QUESTION
               Whether the Charities Pooled Trust (CPT), which operates in every state in this region,
                  qualifies as a pooled trust under the Social Security Act (Act), 42 U.S.C. § 1396p(d)(4)(C),
                  and the relevant provisions of the Program Operations Manual System (POMS).
               
               OPINION
               CPT qualifies as a pooled trust under 42 U.S.C. § 1396p(d)(4)(C) and the relevant
                  POMS provisions.
               
               BACKGROUND
               Between October 2016 and July 2018, CPT executive director, W~, executed Master Trust
                  Agreements (MTAs) in Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
                  South Carolina, and Tennessee. Each trust established CPT as a pooled trust in these
                  respective states. The MTA for each state includes identical provisions, except with
                  respect to the extent to which the MTA addresses directed trustees, whether the trustee
                  will notify the state’s Medicaid agency about a beneficiary’s death, and how the trust
                  will distribute the remainder funds in an individual benefit account (IBA) upon a
                  beneficiary’s death. The MTAs also have identical joinder agreements.
               
               NH1, a number holder living in Kentucky, NH2, a number holder living in Tennessee,
                  and NH3, a number holder living in Florida, receive Supplemental Security Income (SSI).
                  NH1 signed a Joinder Agreement with CPT under the Kentucky MTA on February 13, 2017.
                  NH2’s parent and grandparent signed a Joinder Agreement with CPT under the Tennessee
                  MTA on July 3, 2019. NH3 signed a Joinder Agreement with CPT under the Florida MTA
                  on August 22, 2018. NH1, NH2, and NH3 funded the IBAs of their respective trusts through
                  the transfer of their own assets to the trusts.
               
               I. Purpose and Establishment of the Trust
               CPT’s MTAs identify CPT as the Trustee. See MTA, § 2.2.[8] They identify CPT as a non-profit corporation recognized as tax-exempt under section
                  501(c)(3) of the Internal Revenue Code. Seeid.
               The MTAs indicate that the trust intends to comply with 42 U.S.C. § 1396p(d)(4)(C)
                  (§ 1917(d)(4)(A) of the Act). See MTA, § 1.5. They indicate that each trust shall establish a separate account for
                  each beneficiary, but may pool the amounts in the separate accounts for investment
                  and management purposes. See MTA, §§ 4.1, 9.1.
               
               The MTAs classify a trust beneficiary as a person with a disability, as defined by
                  42 U.S.C. § 1382c(a)(3) (codifying § 1614(a)(3) of the Act), whom a grantor identifies
                  as the sole recipient of services and benefits from the individual account created
                  within the trust for such person with a disability. See MTA, § 13.12; Alabama, Georgia, Mississippi, North Carolina, South Carolina MTA,
                  § 2.4; Florida, Kentucky, Tennessee MTA, § 2.6. A trust beneficiary, or the trust
                  beneficiary’s parent, grandparent, or legal guardian, or another person or entity
                  acting pursuant to a court order or other legal authority, can be a grantor and can
                  establish an account for a trust beneficiary in the Trust and contribute assets to
                  the trust for the sole benefit of the trust beneficiary. See MTA, § 3.1; Alabama, Georgia, Mississippi, North Carolina, South Carolina MTA, §
                  2.3; Florida, Kentucky, Tennessee MTA, § 2.5. The stated purpose of the trust is to
                  supplement, not displace, a beneficiary’s government benefits. See MTA, § 3.2.
               
               II. Distribution and Powers of the Trustee
               The Trustee is responsible for overseeing the custody, investment asset allocation
                  model selection, and disbursement of funds contributed to the trusts. See MTA, § 2.2. In carrying out this responsibility, the Trustee may retain an independent
                  investment advisor to handle the custody, investment, and management of the trust
                  assets. See Alabama, Georgia, Mississippi, North Carolina, South Carolina MTA, § 2.5; Florida,
                  Kentucky, Tennessee MTA, § 2.7. The Trustee and any investment advisor shall perform
                  their duties provided in the trusts to receive, hold, manage, and control all income
                  and principal in the IBAs comprising the Trust as may be appropriate to effectuate
                  the intent and purpose of the trusts. See MTA, § 10.1.
               
               The Trustee shall hold, administer, and distribute all property and income from an
                  individual trust beneficiary’s IBA for the sole benefit of the beneficiary. See MTA, §§ 6.1, 6.2. Distributions are solely within the Trustee’s discretion, but the
                  Trustee must make them for the sole benefit of a beneficiary and should make them
                  if the distribution has the effect of supplanting or replacing any government assistance
                  or disqualifying a beneficiary from receiving government assistance. See MTA, § 6.1.
               
               The Trustee assesses enrollment fees for the fees and expenses associated with a beneficiary
                  enrolling in one of the trusts and establishing an IBA and annual administration fees
                  for the administration and maintenance of an IBA at the time a beneficiary enrolls
                  in the trust. See MTA, § 9.2. The Trustee may adjust the enrollment fees schedule and annual administration
                  fees schedule from time to time. See id.
               III. Irrevocability and Spendthrift
               The trusts established under each state’s MTA are irrevocable upon the Trustee’s acceptance
                  of a beneficiary’s joinder agreement and related required documents, and the grantor’s
                  contributed amount, and upon the grantor and beneficiary completing the enrollment
                  requirements to join the trust. See MTA, § 1.3. The MTA treats the amount contributed to a beneficiary’s IBA as irrevocably
                  assigned, transferred, conveyed and delivered to the Trustee to be used for the sole
                  benefit of the beneficiary. MTA, § 4.2. Once the Trustee accepts the contributed amount,
                  it is not refundable to the beneficiary. Seeid. A beneficiary has no right to demand a distribution from the trust for his or her
                  own support or maintenance. See MTA, § 9.8.
               
               Each trust is a spendthrift trust. See MTA, § 9.9. No beneficiary can subject any part of either trust to an assignment;
                  attachment; levy; a creditor’s control; a creditor’s legal or equitable action, proceeding,
                  suit, or procedure to take from the Trust; or a compelled distribution to any beneficiary’s
                  creditor. Seeid.
               IV. Termination
               Upon a beneficiary’s death, the Trustee will use remaining funds in the beneficiary’s
                  IBA to pay back to a state’s Medicaid agency or agencies an amount equal to the total
                  amount of medical assistance paid on behalf of the beneficiary under a state Medicaid
                  plan. See MTA § 7.2B, D. If the payback amount is equal or greater than the amount remaining
                  in the IBA, the MTAs for Alabama, Georgia, and North Carolina indicate that the trust
                  will retain ten percent of the remaining amount and use the remaining ninety percent
                  to pay back the Medicaid agency or agencies. Alabama, Georgia, North Carolina MTA,
                  § 7.2D.1. The MTAs for the rest of the states in the Atlanta region indicate that
                  under the same circumstances, the Trust will retain fifty percent of the remaining
                  amount and use the remaining fifty percent to pay back the Medicaid agency or agencies.
                  See Kentucky, Mississippi, South Carolina, Tennessee MTA, § 7.2D.1. If the payback amount
                  is less than the amount remaining in the IBA, the MTAs for every state in the Atlanta
                  region indicate that the Trust will retain five percent of the amount remaining in
                  the IBA and pay back the full amount to the Medicaid agency or agencies. See MTA, § 7.2D.2. The Trustee will distribute any remaining amount left after the Trust
                  retains five percent and pays back the Medicaid agency or agencies to any remainder
                  beneficiaries of the deceased beneficiary identified in the IBA joinder agreement.
                  See MTA, § 7.2C, D.2.
               
               A beneficiary cannot terminate the Trust or any part of the beneficiary’s IBA at any
                  time, under any circumstances. See MTA, § 8.1. If the Trust terminates during the lifetime of a beneficiary, the Trustee
                  will use any funds remaining in an IBA to pay back a state’s Medicaid agency or agencies
                  an amount equal to the total amount of medical assistance paid on behalf of the beneficiary
                  under a state Medicaid plan, with the remaining amounts distributed to the beneficiary.
                  See MTA, § 8.1.
               
               DISCUSSION
               A. To qualify as a pooled trust, a trust must meet six
                     requirements.
               To be eligible for Supplemental Security Income (SSI), the dollar value of a claimant’s
                  countable resources cannot exceed certain statutory limits. See 42 U.S.C. § 1382(a)(1)(B), (3)(B); 20 C.F.R. §§ 416.202(d), 416.1201, 416.1205; POMS
                  SI 01110.003(A). Under 42 U.S.C. § 1382b(e), a trust is a resource unless it meets certain requirements,
                  including those articulated in § 1396p(d)(4)(C). Trusts that meet the requirements
                  of 42 U.S.C. § 1396p(d)(4)(C) are considered to be qualifying pooled trusts.
               
               B. The MTAs for every state in the Atlanta Region qualifies as a pooled
                     trust.
               The MTAs for every state in this region qualify as pooled trusts. As further explained
                  below, the MTAs meet each of the six criteria articulated in 42 U.S.C. § 1396p(d)(4)(C)
                  as follows:
               
               1. Disabled Individual
               To qualify as a pooled trust, the trust must contain “the assets of an individual
                  who is disabled.” 42 U.S.C. § 1396p(d)(4)(C); see POMS SI 01120.203.D.2 (stating that “the individual whose assets were used to establish the trust account
                  must be disabled for SSI purposes . . . .”). That requirement is satisfied here.
               
               The MTAs require that a trust beneficiary be a person with a disability. See MTA, § 13.12; Alabama, Georgia, Mississippi, North Carolina, South Carolina MTA,
                  § 2.4; Florida, Kentucky, Tennessee MTA, § 2.6. Although a grantor besides the trust
                  beneficiary may contribute assets to the trust, the grantor makes those contributions
                  for the sole benefit of the trust beneficiary. See MTA, § 3.1; Alabama, Georgia, Mississippi, North Carolina, South Carolina MTA, §
                  2.3; Florida, Kentucky, Tennessee MTA, § 2.5. Additionally, the individuals who established
                  IBAs under the MTAs for Florida, Kentucky, and Tennessee are disabled and used their
                  own assets to fund their IBAs.
               
               2. Established and Managed by a Nonprofit
                        Association
               Second, the trust must be “established and managed by a non-profit association.” 42
                  U.S.C. § 1396p(d)(4)(C)(i); see POMS SI 01120.203.D.3 (trust is “established and maintained by the actions of a nonprofit association”).
                  This requirement is satisfied as well.
               
               According to the MTAs, CPT is the settlor and trustee of the MTAs and is a non-profit
                  corporation under section 501(c)(3) of the Internal Revenue Code. MTA, § 2.2. CPT
                  is a fictitious name for the Institute for Health Care Advocacy, Inc. See sunbiz.org – Florida Department of State, http://dos.sunbiz.org/scripts/ficidet.exe?action=DETREG&docnum=G09000149562&rdocnum=G09000149562 (last accessed Feb. 24, 2020). The Institute for Health Care Advocacy, Inc. is an
                  active not-for-profit Florida corporation. See sunbiz.org – Florida Department of State, http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=INSTITUTEFORHEALTHCAREADVOCACY%20N930000037871&aggregateId=domnp-n93000003787-3d08880b-9b2a-400f-bc4b-4f26864703fb&searchTerm=Institute%20for%20Health%20Care%20Advocacy&listNameOrder=INSTITUTEFORHEALTHCAREADVOCACY%20N930000037871 (last accessed Feb. 24, 2020). The fictitious name registration for CPT expired on
                  December 31, 2019. See sunbiz.org – Florida Department of State, http://dos.sunbiz.org/scripts/ficidet.exe?action=DETREG&docnum=G09000149562&rdocnum=G09000149562 (last accessed Feb. 24, 2020). However, under Florida law, the failure of a business
                  to register a fictitious name “does not impair the validity of any contract, deed,
                  mortgage, security interest, lien, or act of such business . . . .” Fla. Stat. Ann.
                  § 865.09(9)(b). Accordingly, this requirement is still satisfied in spite of the failure
                  of the Institute for Health Care Advocacy, Inc., to maintain its registration of CPT
                  as a fictitious name.
               
               3. Separate Accounts, Pooled for Investing
               Third, to be a pooled trust, the trust must maintain a separate account for each beneficiary.
                  42 U.S.C. § 1396p(d)(4)(C)(ii); see POMS SI 01120.203.D.4. However, “for purposes of investment and management of funds, the trust pools
                  these accounts.” 42 U.S.C. § 1396p(d)(4)(C)(ii); seePOMS SI 01120.203.D.4 (the “trust may pool the funds in the individual accounts . . . for purposes
                  of investment and management of funds”). This requirement is reflected in POMS, which
                  notes that “[t]he trust must be able to provide an individual accounting for each
                  individual.” POMS SI 01120.203.D.4. The MTAs for every state in this region meet these requirements.
               
               The MTAs indicate that each trust shall establish a separate account for each beneficiary,
                  but trust may pool the amounts in the separate accounts for investment and management
                  purposes. MTA, §§ 4.1, 9.1. The MTAs also indicate that the trustee, or its agent,
                  must “maintain records for each Trust IBA in the name of each Trust Beneficiary and
                  showing the Contributed Amount plus any income earned from the Contributed Amount.”
                  MTA, § 4.1. The trust must provide periodic reports, at least annually, about receipts
                  and disbursements to and from the individual’s account. See MTA, § 9.4.
               
               4. Established for the Sole Benefit of the Disabled
                        Individual
               The fourth requirement for a pooled trust is that the trust account is “established
                  solely for the benefit of individuals who are disabled.” 42 U.S.C. § 1396p(d)(4)(C)(iii);
                  accord POMS SI 01120.203.D.5 (trust “must be established for the sole benefit of the disabled individual”).
                  The statute does not provide guidance on “sole benefit,” but the POMS explains that
                  a trust is “established for the sole benefit of an individual” when it “benefits no
                  one but that individual, whether at the time the trust is established or at any time
                  for the remainder of the individual’s life.” POMS SI 01120.201.F.1.
               
               The trust may pay third parties for goods or services for the beneficiary and still
                  be for the “sole benefit” of the beneficiary. POMS SI 01120.201.F.3. The trust also may “provide for reasonable compensation for (a) trustee(s) to
                  manage the trust and reasonable costs associated with investment, legal, or other
                  services rendered on behalf of the individual with regard to the trust.” POMS SI 01120.201.F.4.
               
               The MTAs for every state in this region meet this requirement. The MTAs indicate that
                  the trustee must “hold, administer, and distribute all property, and all income therefrom
                  from an Individual Trust Beneficiary’s IBA, for the sole
                     benefit of the Trust Beneficiary during the Trust Beneficiary’s lifetime and after Trust
                  termination.” MTA, § 6.2 (emphasis in original); MTA, § 6.3 (“Trust Beneficiary’s
                  IBA is for the sole benefit of the Trust Beneficiary.”) (emphasis in original).
               
               The MTAs also allow for fees in accordance with a written fee schedule and expenses
                  for administering the trust. MTA, §§ 9.2, 10.5. The MTAs further state that the trust
                  will compensate a trustee for “services rendered and reimbursed reasonable expenses
                  incurred on behalf of the Trust or a Trust Beneficiary.” MTA, § 10.5. Additionally,
                  the MTAs allow for charges of pro rata legal fees to all individual trust accounts,
                  or to accounts of affected beneficiaries, and the trustee will determine “if defense
                  costs affect a substantial number of Trust beneficiaries” and warrant allocation.
                  MTA, § 10.6. These provisions pass muster under the statute because they constitute
                  “reasonable costs associated with investment, legal, or other services rendered on
                  behalf of the individual with regard to the trust.” POMS SI 01120.201.F.4.
               
               The MTAs contain an early termination provision that accounts for a scenario where
                  the trust terminates prior to the death of the beneficiary. MTA, Art. 8. An early
                  termination provision is allowable under the pooled-trust exception so long as three
                  criteria are met: (1) “[u]pon early termination (i.e., termination prior to the death
                  of the beneficiary), the State(s), as primary assignee, would receive all amounts
                  remaining in the trust at the time of termination up to an amount equal to the total
                  amount of medical assistance paid on behalf of the individual under the State Medicaid
                  plan(s);” (2) “[o]ther than payment for those expenses [for taxes, reasonable fees,
                  and administrative expenses], no entity other than the trust beneficiary may benefit
                  from the early termination (i.e., after reimbursement to the State(s), all remaining funds are disbursed to the trust beneficiary);” and (3) “[t]he early termination
                  clause gives the power to terminate to someone other than the trust beneficiary.”
                  POMS SI 01120.199.F.1 (bold in original). The trust may pay taxes, reasonable fees, and administrative
                  expenses before reimbursing any state(s) for medical assistance. See POMS SI 01120.199.F.3.
               
               The MTAs for this region satisfy these criteria. Specifically, the MTAs indicate that,
                  if the trust terminates during the beneficiary’s life, all remaining funds in that
                  account will be paid to reimburse each state for medical assistance paid on behalf
                  of the beneficiary. MTA, § 8.1. The MTAs also indicate that, after paying the states,
                  “if there are any assets remaining, the Trustee shall distribute all of the remaining
                  assets to the Trust Beneficiary.” MTA, § 8.1. Additionally, the beneficiary does not
                  have the power to terminate his or her trust account. See MTA, § 8.1.[9]
               5. Established Through the Actions of the Individual, Parent,
                        Grandparent, Legal Guardian, or Court
               To qualify as a pooled trust, the trust account also must be “established... by the
                  parent, grandparent, or legal guardian of such individuals, by such individuals, or
                  by a court.” 42 U.S.C. § 1396p(d)(4)(C)(iii); see POMS SI 01120.203.D.6. The MTAs here meet this requirement, as they require that a beneficiary or a
                  grantor, who must be a parent, grandparent, legal guardian, or other person acting
                  pursuant to a court order, execute the joinder agreement to establish an IBA under
                  the MTA. MTA, §§ 3.1, 13.2; Alabama, Georgia, Mississippi, North Carolina, South Carolina
                  MTA, § 2.3; Florida, Kentucky, Tennessee MTA, § 2.5. The joinder agreements submitted
                  for NH1, NH2, and NH3 for the Florida, Kentucky, and Tennessee MTAs, respectively,
                  also show that each of these individuals have established their IBAs either through
                  their own actions or through the actions of their parents.
               
               6. Remaining Amounts Paid to the State
               Sixth, “[t]o the extent that amounts remaining in the beneficiary’s account upon the
                  death of the beneficiary are not retained by the trust, the trust pays to the State
                  from such remaining amounts in the account an amount equal to the total amount of
                  medical assistance paid on behalf of the beneficiary under the State plan.” 42 U.S.C.
                  § 1396p(d)(4)(C)(iv); accord POMS SI 01120.203.D.8. The trustee may pay taxes and reasonable fees and costs before paying the state
                  for medical assistance. SeePOMS SI 01120.203.E.1.
               
               The MTAs meet this requirement, as well. Specifically, the MTAs allocate remaining
                  assets between the trust, the state(s), and the remainder beneficiaries. MTA, § 7.2.
                  If the state medical assistance amount is equal to or greater than the total amount
                  left in the beneficiary’s IBA, the MTAs for Alabama, Georgia, and North Carolina state
                  that the trust will retain ten percent of the remaining amount and use the remaining
                  ninety percent to pay back the Medicaid agency or agencies. See Alabama, Georgia, North Carolina MTA, § 7.2D.1. The MTAs for the rest of the states
                  in the Atlanta region state that under the same circumstances, the trust will retain
                  fifty percent of the remaining amount and use the remaining fifty percent to pay back
                  the Medicaid agency or agencies. See Kentucky, Mississippi, South Carolina, Tennessee MTA § 7.2D.1. If the state medical
                  assistance amount is less than the amount left in the beneficiary’s IBA, the trust
                  in every state in the Atlanta region will retain the first five percent of the amount;
                  the trustee will pay the full amount owed to the state; and the trustee will pay any
                  remaining amount to the beneficiary’s heirs. See MTA, § 7.2D.2. This distribution scheme comports with the statute.
               
               In addition, the MTAs allow the trustee to pay certain administrative expenses, such
                  as taxes and reasonable fees and costs, before paying the state for medical assistance.
                  MTA, § 7.4A. The MTAs incorporate by reference the allowable and prohibited expenses
                  in SSA’s POMS, by stating the Trustee will not pay any administrative expenses not
                  allowed by the SSA’s POMS. MTA, § 7.4B.
               
               CONCLUSION
               The Trust complies with all the requirements for a pooled trust under section 1917(d)(4)(C)
                  of the Act and the implementing POMS provisions.