A qualifying income trust (QIT), also called a Miller Trust, must meet federal rules in 42 U.S.C. § 1396p(d)(4)(B) and your state Medicaid manual. The trust must be irrevocable, hold only the applicant's income (not savings or other assets), name the state as residuary beneficiary up to Medicaid payments made, and receive income deposits during the same calendar month the money arrives. Texas HHSC and Florida DCF add bank account, trustee, and legal review steps before nursing home or waiver coverage can start.
Congress added Qualified Income Trusts in 1993 through Section 1917 of the Social Security Act, now codified at 42 U.S.C. § 1396p(d)(4)(B). The statute lets income-cap states ignore income that passes through a properly structured trust when testing Medicaid eligibility for nursing home and home-and-community waiver services.
Four federal pillars apply in every state that allows QITs. The trust must be irrevocable. The corpus must contain only the applicant's income, including interest that accumulates inside the account. The state must be named residuary beneficiary to receive remaining funds at death, up to total Medicaid paid on the applicant's behalf. Income directed to the trust must be deposited during the calendar month it is received.
QITs do not waive the asset test. A retiree with $1,600 in countable resources and $3,400 monthly pension income still needs both a valid trust and a resource worksheet that passes. Read our Miller Trust guide for the full income-cap state list and filing sequence.
Helen, 79, in Mesa drew $3,150 gross monthly from Social Security and a railroad pension in February 2026. Her ALTCS caseworker counted $168 above Arizona's $2,982 cap. Helen's son opened a QIT at a local credit union, but the application stayed pending until Arizona DES saw a signed trust instrument, a dedicated account number, and a February deposit that brought outside income below the cap.
Common mistake:Treating a QIT like an asset protection trust. Federal law exempts only income streams, not IRA balances or home sale proceeds. Depositing principal can void the trust or trigger transfer penalties on a separate worksheet.
Medicaid agencies classify revocable trusts as available resources. If the applicant can cancel the arrangement and pull money back, the entire trust balance counts toward the $2,000 resource cap in Texas, Florida, and Georgia.
Texas Administrative Code § 358.339 and Florida DCF Appendix A-22.1 both state that a QIT must be irrevocable. Florida policy allows amendment language only when the power to amend does not include the power to revoke. A trust the applicant can dissolve next month fails the test.
Irrevocability also locks in the state residuary beneficiary clause. At death, remaining trust funds go to Texas HHSC, Florida AHCA, or the successor Medicaid agency before children or other heirs receive a distribution.
James, 82, in Fort Worth signed a trust his grandson found online that included a "revoke with 30 days notice" clause. HHSC legal staff rejected the document in January 2026 while James accrued $11,400 in private-pay nursing charges at a Tarrant County facility. His daughter paid an elder law attorney $1,800 to draft a new irrevocable instrument before February coverage could start.
The corpus of a QIT is income only. Texas F-6800 states plainly that if resources are placed in the trust, it is not a QIT. Florida DCF repeats the rule: consist of your income only, and do not include or add assets.
Qualifying deposits include Social Security, VA pension, railroad retirement, private pensions, annuity payments, and wages. Interest earned inside the QIT account stays inside and counts as trust income. Lump-sum retroactive Social Security awards, IRA withdrawals, CD principal, and inheritance checks are resources, not QIT deposits.
Texas requires the entire payment from each chosen income source to enter the trust. You may route only pension income while leaving Social Security in personal checking, but you cannot deposit half of a pension check and keep the rest outside.
Rosa, 76, in Jacksonville held $3,280 gross monthly in March 2026. Her son diverted $298 to a new QIT but left $200 of the same pension payment in her Wells Fargo checking account. Florida DCF denied ICP eligibility for March because the pension source was split across two accounts.
Compare trust income rules with spend down vs Miller trust when a family member suggests paying medical bills instead of opening a trust in Florida or Texas.
A QIT requires two pieces: a signed trust instrument and a dedicated financial account. Texas HHSC Appendix XXXVI calls the account a trust account at a bank or credit union used only for income listed in the trust document.
Open the account in the beneficiary's name with language that identifies it as a QIT. Texas expects the account to use the beneficiary's Social Security number. Ohio and Georgia manuals require the title to clearly identify the account as a qualified income trust.
Some banks demand a $10 to $20 opening deposit. Texas HHSC allows nominal resource deposits for that purpose without counting the amount as a gift or countable resource. After the account opens, only applicant income may enter.
Joint accounts create problems. Texas requires a new account when a joint owner makes personal deposits and withdrawals. Florida DCF expects a special account funded monthly. A convenience signer may be acceptable if that person never uses the account for personal funds.
Carlos, 84, in San Antonio tried to reuse a joint checking account he shared with his daughter. HHSC asked for a separate QIT account at Randolph-Brooks Federal Credit Union before STAR+PLUS waiver income could be disregarded in April 2026.
The deposit deadline is the calendar month income arrives, not the Medicaid application month or the nursing home admission date. Texas F-6800 states that income for which the trust is established must be deposited during the month it is received by the person.
Florida DCF is explicit: you cannot make deposits for a past or future month. Fail to deposit enough income in any given month and Medicaid will not pay long-term care services for that month. There is no retroactive fix.
Texas offers limited first-month relief. If only a partial deposit of the income source is possible in the opening month, HHSC may disregard the entire income source for that month when the trust is otherwise valid. Florida has no equivalent partial-month forgiveness for insufficient deposits.
Direct deposit is not required. A trustee may transfer funds manually, but the transfer must clear during the income month. Marco in Miami received a $1,640 Social Security deposit on March 3, 2026. His daughter moved $180 to the QIT on March 28. DCF counted the deposit as timely because it posted before March 31.
Income-cap states reject medical bill stacking for most nursing home cases. Read medically needy Medicaid explained only when your state runs a deductible spend-down pathway instead of a QIT.
The trustee manages the QIT account. Most states require someone other than the applicant to serve, often an adult child, professional fiduciary, or bank trust department. The trustee accepts deposits, pays authorized expenses, and keeps records for annual Medicaid reviews.
After Medicaid approval, trust income pays post-eligibility obligations in a fixed order. Personal needs allowance (often $45 to $60 monthly in Texas nursing homes) comes first when all income enters the trust. Community spouse monthly income allowance and dependent allowances follow state caps. Nursing home or waiver provider share-of-cost comes next. Medicaid pays the balance.
Georgia DFCS began twelve-month QIT account reviews in June 2025, coinciding with annual Medicaid redeterminations. Trustees should keep monthly bank statements, deposit logs, and disbursement receipts.
Eleanor, 80, in Atlanta named her niece trustee in May 2026. The niece paid the personal needs allowance to Eleanor's nursing home beauty shop account, sent $2,340 to the DeKalb County facility as patient liability, and left the trust near zero by May 31. DFCS requested the May statement at redetermination.
Trustee mistakes do not erase the irrevocable requirement. If the trustee misapplies funds, Medicaid may sanction the case or demand corrected payments, but the applicant cannot revoke the trust to reclaim deposits.
Common mistake:Letting the applicant sign checks from the QIT account. HHSC and DCF treat self-dealing as evidence the trust is not truly irrevocable. Name a separate trustee before the first deposit.
Texas publishes QIT standards in HHSC F-6800 and Appendix XXXVI to the Medicaid for the Elderly and People with Disabilities handbook. The appendix includes a model trust instrument attorneys may adapt, though HHSC accepts other forms that meet the same criteria.
Texas applies a $2,901 monthly special income limit to MEPD nursing facility and STAR+PLUS waiver cases in 2026. Applicants above that figure need a QIT unless they qualify for a different program with a separate income test. Community Attendant Services cases do not use QITs.
HHSC disregards QIT income the first month a valid signed trust exists, a QIT account with the beneficiary's SSN is open, and enough income enters the account to bring remaining income below $2,901. Retroactive disregard may reach three months before the application file date when all other eligibility rules pass.
Report the trust to Texas Medicaid and Healthcare Partnership using Form H1210, Subrogation for Trusts, Annuities and Court Settlements, so the state residuary interest is on file. Legal staff review non-model trusts before certification.
Patricia, 77, in Houston earned $3,220 monthly from Social Security and a teacher pension in June 2026. Her attorney deposited the full pension into a QIT at a Chase branch in Harris County and left Social Security outside because that source alone kept her under the cap. HHSC accepted the split-source plan because each chosen source entered the trust in full.
Model your asset total on the Texas calculator before you fund the trust. Income and resource tests run on separate HHSC worksheets.
Florida DCF's Qualified Income Trust Information Sheet lists the core requirements: irrevocable agreement, state residuary beneficiary up to Medicaid paid, income only, and signatures from the applicant, spouse, or authorized representative.
Every Florida trust goes to Regional Legal Counsel through the eligibility specialist. Appendix A-22.1 walks staff through revocability checks, income-only corpus review, and approval routing. A notarized trust that skips DCF legal review can leave a family paying private rates above $9,000 monthly in Miami-Dade while waiting for counsel.
Florida tests gross income before Medicare, tax, or insurance deductions for ICP, SMMC Long-Term Care, PACE, and HCBS waiver cases. The 2026 cap sits at $2,982, tied to 300% of the federal SSI benefit rate. A Pinellas County veteran may look under the cap on net deposits but fail on gross VA plus Social Security.
Monthly deposits must continue for each month the applicant needs Medicaid, including months before formal approval. DCF verifies deposits at the source with bank statements. Income returned from the trust to the applicant counts as income again.
Linda, 81, in Tampa grossed $3,090 monthly in April 2026. Her QIT deposit of $120 was $8 short after a rounding error. DCF denied ICP payment for April. Her son increased May's deposit to $130 and kept April private-pay, a $9,200 lesson in Florida's no-correction rule.
Run asset math on the Florida calculator and read Medicaid waiver vs regular Medicaid if the applicant seeks SMMC waiver services instead of nursing home ICP.
Arizona ALTCS treats qualifying income trusts as Special Treatment Trusts with the same federal income-only and irrevocable rules. Gross income above $2,982 in 2026 triggers trust planning for many nursing home and waiver applicants. Use the Arizona calculator to confirm countable assets before ALTCS intake.
Georgia DFCS requires a QIT established in Georgia. A trust drafted for a Florida snowbird does not transfer. The trust must be irrevocable, income-only, and effective the month it is signed. DFCS reviews activity every twelve months. The Georgia calculator flags when pension income exceeds the cap while assets already pass.
North Carolina is not a classic income-cap state for every pathway. DMA uses medically needy deductible spend-down for many community cases. Nursing facility applicants may face different budgeting rules. The North Carolina calculator models asset gaps; read Medicaid spend down on monthly income for deductible math before you assume a QIT is required.
Walter, 78, in Charlotte applied for nursing facility Medicaid with $3,050 monthly income in 2026. His county worker used long-term care budgeting worksheets rather than a Miller Trust because North Carolina's pathway differed from his daughter's Texas research. Walter's family confirmed the program type with DMA before opening any account.
Use the table below as a pre-filing worksheet. Your caseworker makes the final call, but missing one row can cost a month of private-pay care.
We verify figures against state manuals and publish methods at our editorial policy. Pair this checklist with the Miller Trust guide and your state calculator page.
Attorney fees for QIT setup commonly run $1,200 to $2,500 in Texas and Florida metro areas. Bank accounts are usually free when you maintain a low balance after monthly disbursements.
After the trust is active, compare funeral and burial planning rules in our related funeral trust Medicaid rules post. Funeral trusts follow different exemption tests than income trusts.
| Requirement | Federal rule | Texas HHSC | Florida DCF |
|---|---|---|---|
| Trust type | Irrevocable QIT under § 1396p(d)(4)(B) | Irrevocable; legal review for non-model forms | Irrevocable; Regional Legal Counsel review |
| Corpus | Applicant income only | Pension, Social Security, other income; no resources | Income only; no assets added |
| Income cap | State special income limit | $2,901 monthly MEPD / STAR+PLUS | $2,982 gross monthly ICP / HCBS |
| Deposit timing | Same calendar month received | Month received; partial first month rule | Same month only; no past/future deposits |
| Bank account | Dedicated account | SSN titled; $10–$20 opening deposit OK | Special account; monthly statements |
| State payback | Up to Medicaid paid at death | Residuary beneficiary; Form H1210 | State receives remainder up to benefits paid |
| Trustee | Manages deposits and payments | Pays facility, PNA, spousal allowances | Same; applicant cannot revoke |
| Asset test | Separate from QIT | $2,000 individual resource cap | $2,000 individual resource cap |
QIT rules share a federal backbone, but income caps and review steps diverge. Texas HHSC posts $2,901 on 2026 MEPD materials. Florida DCF, Georgia DFCS, and Arizona ALTCS use $2,982 tied to 300% of the federal SSI rate.
Florida requires Regional Legal Counsel approval on every trust. Texas accepts HHSC Appendix XXXVI model language but sends non-standard forms to legal staff. Georgia rejects trusts established outside Georgia.
North Carolina DMA often applies medically needy deductible spend-down instead of Miller Trust deposits for community and some facility cases. A Charlotte applicant and a Houston applicant with identical $3,100 monthly income may face different worksheets.
Use the Texas calculator, Florida calculator, Arizona calculator, Georgia calculator, and North Carolina calculator to match asset totals before you open a trust account.
Common mistake:Assuming one income cap nationwide. A trust funded for a $2,901 Texas gap will be short in Florida when gross income tops $2,982. Match deposits to the filing state cap, not a neighbor's spreadsheet.
A QIT solves excess income after countable assets already pass. The calculator hub links all 51 state pages with local resource caps and exempt spending channels.
Start with the Texas calculator when HHSC MEPD income tops $2,901. Florida families above $2,982 gross should run the Florida calculator before DCF intake.
Arizona, Georgia, and North Carolina applicants can model asset gaps on the Arizona, Georgia, and North Carolina calculator pages. Return to the Miller Trust guide for deposit timing and trustee duties.
A qualifying income trust (QIT), also called a Miller Trust, is an irrevocable arrangement that holds only the applicant's monthly income so Medicaid can ignore that money during eligibility tests in income-cap states. The state must be named to receive remaining funds at death, up to total Medicaid benefits paid. It does not hold savings, IRA principal, or other assets.
The trust must be irrevocable, contain only the applicant's income, name the state as residuary beneficiary, and receive deposits during the same calendar month income arrives. You also need a dedicated bank account, a trustee other than the applicant in most states, and monthly funding for each month you need coverage. Asset spend-down to the resource cap is a separate test.
Income must enter the QIT account during the calendar month it is received. Texas HHSC and Florida DCF both enforce same-month rules. Florida does not allow deposits for past or future months. Missing a month or depositing too little can deny Medicaid payment for that entire month with no retroactive correction.
No. Medicaid treats revocable trusts as available resources. Texas and Florida both require irrevocable QITs. Florida allows amendment language only when the power to amend does not include the power to revoke. A trust the applicant can cancel fails the QIT test.
Texas HHSC requires a dedicated trust account at a bank or credit union, titled with the beneficiary's Social Security number, that receives only income listed in the trust instrument. A $10 to $20 opening deposit from nominal resources is allowed. Joint accounts with personal activity require a new account. Deposits must arrive during the income month.
Yes. Florida DCF eligibility specialists forward executed trust agreements to Regional Legal Counsel for review under Appendix A-22.1. The trust must be irrevocable, income-only, and signed by the applicant, spouse, or authorized representative. Funding the account before counsel approves the document can leave families paying private nursing home rates.
