What Can a Qualified Income Trust Pay For in Missouri?
In Missouri the trust is used only for the HCB in-home waiver (age 63 and over) and the MOCDD program for children. At least the income above the HCB maximum goes in each month, and the trustee may spend it only on the uses the state's form lists: the medical and care needs of the participant, or of a spouse or disabled or minor child living with them, and certain costs of running the trust. There is no personal needs allowance, spousal allowance or payment to a facility, because the participant keeps their income up to the maximum outside the trust. Every item below is cited to Missouri FSD's own published rules; where Missouri FSD says nothing about an item, this page says so instead of filling the gap. This guide is informational only and is not legal or financial advice.
In Missouri, only the applicant's income above the HCB maximum goes into the trust, and the trustee may spend it only on the purposes Missouri FSD allows. Paying for anything else can put eligibility at risk. Here is the list, with the Missouri FSD source for each item.
What Missouri FSD's rules allow
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Medical benefit of the participant or family living with them
Distributions may be used only for the medical benefit of the participant, or of a spouse or disabled or minor child living with them, including non-covered qualified medical expenses.
Source: FSD form MO 886-4657, section 3.2
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Remedial care and health insurance
Remedial care, and premiums for health insurance other than MO HealthNet.
Source: FSD form MO 886-4657, section 3.2
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Dental, hearing and therapy services
Necessary dental care, auditory care, psychological services, supplemental nursing or physical therapy, and rehabilitation services.
Source: FSD form MO 886-4657, section 3.2
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Home modifications and medical transportation
Medically necessary improvements or alterations to real estate, and travel to and from medical or care appointments.
Source: FSD form MO 886-4657, section 3.2
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Personal care
Payments for personal care, subject to section 208.213, RSMo.
Source: FSD form MO 886-4657, section 3.2
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Reimbursing the participant
Reimbursement for out-of-pocket payments the participant made for one of the listed services.
Source: FSD form MO 886-4657, section 3.2
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Costs of running the trust
Trustee bonds required by law, bank fees on the trust account, reasonable legal fees to create and maintain the trust, reasonable guardianship fees, fees of a non-profit pooled-trust organization to create and maintain the trust, and taxes the trust owes.
Source: FSD form MO 886-4657, sections 3.2 and 3.3
Trustee and bank fees
The trustee may charge the lesser of 3% of the income diverted into the trust or $10 a month. A trustee who is the participant's spouse, or a disabled child living with them, may not take a fee; an unrelated commercial trustee may charge a commercially reasonable fee (FSD form MO 886-4657, section 3.3).
What the trust can't be used for
The trustee may make only the distributions sections 3.2 and 3.3 allow; any other distribution may affect eligibility unless the trustee restores the funds (section 3.4). FSD's review checklist says the trust may not buy life insurance, that travel for anyone other than the participant must be for the participant's benefit, and that paying for the funeral before the Medicaid payback is not acceptable.
Timing, and money left over
Income goes into the trust in the month it's received, or within 10 days if fewer than 10 days remain in the month. The form contemplates a running balance, and the trustee keeps full accounting records of deposits, disbursements and the balance for FSD's review (FSD form MO 886-4657, sections 1.3, 1.4, 3.1 and 3.5).
Keeping the monthly record
The trustee is the one who has to show that the trust paid only these items. A month-by-month record of every deposit and every payment, checked against the bank statement, is what makes that easy to show when Missouri FSD asks.
Related: who can be the trustee in Missouri, what happens to the money at death, and the Miller Trust trustee guide for how the monthly cycle works in every state.
Trust not open yet? The account comes first
None of these payments can start until the trust account exists, and most branches have never opened one. Free one-pager: the questions to ask before you drive to a branch, emailed now. Then 4 more short emails over the next 10 days — then we stop.