How to notify government agencies after establishing a self-funded Wispact trust

last updated 02/22/2021

You have successfully opened and funded a new Wispact Trust I sub-account for a client. Now you must notify the proper government agencies of the trust’s creation and funding. What is required, and how should you give the notice?

Quick answer

If the Wispact beneficiary receives Wisconsin Medicaid, fax the Contribution Agreement and a cover letter describing the source, date, and authority of all transfers to the trust to the CDPU at 1-855-293-1822 (or 1-888-409-1979 for Milwaukee). Don’t forget to identify the beneficiary’s name and case number.

If the Wispact beneficiary receives SSI, fax or mail the Contribution Agreement and a cover letter describing the source, date, and authority of all transfers to the trust to the beneficiary’s local Social Security office (which can be located here). Don’t forget to identify the beneficiary’s name and social security number.

Finally, send a copy of these notices to Wispact. You can mail them to Wispact, Inc., 226 Corporate Dr., Madison, WI 53714 or fax them to 608-252-8449.


Wispact forms: Contribution Agreement; Attorney Instructions for Trust 1

Wispact Attorney Sample Documents

Medicaid Eligibility Handbook § 16.6.6

Wis. Admin. Code § DHS 104.02(6)

POMS SI 02301.005


According to Wispact’s Contribution Agreement and Attorney Instructions, it is the attorney’s responsibility to notify the proper government agencies after creation and funding:

  • You must give notice “as required by applicable public benefits laws” for any public benefits the beneficiary is currently receiving or may receive in the near future.
  • A notice typically includes:
    1. A statement of all transfers to the trust, including each transfer’s source, date, and authority; and
    2. A copy of the Contribution Agreement.
  • You must provide Wispact with a copy of the notice or an affidavit of mailing to verify that notice has been mailed to the appropriate government agencies.
  • You must continue the representation until a determination has been made on the effect of this sub-account on the beneficiary’s public benefits. You must timely appeal any adverse ruling and notify Wispact of it (Wispact may intervene as an interested party and may help pay the cost of an appeal).

In most cases, the means-tested public benefits requiring notice will be a Wisconsin Medical Assistance program (i.e. Medicaid), Supplemental Security Income (SSI), or both.

Notice required for Wisconsin Medical Assistance
Wisconsin Medicaid members must report any change in income or assets “which may affect eligibility.” Medicaid Eligibility Handbook § 12.1, Wis. Admin. Code § DHS 104.02(6). That would include establishing a Wispact trust sub-account. The report is made to the income maintenance agency—the county income maintenance or economic support agency, or the consortium it’s part of. The Wisconsin Dept. of Health Services collects the contact information for all county income maintenance agencies and consortia here.

Probably the easiest way to give notice is by fax, because the number is the same for every county (except Milwaukee): 1-855-293-1822. The fax goes to the Centralized Document Processing Unit (the CDPU, as we say in the biz) in Janesville. For Milwaukee, it’s 1-888-409-1979 for the MDPU.

Notice required for SSI
Recipients of SSI (or their representative payees) must report changes “that can affect SSI benefits.” POMS SI 02301.005. That would include establishing a Wispact trust sub-account.

According to the POMS, the report should include:

  • The reporter’s name;
  • The recipient’s name and social security number;
  • Facts about the change; and
  • When the change happened.

The report can be “in writing, by telephone, or in person.” Id. Make the report to the recipient’s local Social Security office—you can use SSA’s online office locator for the contact info.

The report is due within 10 calendar days after the month in which the change occurred. When reporting by mail, the postmark must be within that period. Id.

Form letter language

You can find several examples of notice letters at Here’s my own take:

Re: Creation of sub-account in Wispact (d)(4)(C) pooled trust, [client name, SSN, case no.]

Please take notice that my client, [client name], has created and funded a sub-account in a pooled trust under 42 U.S.C. § 1396p(d)(4)(C). This sub-account is an exempt resource for the purpose of determining SSI and Medical Assistance eligibility. The Social Security Administration’s regional office in Chicago has also approved Wispact Trust I as an exempt resource and has the master trust on file.

Here are the details of the trust:

  • The sub-account number is [___________].
  • The master trust’s name is Wispact Trust I. The master trust document can be found at
  • The master trust and sub-account are managed by Wispact, Inc., of 226 Corporate Dr., Madison, WI 53714.
  • The sub-account was funded by [name of Applicant] as [source of legal authority]. It was funded with a cashier’s check for [$___] dated [___]. A copy of the check is enclosed.
  • A copy of the Wispact Contribution Agreement dated [___] establishing the sub-account is enclosed.

If you need any more information about the creation of this trust, please contact me.