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Trust Unit/Special Needs Trusts FAQ

1. What is a trust?

A trust is a legal arrangement where property is held by a trustee (the person who handles the trust) for the benefit of a beneficiary (the person for whom the trust is created). It is usually established either by a written trust agreement or by the terms of a will. The general administration of the trust is governed by the terms of the document that creates it.

2. What is the Trust Unit?

The Trust Unit is the office that reviews Special Needs Trusts (SNTs) and annual trust accountings sent to the Legal Services Section of the Georgia DCH.

3. Why does Georgia review Special Needs Trusts?

If a SNT does not meet certain legal requirements the beneficiary might not be able to become eligible for Medicaid or might lose eligibility for Medicaid. These legal requirements are specified by federal law and policy and Georgia law and policy.

4. What rules apply to trust expenditures?

In general terms, trustees must always follow the federal and state law applicable to Special Needs Trusts, and also Georgia Medicaid policy. This Georgia policy is located in the Georgia Department of Human Resources’ Division of Family and Children Services (DFCS) Medicaid Manual at Section 2337 for Qualified Income Trusts and Pooled Trusts and at Section 2346 for Special Needs Trusts. The Manual can be found in local DFCS offices.

5. What happens at the trust beneficiary’s death?

Notice of the death must be given to the Trust Review Unit and DCH Third Party Liability within five (5) days of the death, preferably by fax (678-564-1169). The notification should include:

  • Full name of the deceased beneficiary
  • Medicaid ID number and/or Social Security number of the beneficiary
  • Date of death and copy of the death certificate
  • Contact information for the personal representative and/or attorney handling the estate, including name, address, and telephone number

When the Death Certificate is issued, arrangements for appropriate repayment of medical assistance received will be made and payment, along with a copy of the Death Certificate, must be sent to:
Georgia Department of Community Health
Attn: Trust Unit
900 Circle 75 Parkway
Suite 650
Atlanta, GA 30339

6. What trusts need to be sent in for review?

Trusts that need to be sent to the DCH Trust Unit for review include (1) Special Needs Trusts funded with assets of the person establishing the trust or with assets of the beneficiary, (2) Pooled Trust Accounts (3) Testamentary Special Needs Trusts (including those set up in a Living Trust or Family Trust), and (4) Third Party Special Needs Trusts where the beneficiary is receiving Medicaid.

7. Where are trusts sent for review?

Trust documents and supporting documentation are sent to:
Georgia Department of Community Health
Attn: Trust Review Unit
900 Circle 75 Parkway
Suite 650
Atlanta, GA 30339

Phone: 678-564-1168
Fax: 678-564-1169

8. What is the review process?

The review process is a standardized system in which the trust document and all supporting documentation are reviewed to make sure that the requirements of federal law and policy and Georgia law and policy have been met. The source of funds going into the trust must be revealed. If the funds come from a lawsuit or settlement and there is a pre-trust Medicaid lien, the lien must be resolved before the trust can be approved. Opportunities are provided to make needed corrections or provide additional information. The process is designed to encourage approvals.

9. How long does the review take?

If the trust document and all necessary supporting documentation are submitted and the required criteria are met, a trust generally can be approved in 30 to 45 days. If there are problems or deficiencies, there is a More Information Needed process that provides notice of the specific problems and/or deficiencies and allows time to correct them.

10. What happens if the trust is approved?

If the trust is approved, the approval is entered in the records and a formal Approval Notice is issued and mailed to the person who submitted the trust. The notice includes a reminder that an annual inventory update and accounting must be filed within sixty (60) days of the anniversary date of the trust.

11. What happens if the trust is not approved?

If the trust is not approved, a formal Denial Notice is mailed to the person who submitted the trust, and to DFCS. This denial may result in the loss of eligibility for Medicaid. In the Denial Notice, one last opportunity is given to request Reconsideration. The Reconsideration process gives additional time for any problems and/or deficiencies to be corrected.

12. Who reviews trust accountings?

Annual inventory updates and accountings are reviewed by the Accounting Review staff of the Trust Unit, which includes a Certified Public Accountant (CPA).

13. What are the trust accounting requirements?

The basic requirement is that the trustee must annually file an inventory update and accounting with the Trust Unit. The inventory update and accounting must be filed within sixty (60) days of the anniversary date of the establishment of the trust, and must include copies of financial statements that verify the trust inventory. A general guide on how to prepare accountings is available from the Trust Unit.

14. What is the accounting review process?

The accounting review process consists of a financial examination of the trust inventory updates and annual accountings filed by the trustees of approved SNTs. The general purpose of this review is to verify the financial integrity of the trust and that the trust is being administered for the sole benefit of the beneficiary. At the conclusion of the trust accounting review process, the annual inventory update and accounting is formally approved or denied. Denial may result in the loss of eligibility for Medicaid.

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