06/10/2025
Summary
- Medical eligibility or amount may be affected by donations or benefits received from fundraising.
- Donations or fundraising benefits directly received by the customer or their responsible relative are considered countable income in the month obtained. Any donations or fundraising benefits that roll over (remain) the following month may be counted as resources.
- Donations or fundraising benefits directly paid to a vendor or service provider are exempt.
- Introduction
- Income/Resources
- Types of Accounts
- Crowdfunding
- ABLE/Special Needs Trust (SNT) Accounts
- Manual Revisions
Introduction
This manual release updates medical policy on the applicability of donations or fundraising benefits in determining medical eligibility.
Medical assistance shall not be affected by the receipt of donations or benefits from fundraisers as long as neither the person nor members of the person's family have actual control over the funds. 305 ILCS 5/5-2 and 5-4.
Income/Resources
- Any funds directly paid to the vendor or service provider on behalf of the customer are exempt.
- If the customer is a direct recipient of funds from donations or fundraising benefits, it is countable income in the month received and a countable resource the following month.
- If some of the money being raised is used for immediate medically necessary needs, the funds can be used to meet spend-down and avoid benefit eligibility problems. That timing must be carefully coordinated because only funds spent in the same month they are received will not be counted as resources.
- Ex: Suzie has a spenddown of $1,000. Suzie has a surgery scheduled for January. Suzie's grandmother writes a check for $1,000 to Suzie in January. Suzie cashes the check in January and spends it in January on a medically needed wheelchair. The $1,000 medical expense to purchase the wheelchair will be used to meet Suzie spend-down for January, putting Suzie in 'met' status having full Medicaid coverage to cover the surgery.
Types of Accounts
Crowdfunding
Crowdfunding is the practice of obtaining needed funding by soliciting contributions from a large number of people, typically from an online community such as GoFundMe.
- If the customer sets up the account themselves and has access to it, it is countable income in the month received and a countable resource the following month.
ABLE/Special Needs Trust (SNT) Accounts
The Achieving a Better Life Experience Act of 2014, better known as the ABLE Act, created tax-free savings accounts that could be used to pay for disability-related expenses without affecting an individual's eligibility for medical. 26 U.S.C. § 529A, and 89 Ill. Adm. Code §113.141.
Note: Only individuals whose disability occurred prior to their turning 26 years of age can hold ABLE accounts.
A special needs trust (SNT), sometimes referred to as a supplemental needs trust, is a legal vehicle enabling assets to be held on behalf of someone with disabilities without affecting their eligibility for public benefits such as Medicaid or Supplemental Security Income.
Resources (funds) held by the trusts are not "countable" for the purpose of establishing medical eligibility.
- Funds must be written and deposited directly to the SNT or ABLE account.
- Customers must be careful: if the money goes to the customer first, it will count towards their eligibility.
Ex 1: Suzie's grandmother writes a check for $1,000 to Suzie. Suzie cashes the check and then writes another check to put the money into her ABLE account. This is considered income in the month received and a countable resource the following month.
Ex 2: Suzie's grandmother writes a check for $1,000 to Suzie's ABLE account. This is exempt.
Note: Upon the individual's death, funds remaining in an SNT, as well as an ABLE account, would be subject to claims by Medicaid for services performed.
Manual Revisions
[signed copy on file]
Dulce M. Quintero
Secretary, Illinois Department of Human Services
Elizabeth M. Whitehorn
Director, Illinois Department of Healthcare and Family Services
