7 Things to Know Before Creating a Miller Trust in Florida
When a Florida senior applies for long-term care Medicaid and their monthly income exceeds the program's income cap, a qualified income trust becomes a necessary part of the application. Also known as a Miller trust or a QIT, this specialized legal document allows an applicant whose income is too high to qualify under the standard rules to meet the Medicaid income eligibility requirement by directing excess income into the trust each month.
The qualified income trust is one of the most commonly misunderstood tools in Florida Medicaid planning. Many families assume that an income that exceeds the Medicaid limit simply disqualifies their loved one from coverage, which is not the case. Others attempt to set up the trust without legal assistance and encounter delays or denials because the document does not meet the precise requirements imposed by Florida and federal Medicaid rules. Understanding the seven most important things to know before creating a qualified income trust can save families significant time, money, and stress during an already difficult period. For personalized guidance, speak with a Florida Medicaid planning attorney at Elder Needs Law.
One: A Qualified Income Trust Is Only Needed When Income Exceeds the Cap
The first and most fundamental thing to understand about the qualified income trust is that it is only required when a Medicaid applicant's gross monthly income exceeds the Florida long-term care Medicaid income cap. In 2026, that cap is $2,901 per month. Applicants whose total monthly gross income is at or below this amount do not need a QIT and can meet the income eligibility requirement directly without any additional legal documents.
For applicants who do exceed the cap, the QIT is not optional. Florida operates as an income cap state for long-term care Medicaid, which means that applicants above the income limit have no pathway to eligibility without a properly established and administered qualified income trust. There is no spend-down mechanism available for income in Florida the way there is for assets, making the QIT an essential planning tool for a significant portion of Florida Medicaid applicants.
Two: The Trust Must Be Irrevocable and Properly Structured
A qualified income trust in Florida must be irrevocable, meaning that once it is established the terms cannot be changed by the grantor. The trust must name the Medicaid applicant as the sole beneficiary during their lifetime and must include a provision stating that upon the recipient's death any remaining funds in the trust will be paid first to the state of Florida as reimbursement for Medicaid costs before any remaining balance can pass to other named beneficiaries.
The trust document must also meet specific technical requirements imposed by Florida Medicaid rules including proper identification of the trustee, clear instructions for how income is to be deposited and disbursed each month, and language confirming the trust's status as a qualified income trust under federal law. A trust that omits any of these required elements will not be accepted by the Florida Department of Children and Families and will need to be corrected before the Medicaid application can move forward.
Three: Only Income Goes Into the Trust Each Month
One of the most important operational rules governing the qualified income trust is that only income goes into the trust. Assets such as money from a bank account, proceeds from the sale of property, or any other non-income funds should never be deposited into the QIT. Depositing assets into the trust rather than income can create significant complications with the Medicaid application and may trigger additional review of the applicant's financial history.
Every month, all or a portion of the applicant's income that exceeds the income cap must be deposited into the QIT account. The trustee then disburses funds from the trust according to the rules governing allowable QIT expenditures, which include the patient pay amount owed to the nursing home, the personal needs allowance retained by the recipient, and in some cases a monthly allowance for a community spouse. Any funds remaining in the trust at the end of the month after these disbursements are made stay in the trust and cannot be redirected or used for any other purpose.
Four: The Trust Requires a Dedicated Bank Account
Establishing a qualified income trust is not complete simply by signing the trust document. The trust must also have its own dedicated bank account opened in the name of the trust. Income is deposited into this account each month and disbursements are made from it. The QIT account must be kept completely separate from any other bank accounts belonging to the applicant or the trustee, and it must be used exclusively for QIT-related transactions.
When the Medicaid application is filed, the Florida Department of Children and Families will require documentation showing that the QIT bank account has been established. Without an active account, the trust cannot function as required and the application will not be approved. Families should plan for the time needed to open the account after the trust is signed, particularly if banking delays could affect the timing of the Medicaid application.
Five: The Trustee Has Ongoing Administrative Responsibilities
Serving as trustee of a qualified income trust is not a passive role. The trustee is responsible for managing the trust account on a monthly basis, ensuring that income is deposited correctly and on time, making authorized disbursements in the correct amounts, maintaining accurate records of all transactions, and being prepared to provide documentation of trust activity to the Florida Department of Children and Families upon request.
The trustee is typically a family member such as an adult child or a spouse, though a professional trustee can also be appointed if no suitable family member is available or willing to serve. The trustee must understand the rules governing QIT administration and must follow them consistently every month for as long as the Medicaid recipient remains on the program. Errors in trust administration, such as failing to deposit income on time, making unauthorized disbursements, or commingling trust funds with personal funds, can jeopardize the recipient's Medicaid eligibility. A Florida elder law attorney can train the trustee on their responsibilities and provide ongoing guidance when questions arise.
Six: Changes in Income Must Be Reported and the Trust May Need to Be Updated
A qualified income trust is designed to address the applicant's income situation at the time of the Medicaid application, but income can change over time. A Social Security cost-of-living adjustment, a change in pension amount, or the start of a new income source can all affect the monthly deposit amount and the patient pay calculation. These changes must be reported to the Florida Department of Children and Families as a change in circumstances, and the QIT administration must be updated to reflect the new income amounts.
In some cases a change in income may bring the recipient's total monthly income below the income cap, which could mean the QIT is no longer necessary. In other cases an income increase may require adjustments to the monthly disbursement schedule. Working with a Florida elder law attorney who provides ongoing Medicaid maintenance services ensures that changes in income are handled correctly and that the trust continues to function as required. Read our guide on change in circumstances reporting for Florida Medicaid for a full overview of what must be reported and when.
Seven: Funds Remaining in the Trust at Death Go to the State First
The most important thing families need to understand about the qualified income trust before it is created is what happens to any funds remaining in the trust when the Medicaid recipient passes away. Under Florida and federal Medicaid law, any balance remaining in the QIT at the time of the recipient's death must be paid first to the Florida Agency for Health Care Administration as reimbursement for the Medicaid costs paid on the recipient's behalf during their lifetime. This is a non-negotiable requirement that cannot be avoided or modified through the trust document.
Only after the state has been fully reimbursed from the trust balance can any remaining funds be distributed to the other beneficiaries named in the trust. In practice, the monthly nature of QIT administration means that the balance in the trust at the time of death is typically small, often consisting only of the funds deposited for the final partial month. However, families should be aware of this requirement and should not expect any meaningful inheritance from the QIT balance.
It is also worth noting that the QIT is separate from Florida's broader Medicaid estate recovery program, which allows the state to seek reimbursement from the deceased recipient's probate estate for Medicaid costs that exceed what the trust reimburses. Read our overview of avoiding Medicaid estate recovery in Florida for a complete picture of how estate recovery works and what planning tools can reduce exposure.
How a Florida Elder Law Attorney Helps With the Qualified Income Trust
A Florida elder law attorney plays an essential role at every stage of the qualified income trust process. At the drafting stage, the attorney ensures the trust document meets all Florida and federal Medicaid requirements and is accepted by the Department of Children and Families without delay. At the application stage, the attorney coordinates the QIT documentation with the rest of the Medicaid application to present a complete and accurate package that minimizes the risk of a request for additional information or a denial.
After the application is approved, the attorney can train the trustee on their monthly administrative responsibilities, provide written instructions for managing the trust account, and serve as a resource when income changes or other circumstances arise that affect trust administration. Families who attempt to draft or administer a QIT without legal guidance frequently encounter avoidable problems that delay Medicaid approval, disrupt ongoing eligibility, or result in the need to correct the trust document after the fact.
The qualified income trust is one component of a broader Florida Medicaid plan that may also include asset spend down strategies, personal services contracts, irrevocable trusts, and estate recovery planning. Read our guide on Florida Medicaid spend down strategies for an overview of how the QIT fits into the larger planning picture.
Frequently Asked Questions
Q. What is a qualified income trust in Florida?
A. A qualified income trust, also known as a Miller trust or QIT, is a legal document required for Florida Medicaid applicants whose monthly gross income exceeds the long-term care Medicaid income cap of $2,901 in 2026. By directing excess income into the trust each month, the applicant meets the income eligibility requirement for Florida Medicaid. The trust must be drafted and administered in strict compliance with Florida and federal Medicaid rules.
Q. Who needs a qualified income trust in Florida?
A. A qualified income trust is required for any Florida long-term care Medicaid applicant whose total monthly gross income exceeds $2,901 in 2026. Applicants at or below that income level do not need a QIT. The trust is most commonly needed by applicants who receive multiple income sources such as Social Security, a pension, and rental income whose combined total exceeds the cap.
Q. What happens to the money in a qualified income trust after a Medicaid recipient passes away?
A. Any funds remaining in the QIT at the time of the recipient's death must be paid first to the state of Florida as reimbursement for Medicaid costs before any remaining balance can be distributed to other named beneficiaries. This requirement is mandatory under Florida and federal Medicaid law and cannot be modified. In practice the end-of-life trust balance is typically small due to the monthly nature of QIT administration.
Q. Can I set up a qualified income trust without an attorney in Florida?
A. While there is no legal prohibition against doing so, setting up a QIT without an attorney carries significant risk. A trust that does not comply precisely with Florida Medicaid requirements will not be accepted by DCF and will delay or cause denial of the Medicaid application. Errors in monthly administration can also jeopardize ongoing eligibility. Working with a Florida elder law attorney ensures the trust is drafted and administered correctly from the beginning.
Work With a Florida Medicaid Planning Attorney
A qualified income trust must be done right the first time. The Florida Medicaid planning attorneys at Elder Needs Law draft qualified income trusts that meet all Florida and federal Medicaid requirements, train trustees on their monthly administrative responsibilities, coordinate the QIT with the broader Medicaid application, and provide ongoing support to ensure continued eligibility throughout the recipient's time on the program. We serve all of Florida remotely and in person from offices in Aventura, Boca Raton, Plantation, and Spring Hill. Contact us today to schedule a consultation.
