Income Spend Down Trust Program

Why Use an Income Spend Down Trust?

Individuals whose monthly income exceeds the Home and Community-Based Services (“HCBS”) waiver limit within a few hundred dollars may become eligible for enrollment through the use of an Income Spend Down (“ISD”) Trust.

The ISD Program allows individuals who rely on the HCBS waiver to remain in their homes while continuing to receive essential healthcare and support services.
 

What is an Income Spend Down Trust? 

The Home and Community-Based Services (HCBS) waiver program requires applicants to meet specific financial eligibility criteria, including a maximum gross monthly income of $2,982, among other requirements, in order to receive waiver services.

The Income Spend Down Trust Program offered by Achieva Family Trust is designed for waiver applicants whose monthly income exceeds this limit by up to a few hundred dollars. This allows an applicant’s “excess income” to be deposited into an “Income Spend Down” pooled trust, allowing the individual to maintain eligibility for waiver services.

Individuals age 65 and older who utilize an Income Spend Down Trust are additionally required to spend down these trust funds each month on qualified medical or care-related expenses.

What does the ISD Trust Program Do? 

The ISD Program provides:

• Monthly Income Management – Captures excess income exceeding Medicaid limits and administers it through the Income Spend Down Trust.
• Expense Review & Payment – Reviews beneficiary expenses to be “spent down” to ensure they are allowable, reasonable, and properly documented.
• Medicaid Compliance Support – Helps ensure all expenditures align with Medicaid rules and avoid jeopardizing eligibility.
• Administrative Oversight – Maintains records, tracking, and reporting to support continued program compliance.
• Coordination with Legal & Care Teams – Collaborates with attorneys, guardians, caseworkers, and other professionals to support the beneficiary’s overall care and financial plan.

Program Eligibility Requirements

Applicants must:

• Be eligible for Community Health Choices (“CHC”) or Living Independence for the Elderly (“LIFE”) according to the respective program requirements;
• Have a gross monthly income within
  • $300 above the HCBS waiver incomelimit for the CHC Program, or
  • $500 above the HCBS waiver income limit for the LIFE Program above
• Have countable assets under $8,000 (single applicants);
• Possess the legal capacity to execute the required documents (or have a valid Power of Attorney or court-appointed Guardian); and
• For CHC participants age 65+ ONLY: Be able to consistently provide documentation of ongoing, unreimbursed medical or care-related expenses equal to their monthly excess income amount.

Learn More

For additional information regarding enrollment, eligibility, or coordination with existing estate plans, please contact the Achieva Family Trust Legal Department: