant in the
future, shall be considered a payment that can be made under some
circumstances.
i. For example, if an
irrevocable trust provides that the trustee can disburse only $ 1,000 to or for
the individual out of a $ 20,000 trust, only the $ 1,000 is treated as a
payment that could be made. The remaining $ 19,000 is treated as an amount
which cannot, under any circumstances, be paid to or for the benefit of the
individual and may be subject to a transfer penalty. On the other hand, if a
trust contains $ 50,000 that the trustee can pay to the grantor only in the
event that the grantor needs, for example, a heart transplant, this full amount
is considered as payment that could be made under some circumstances, even
though the likelihood of payment is remote. Similarly, if a payment cannot be
made until some point in the distant future, it is still payment that can be
made under some circumstances and the funds are included.
6. Placement of excluded assets in trust,
with the exception of a home, shall not result in a penalty of ineligibility
because the transferred asset is not an asset for transfer purposes. However, a
home, whether excluded or not, when transferred into a trust shall be presumed
to have been transferred for the purposes of qualifying for Medicaid.
(f) Transfer to a trust (or similar instrument, including an annuitized trust) for the sole benefit of a community spouse shall be treated in accordance with the provisions of (e) above. If the trust is established by either member of the couple (using at least some of the couple's assets), the trust shall be reviewed by the county welfare agency for availability of resources, in accordance with (e) above. If the payment from such a trust shall be considered an available resource to either spouse, the trust shall be included as a countable resource in determining Medicaid eligibility for the institutionalized spouse pursuant to 10:71-4.8.
(g) The trust provisions shall not apply to the following trusts so long as the trust document meets all the requirements set forth in this chapter:
1. A special needs
trust, that is, a trust containing the assets of a disabled individual and
which is established prior to the time the disabled individual reaches the age
of 65 and which is established for the sole benefit of the disabled individual
by a parent, grandparent, legal guardian of the disabled individual or a court,
may be excluded from the rules regarding the treatment of a trust. To qualify
for the exclusion, the trust shall contain the following provisions:
i. The trust shall be identified as an OBRA
'93 trust established pursuant to
42
U.S.C. §
1396p(d)(4)(A).
(1) The trust shall not contain any
provisions intended to give anyone or a court the power to alter the form of
the trust from an individual trust to a "pooled trust" under
42
U.S.C. §
1396p(d)(4)(C).
Notwithstanding amendments to the trust solely to conform to the requirements
of this subsection and/or
42
U.S.C. §
1396p(d)(4),
there shall be no provisions permitting the trust to be altered for any other
reasons.
ii. The trust
shall specifically state that the trust is for the sole benefit of the trust
beneficiary.
(1) Only trusts which are
intended for the sole benefit of the disabled individual are special needs
trusts. Any trust which provides benefits to other persons shall not be
considered an individual special needs trust. If expenditures are made from the
trust which shall also incidentally provide an ongoing and continuing benefit
to other persons, those other persons who also benefit shall contribute a
prorata share to the trust for the subsequent expenses associated with their
use of the acquisition,
(A) For example, if
the trust acquires housing for the benefit of the trust beneficiary, and other
family members also live in that house, the trust document shall provide that
the trustee shall require and collect a pro rata contribution for the expenses
of uses incurred, and shall return such contribution to the trust. Such
collections shall be reflected in the annual required trust accounting. Any
property acquired by the trust shall be titled solely in the trust's name. In
addition, unless the trust is given equity in any improvements to real
property, the trust shall not pay for upkeep, property taxes or other expenses
associated with the property or any additions to the existing
property.
iii. The trust shall specifically state that
its purpose is to permit the use of trust assets to supplement, and not to
supplant, impair or diminish, any benefits or assistance of any Federal, State
or other governmental entity for which the beneficiary may otherwise be
eligible or which the beneficiary may be receiving.
(1) If the trust provides for food, clothing
or shelter, such expenditures shall be considered income under Social Security
and Medicaid eligibility rules.
(2)
It may be permissible for the trust to acquire property which is used to
provide shelter for the trust beneficiary, but the trustee shall take care to
ensure that such acquisitions do not create unintended problems (such as
disqualifying someone for Federal benefits). Additionally, parents shall not be
relieved of their duty to support their minor child, if they are capable of
doing so. A minor's funds in a trust shall not be expended on routine support,
unless the parents' income is insufficient for these expenses.
3B:12-43.
iv. The trust shall specifically state the
age of the trust beneficiary, that the trust beneficiary is disabled within the
definition of
42
U.S.C. §
1382c(a)(3)
and whether the trust beneficiary is competent at the time the trust is
established.
(1) If the trust beneficiary is
a minor, the trustee shall execute a bond to protect the child's funds or shall
get a court's permission not to do so.
(2) If there is some question about the trust
beneficiary's disability, independent proof may be required.
(3) If the trust beneficiary is a minor, the
trust shall state whether the trust beneficiary is expected to be competent at
his or her majority.
v.
The trust shall specifically identify, in an attached schedule, the source of
the initial trust property and all assets of the trust. If the trust is being
established with funds from the proceeds of a settlement or judgement
subsequent to the bringing of a legal cause of action, Medicaid's claim for its
expenditures that are related to the cause of action shall be repaid
immediately upon the receipt of such proceeds and prior to the establishment of
the trust.
(1) Subsequent additions made to
the trust corpus shall be reported to the appropriate eligibility determination
agency. Subsequent additions to the trust (other than interest on the corpus)
shall cease when the trust beneficiary reaches age 65, or shall be subject to
transfer provisions.
(2) If
subsequent additions are to be made to the trust corpus with funds not
belonging to the trust beneficiary, it shall be understood that those funds are
a gift to the trust beneficiary and cannot be reclaimed by the donor.
vi. If the trust makes provisions
which are intended to limit invasion by creditors or to insulate the trust from
liens or encumbrances, the trust shall state that such provisions are not
intended to limit the State's right to reimbursement or to recoup incorrectly
paid benefits.
vii. The special
needs trust shall state that it is established by a parent, grandparent, or
legal guardian of the trust beneficiary, or by a court.
(1) The trust shall identify the
grantor/settlor by name and as the parent, grandparent, legal guardian, or
court. A court can be named as the grantor, if the trust is established
pursuant to a settlement of a case before it, or if the court is otherwise
involved in the creation of the trust.
viii. The trust shall specifically state that
it is irrevocable. Neither the grantor, the trustee(s), nor the beneficiary
shall have any right or power, whether alone or in conjunction with others, in
whatever capacity, to alter, amend, revoke or terminate the trust or any of its
terms or to designate the persons who shall possess or enjoy the trust estate
during his or her lifetime.
(1)
Notwithstanding the irrevocability provision above, the trust can state that
"the trust shall be irrevocable except that the trust may be amended as
necessary to conform with the requirements of
42 U.S.C.
1396 p and/or state law."
ix. The trustee shall be
specifically identified by name and address. The trust shall state that the
original trust beneficiary cannot be the trustee. The trust shall make
provisions for naming a successor trustee in the event that any trustee is
unable or unwilling to serve. The Bureau of Administrative Control, Division of
Medical Assistance and Health Services, as well as the trust beneficiary and/or
guardian, shall be given prior notice if there is a change in the
trustee.
x. The trust shall
specifically state that the trustee shall fully comply with all State laws,
including the Prudent Investor Act,
3B:20-11.1 et seq. The trust shall
provide that the trustee cannot take any actions not authorized by, or without
regard to, State laws. If the trust gives the trustee authorization or power
not provided for in the Prudent Investor Act, an accompanying letter shall
provide an explanation for each such authorization or power.
xi. Except as approved by court order, after
notice to the Division of Medical Assistance and Health Services, individual
trustee fees shall be in accordance with
3B:18-23 et seq. or, in the case
of a corporate trustee, the corporate trustee's regular fee schedule. The
trustee shall not delay or defer accepting compensation or commissions more
than one year from the date(s) they would otherwise be payable under the terms
of the trust or of any applicable statute or rule. If the trust identifies a
guardian, the trust shall specifically identify him or her by name. A guardian
shall be compensated only as provided by law. The parent of a minor child shall
not be compensated from the trust as the child's guardian.
(1) If an adult beneficiary is not competent,
the trust shall specifically state that the "guardianship protections for the
incompetent's funds which are required by New Jersey law and Court rules are
incorporated by reference into this trust." The trustee shall either file a
bond or shall get the Court's permission not to do so.
xii. The trust shall specifically state that,
upon the death of the primary beneficiary, the State will be notified, and
shall be paid all amounts remaining in the trust up to the total value of all
medical assistance paid on behalf of the beneficiary. The trust shall comply
fully with this obligation under the statute to first repay the State, without
requiring the State to take any action except to establish the amount to be
repaid. Repayment shall be made to the Treasurer, State of New Jersey, and
shall be sent to the Division of Medical Assistance and Health Services, to the
attention of the Bureau of Administrative Control, PO Box 712, Trenton, New
Jersey 08625-0712, or to any successor agency.
xiii. If there is a provision for repayment
of other assistance programs, the trust shall specifically state that the
Medicaid Program shall be repaid prior to making repayment to any other
assistance programs.
xiv. The trust
shall specifically state that if the beneficiary has received Medicaid benefits
in more than one state, each state that provided Medicaid benefits shall be
repaid. If there is an insufficient amount left to cover all benefits paid,
then each state shall be paid its proportionate share of the amount left in the
trust, based upon the amount of support provided to the beneficiary.
xv. No provisions in the trust shall permit
the estate's representative to first repay other persons or creditors at the
death of the beneficiary. Only what remains in the trust after the repayments
specified in (g)1xii, xiii and xiv above have been made shall be considered
available for other expenses or beneficiaries of the estate. The trust may
provide for a prepaid burial plan, but shall not state that it will pay for
reasonable burial expenses after the death of the trust beneficiary.
xvi. The trust shall specify that a formal or
informal accounting of all expenditures made by the trust shall be submitted to
the appropriate eligibility determination agency on an annual basis.
xvii. The State shall be given advance notice
of any expenditure in excess of $ 5,000, and of any amount which would
substantially deplete the principal of the trust. Notice shall be given to the
Division of Medical Assistance and Health Services, Bureau of Administrative
Control, PO Box 712, Mail Code 6, Trenton, New Jersey 08625-0712, or any
successor agency, 45 days prior to the expenditures.
xviii. New Jersey rules and laws do not
permit a trust to create a will for an incompetent or a minor. The money
creating the trust, any additions and/or interest accumulated, cannot be left
to other parties, but shall pass by intestacy. The trust shall not create other
trusts within it.
2. A
pooled trust is a special needs trust, containing the assets of a disabled
individual, which meets the following conditions:
i. The trust shall be established and managed
by a non-profit association;
ii. A
separate account shall be maintained for each beneficiary of the trust, but for
purposes of investment and management of the funds, the trust may pool the
funds from those accounts;
iii.
Accounts in the trust shall be established solely for the benefit of the
disabled individual by the individual, by a parent, grandparent, or legal
guardian of the individual, or by a court;
iv. To the extent that amounts remaining in
the beneficiary's account upon the death of the beneficiary are not retained by
the trust, the trust shall pay to the State of New Jersey the amount remaining
in the account, up to an amount equal to the total amount of medical assistance
paid under Title XIX of the Social Security Act on behalf of the individual. To
meet this requirement, the trust shall include a provision specifically
providing for such payment; and
v.
Funds of an individual 65 or older, which are transferred to a pooled trust
shall be subject to the transfer penalty provisions contained in
10:71-4.10.
(h) Title XIX of the Social Security Act ( 42 U.S.C. § 1917(d)(4)(B)) provides for an exemption from the trust provisions for qualified income trusts (also known as Miller trusts). Special provisions for this form of trust apply, under the law, only in those states which do not provide medically needy coverage for nursing facility services. Because New Jersey does cover services in nursing facilities under the medically needy component of the Medicaid program, the establishment of a qualified income trust shall be presumed to be an asset transfer for the purposes of qualifying for Medicaid. This presumption shall apply whether the individual is seeking nursing facility services or home and community based services under one of the waiver programs.
(i) Upon the denial of eligibility or the termination of long-term care level services due to the application of the trust provisions in (e) and (f) above, the county welfare agency shall notify the applicant/beneficiary of his or her right to request an undue hardship exception. An applicant/beneficiary may apply for an exception to these trust provisions if he or she can show that the transfer will cause an undue hardship to him- or herself. The applicant/beneficiary shall provide sufficient documentation to support the request for an undue hardship waiver to the county welfare agency within 20 days of notification of the denial of eligibility or termination of benefits due to these trust provisions.
1. For the purposes of this chapter, undue
hardship shall be considered to exist when:
i. The application of the trust provisions
would deprive the applicant/beneficiary of medical care such that his or her
health or his or her life would be endangered. Undue hardship may also exist
when application of the trust provisions would deprive the individual of food,
clothing, shelter, or other necessities of life; and
ii. The applicant/beneficiary can irrefutably
demonstrate the assets placed in trust are beyond his or her control and that
the asset cannot be recovered. The applicant/beneficiary shall demonstrate that
he or she made good faith efforts, including exhaustion of remedies available
at law or in equity, to recover the assets placed in trust.
2. In the event that a waiver of
undue hardship is denied, neither the Department of Human Services, the
Department of Health and Senior Services, nor the county boards of social
services shall have any obligation to take any action to assure that payment of
services is provided during the penalty period.
3. If the request for undue hardship
consideration is denied by the county welfare agency, the county welfare agency
shall notify the applicant of the denial and that the applicant may request a
fair hearing in accordance with the provisions of N.J.A.C. 10:49-10.
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