A Miller Trust, also called a Qualified Income Trust (QIT), holds only the applicant's income so Medicaid can ignore that money during an eligibility test in income-cap states. Texas, Florida, Georgia, and Arizona require this path for many nursing home and waiver cases when gross monthly income exceeds the special income limit but countable assets already pass. The trust does not fix a resource spend-down problem. It solves an income problem, and each month's deposit must land in the trust account during the same calendar month the income arrives.
Congress created the Miller Trust option in 1993 through 42 U.S.C. § 1396p(d)(4)(B) so people with moderate pensions could still qualify for nursing home Medicaid in states that cap monthly income. The trust holds income only. It never holds the house, the car, or a brokerage account.
Medicaid counts what stays outside the trust. If gross income outside the trust falls at or below the special income limit, the applicant can pass the income test while the trustee later sends most trust deposits to the nursing home as patient liability.
Families in San Antonio, Tampa, and Phoenix hear both names. Texas HHSC paperwork says Qualified Income Trust. Florida DCF says the same. Arizona ALTCS calls it a Special Treatment Trust, but the federal logic matches a QIT.
If you are still learning how Medicaid spend-down works for assets, start with our overview at what is medicaid spend down before you open a bank account.
Common mistake:Treating a Miller Trust like a savings account. Depositing a $40,000 CD rollover into the trust counts as a resource transfer, not income planning. Keep principal in exempt or countable asset buckets and move only recurring monthly checks.
You need a QIT when three facts line up: the applicant seeks institutional Medicaid or a home-and-community waiver that follows the same income test, gross monthly income exceeds the state special limit, and countable assets already meet resource rules.
Texas uses a $2,901 monthly special income limit for Medicaid for the Elderly and People with Disabilities (MEPD) nursing facility cases in 2026. Florida uses $2,982, tied to 300% of the federal SSI benefit rate. Georgia and Arizona follow the $2,982 figure for comparable long-term care groups.
Married couples still face the cap on the applicant's income. The community spouse keeps separate income under spousal impoverishment rules described in spousal impoverishment rules, but the institutionalized spouse cannot skip the QIT simply because the wife still works part time in Katy or Clearwater.
Programs differ by state. Florida applies QIT rules to Institutional Care Program (ICP), SMMC Long-Term Care, PACE, and certain hospice groups. Texas applies them to nursing facility MEPD and STAR+PLUS waiver cases that share the same income standard.
Income-cap states and medically needy states solve excess income differently. In cap states, income above the limit blocks eligibility until it passes through a QIT. In medically needy states, applicants stack unpaid medical bills against a monthly deductible until countable income falls below the program limit.
North Carolina uses deductible spend-down for many community cases and long-term care budgeting rules that differ from Texas. Our north carolina calculator page walks through asset gaps, but it does not replace a Miller Trust because North Carolina is not a classic income-cap state for every pathway.
Pennsylvania, Ohio, and Illinois families often hear about medical bill spend-down first. A daughter in Philadelphia cannot copy her neighbor's bill-pay strategy for her father in Bexar County. Texas law requires the trust route instead.
Income limits and asset limits interact. Read medicaid income limits spend down for deductible math and medicaid asset limits explained for resource caps so you do not chase the wrong tool.
Texas publishes QIT standards in HHSC Appendix XXXVI to the Medicaid for the Elderly and People with Disabilities handbook. The appendix includes a model instrument, deposit rules, and reminders that only pension, Social Security, and other applicant income may enter the account.
Applicants route income through a separate bank account titled in the trust name. HHSC expects the trustee to pay the nursing facility, home-and-community providers, spousal allowances, and a personal needs allowance according to priority listed in the trust and state policy.
When income arrives from multiple sources, Texas requires the full payment from each chosen source to go into the trust. You cannot split a Social Security check across personal checking and the QIT. Pick a source, deposit the whole deposit, or choose another source.
Bexar County applicants often start at an Aging and Disability Resource Center before HHSC receives Form H1200. Bring the executed trust, voided check, and proof of monthly deposits to the eligibility interview. Details on filing live in how to apply medicaid spend down.
Florida DCF determines eligibility for SSI-related Medicaid, while AHCA administers services and estate recovery. DCF's Qualified Income Trust Information Sheet requires an irrevocable written agreement, a dedicated account, and monthly deposits for each month the applicant needs coverage.
Every Florida trust must go to Regional Legal Counsel through the eligibility specialist. A family cannot fund an account in Naples using a template from an online forum and assume approval. DCF compares the document to Appendix A-22.1 review steps in the Medicaid policy manual.
Florida counts gross income before Medicare premiums or tax withholding when testing the cap. A veteran in Pinellas County might look under $2,982 after deductions but fail the test on gross VA plus Social Security. Run gross numbers first.
ICP and SMMC Long-Term Care cases both use QIT mechanics. Pair this section with florida calculator when assets still exceed Florida's $2,000 resource limit for a single applicant.
Robert, age 82, lives in San Antonio and receives $1,940 per month from Social Security and $1,400 from a VA pension after his wife died. His gross income totals $3,340, which is $439 above Texas's $2,901 special income limit for 2026. His checking account holds $1,650, so assets pass.
Robert's daughter planned a move to a skilled nursing facility on Congress Avenue after a hospital stay. HHSC would deny MEPD on income alone unless $439 or more landed in a QIT each month. Robert chose to deposit the entire VA pension because it arrives on one predictable date.
His attorney used the HHSC model trust, opened an account at a local credit union, and redirected the VA direct deposit before the facility month started. The trustee kept enough outside the trust for Medicare Part B and a small personal needs allowance HHSC allowed that month.
Robert still needed a level-of-care letter and proof of citizenship. The QIT solved only the income hurdle. For asset rules, exempt property, and burial fund limits, see medicaid exempt assets.
Common mistake:Splitting the VA pension between Robert and his daughter to "stay under the cap." HHSC counts applicant income even when a family member cashes the check. Redirect through the trust instead of informal sharing.
Same-month funding is the rule families miss most often. Texas and Florida both require income deposited into the QIT during the calendar month the applicant receives it. Indiana policy, echoed in many state manuals, repeats that the entire amount from each assigned source must land in the trust account that same month.
Maria in Orlando received $3,050 gross in April when Florida's cap was $2,982. She moved $800 into the QIT on May 3. DCF treated April as over income because the deposit arrived too late, and the nursing home billed May as private pay until she corrected the pattern.
You also cannot cure a missed month with a double deposit next month. Florida's fact sheet states deposits cannot be made for a past or future month. Texas HHSC applies the same forward-only logic during reviews.
Start deposits before approval when care is imminent. Florida policy explicitly allows funding while legal counsel still reviews the document. Waiting for the approval letter while the applicant already moved into a facility creates a gap month.
Use this sequence after an elder law attorney drafts or reviews the trust. The steps mirror Texas Appendix XXXVI and Florida DCF's information sheet, but local banks may add their own paperwork.
First, confirm gross income exceeds the cap but assets pass. Second, execute an irrevocable trust that names the state as remainder beneficiary up to Medicaid payments. Third, open a separate trust account. Fourth, redirect full payments from chosen income sources. Fifth, deposit at least enough each month so income outside the trust sits at or below the cap. Sixth, file proof with the eligibility worker and keep monthly bank statements.
| State / agency | Special income limit (2026) | Trust label | Legal review |
|---|---|---|---|
| Texas HHSC MEPD | $2,901 / month | Qualified Income Trust (QIT) | HHSC model instrument; bank and worker review |
| Florida DCF ICP / SMMC | $2,982 / month gross | Qualified Income Trust (QIT) | Regional Legal Counsel approval required |
| Georgia DCH nursing home | $2,982 / month gross | Qualified Income Trust (QIT) | County DFCS / Gateway worker review |
| Arizona AHCCCS ALTCS | $2,982 / month gross | Special Treatment Trust | ALTCS eligibility unit review |
| North Carolina DSS | No classic QIT cap | Medicaid deductible spend-down | County DSS budgeting, not QIT deposits |
The trustee pays bills in priority order: administrative fees, personal needs allowance, spousal allowances if applicable, medical costs, and nursing home share of cost. Medicaid pays the remainder after those distributions.
Income inside the trust still shapes patient liability even when excluded from the eligibility test. Florida's fact sheet notes that QIT deposits are excluded for eligibility but counted when calculating share of cost. Families should expect most trust income to flow to the facility each month.
After death, the state may collect remaining trust balances up to the amount Medicaid paid on the applicant's behalf. That recovery rule mirrors general Medicaid estate recovery described in medicaid estate recovery explained.
Trustees should never pay household bills for grandchildren or prepay property taxes from QIT funds unless policy explicitly allows the expense. Improper payments can trigger trust invalidation.
Georgia DFCS applies Qualified Income Trust rules for nursing home Medicaid and Elderly and Disabled Waiver Program cases when gross income exceeds $2,982 in 2026. Applicants file through Georgia Gateway and county offices in Fulton, Gwinnett, and Chatham counties.
Arizona ALTCS labels the tool a Special Treatment Trust, but the income-only funding rule matches Texas. Maricopa County applicants often work through AHCCCS contractors while deposits still require same-month timing.
Use georgia calculator and arizona calculator for asset spend-down math. Those pages note income trust needs when savings already pass but pensions exceed the cap.
Transfer penalties still apply to improper gifts even when a QIT is open. Review medicaid look back period before moving assets to relatives in any of these states.
Income-cap states require Miller Trusts for many nursing home and waiver applicants once gross monthly income crosses the special limit. Texas HHSC uses $2,901 in 2026. Florida DCF, Georgia DCH, and Arizona AHCCCS use $2,982 tied to 300% of the federal SSI rate.
Medically needy states handle excess income through deductibles and medical bill spend-down instead of QIT deposits. North Carolina county DSS offices budget patient liability differently and do not follow the Texas QIT playbook.
Open the state tool where the applicant will file: texas calculator, florida calculator, georgia calculator, arizona calculator, or browse all jurisdictions at calculator hub.
Common mistake:Using a Michigan spend-down strategy for a Houston case. Michigan allows different income pathways. Texas requires QIT funding when the MEPD cap is exceeded.
Our state calculators on calculator hub estimate countable asset spend-down against the $2,000 single applicant limit and 2026 CSRA brackets. Texas and Florida pages flag when income exceeds the special limit and a Miller Trust may be needed even if the asset gap shows $0.
The widgets do not draft trusts, redirect direct deposit, or calculate monthly patient liability after approval. They also do not tell you whether SMMC, STAR+PLUS, or ALTCS waiver screening will pass functional criteria.
Use calculator output as a planning screen, then confirm income routing with HHSC, DCF, or a qualified elder law attorney before the admission month. Read QIT requirements and spend-down vs Miller Trust for deposit timing and state pathway comparisons.
A Miller Trust (QIT) holds only the applicant's income for Medicaid eligibility in income-cap states. A special needs trust usually holds assets for a disabled person without disqualifying other benefits. They solve different problems and use different federal statutes.
Texas requires enough deposits so income remaining outside the trust stays at or below the $2,901 special income limit for 2026 nursing facility MEPD cases. Many families deposit an entire pension or Social Security check because partial deposits from the same source are not allowed.
Florida DCF sends trust documents to Regional Legal Counsel for approval, but policy allows deposits while review is pending if care already started. Same-month deposit rules still apply, so waiting too long creates private-pay gaps.
No. QITs accept income only, not IRA principal or other countable resources. Liquidating an IRA creates new income and possible penalties. Work with an attorney on asset spend-down first using medicaid asset limits explained.
Florida and Texas treat a missed month as a month over the income limit. Medicaid can stop for that month even if earlier months were funded correctly. You cannot deposit for a past month later.
Often yes in Texas and Florida nursing home cases. Agencies count gross VA and Social Security before Medicare premiums. The San Antonio veteran example in this guide shows a $3,340 gross total requiring a QIT even when assets are below $2,000.
North Carolina uses medically needy deductibles and long-term care budgeting rather than the Texas-style QIT for most pathways. Use the North Carolina calculator for asset gaps, but do not assume a Miller Trust copied from Florida will work in Raleigh.
States typically allow the applicant, spouse, adult child, or professional fiduciary if the bank accepts the arrangement. The trustee must make monthly distributions and keep records for HHSC or DCF reviews.
