Miller Trusts & Qualified Income Trusts, explained

This guide explains, in plain English, what a Miller Trust actually is, who needs one, exactly how the money moves through it, the one thing it cannot do, and the mistakes that cause it to fail.

What is a Miller Trust (Qualified Income Trust)?

A Miller Trust is an irrevocable trust that holds a person's income so that it no longer counts against Medicaid's income cap. The name comes from a court case; the formal name is a Qualified Income Trust, or QIT. Some states have their own label — Texas, for example, refers to it within its Medicaid planning framework — but the mechanism is the same.

The core idea is narrow and specific: in certain states, if your gross monthly income is above a fixed limit, you are denied long-term-care Medicaid — period. There is no partial qualification. A QIT lets income flow through the trust each month so the state no longer treats you as “over the cap.”

The 2026 number that matters: in most income-cap states the limit is $2,982 a month in gross income for a single applicant — that is 300% of the federal SSI benefit rate. If your income is at or below that, you generally do not need a Miller Trust. If it is over, in an income-cap state, a QIT is usually the path back to eligibility.

Who actually needs one?

You generally need a Miller Trust only if both of these are true:

• You live in an income-cap state (about 25 states use this system), and
• Your gross monthly income exceeds the cap (commonly $2,982 in 2026).

States that use an income cap include Florida, Texas, Georgia, and Ohio. Other states use a “medically needy” or spend-down pathway instead, where excess income goes toward your care rather than into a trust — those states do not use QITs at all. This is why the very first question is always which state.

Quick gut check: add up the applicant's gross Social Security, pension, and any other regular income before deductions. If that total is over the state cap and you are in an income-cap state, a QIT is probably in your future. If you are unsure whether your state is income-cap, that is the first thing to confirm with an attorney.

How the money actually moves (step by step)

This is where people get confused, so here is the mechanism in plain terms:

1. An attorney drafts the QIT to your state's exact requirements, and a trustee (often an adult child) is named.
2. Each month, enough of the applicant's income is deposited into the trust's bank account to bring the “counted” income below the cap. Many families simply route all of it through the trust.
3. The trustee then pays out, in the order the state allows: a small personal needs allowance for the applicant, any spousal income allowance for a husband or wife still at home, and the patient-pay amount to the nursing facility.
4. Whatever theoretically remains stays in the trust — and the state Medicaid agency is named as the remainder beneficiary.

Plain-English example (illustrative only): Say a parent receives $3,400 a month and the cap is $2,982. That $418 of “excess” income is what disqualifies them. By routing income through a Qualified Income Trust, the state stops counting it against the cap — and the money still goes toward the cost of care, which is exactly what Medicaid intends. The trust does not make the income disappear; it changes how it is counted.

The one thing a Miller Trust does not do

This is the most important paragraph on the page. A Miller Trust does not protect assets. It solves an income problem only. It does nothing for a house, savings, or investments, and it has no effect on the 5-year look-back.

Families routinely confuse the two. If your challenge is too much income, you may need a QIT. If your challenge is too many assets, that is a completely different conversation involving different tools — and getting it wrong can trigger penalties. See our guide on what a Medicaid planning attorney does for how the asset side is handled.

The mistakes that cause a Miller Trust to fail

1. Treating it as asset protection. The number-one error. It only handles income.
2. Not funding it every month. A QIT only works for the months income is actually deposited into the trust account. Miss a month and you can be ineligible for that month.
3. Using a generic online trust form. Each state has precise requirements for language, the remainder beneficiary, and how funds may be paid out. A near-miss can be rejected.
4. Putting the wrong money in. The trust holds income, not assets — depositing a lump sum of savings can create new problems.
5. Forgetting the state as remainder beneficiary. Omitting this required term can invalidate the trust.
6. Setting it up too late in the month. Timing of the first deposit relative to the application month matters.

How a Miller Trust gets set up

Because a Qualified Income Trust has to match your state's rules exactly and then be administered correctly every month, this is generally not a do-it-yourself project. A typical path looks like this:

• Confirm your state is an income-cap state and that income is actually over the limit.
• Have an elder law or Medicaid planning attorney draft the QIT for your state.
• Open a dedicated trust bank account (a separate account, not the applicant's personal one).
• Set up the monthly deposit and the trustee's monthly payments.
• Keep clean records for the Medicaid application and any redetermination.

Before you hire anyone: verify the attorney's current license, disciplinary history, and any elder-law certification directly with your state bar. A directory listing is a starting point for research — not a recommendation or endorsement.

How this fits with the rest of Medicaid planning

A Miller Trust is one piece of a larger picture. Most families dealing with the income cap are also weighing the 5-year look-back, asset rules, and the cost and timing of care. If a nursing home or extensive in-home care is on the horizon, talk to an elder law / Medicaid planning attorney about the whole plan — income and assets together — before moving any money. Find a Medicaid planning attorney in your state, or start with the state-by-state limits below.

Frequently asked questions

What is a Miller Trust?

A Miller Trust — also called a Qualified Income Trust (QIT) — is an irrevocable trust used in income-cap states. When a Medicaid applicant's gross monthly income is above the state's limit (commonly $2,982 a month in 2026, which is 300% of the SSI benefit rate), income deposited into the trust each month is no longer counted toward the cap, allowing the person to qualify for long-term-care Medicaid.

Does a Miller Trust protect my assets?

No. A Miller Trust solves an income problem, not an asset problem. It only changes how income is counted; it does nothing to shelter savings, a home, or other assets, and it has no effect on the 5-year look-back. This is the most common misunderstanding about Miller Trusts.

Which states require a Miller Trust?

Only income-cap states use Qualified Income Trusts. About 25 states are income-cap states, including Florida, Texas, Georgia, and Ohio. Other states use a medically-needy or spend-down pathway instead and do not use QITs. Whether you need one depends entirely on your state and your income.

What happens to the money when the person dies?

A Qualified Income Trust must name the state Medicaid agency as the remainder beneficiary. When the beneficiary dies, any funds left in the trust go to the state, up to the total amount Medicaid paid for that person's care. In practice little is usually left, because the income flows through the trust to pay for care each month.

How much does it cost to set up a Miller Trust?

Costs vary by state and attorney, but a Qualified Income Trust is usually a relatively modest, flat-fee document compared with full Medicaid planning. Because it must be drafted to your state's exact rules, funded correctly, and administered every month, most families use an elder law or Medicaid planning attorney rather than an online form.

What if it is not funded correctly each month?

A Miller Trust only works for the months it is properly funded. If the right income is not deposited into the trust in a given month, the person can be over the income cap and ineligible for that month, which can create coverage gaps and large out-of-pocket bills. Correct monthly administration is essential.