How Does a QIT Work in Florida?

If you or a loved one is looking into Florida Medicaid to help cover the cost of home care or a nursing facility, you may have run into a frustrating wall: your income is just a little too high to qualify. Maybe it's Social Security alone. Maybe it's a pension combined with Social Security. Whatever the source, Florida Medicaid has a strict income cap — and even being $1 over that limit means you won't qualify without taking the right steps.

The good news? There's a legal, well-established solution called a Qualified Income Trust — and it can make all the difference.

What Is a Qualified Income Trust (QIT)?

A Qualified Income Trust, commonly called a QIT (or sometimes a Miller Trust), is a specific type of trust that allows Florida Medicaid applicants to qualify for benefits even when their income exceeds the program's limit. It's not a loophole — it's a tool built directly into Florida's Medicaid rules for situations exactly like this.

In 2026, Florida's Medicaid income cap is $2,982 per month. If your gross income from all sources combined exceeds that amount — by even one dollar — you are not eligible for Medicaid without a QIT in place.

The Income Cap: Why Even $1 Over Makes a Difference

Florida Medicaid's income rules don't grade on a curve. If your combined gross income exceeds the cap by any amount, you are considered ineligible — full stop — unless you have a QIT.

Here's a simple example: Say a Medicaid applicant receives $2,983 per month in Social Security. That puts them just $1 over the 2026 income cap of $2,982. Despite being one dollar over the limit, they still need a QIT to qualify. This surprises a lot of families. But once you see how a QIT works step by step, the path forward becomes much clearer.

How a QIT Works — Step by Step

First, an attorney drafts the Qualified Income Trust document, which must be signed, witnessed, and notarized before it's valid. The trust must meet specific requirements under Florida law and Medicaid rules.

Next, a trustee is named. The Medicaid applicant cannot serve as their own trustee — someone else must fill that role. This could be a spouse, an adult child, or another trusted person. That trustee takes on the responsibility of managing the trust account each month.

Once the trust document is ready, the trustee brings it to a bank and opens a checking account in the name of the QIT. It's often easiest to use the same bank where the Medicaid applicant already receives their deposits, since that makes transferring funds simpler each month.

From that point forward, every calendar month the Medicaid recipient must transfer at least the amount by which their income exceeds the cap into the QIT account. In the example above — $1 over the cap — at minimum $1 must go in each month. You can always transfer more than the required amount, but never less. This monthly transfer has to happen consistently for Medicaid eligibility to be maintained.

The trustee — not the Medicaid recipient — then controls what happens to the money in the QIT account. Those funds are typically used for health, wellness, and medical-related expenses. Supplemental care costs are a common use, since Medicaid doesn't always cover every service a person needs.

The Gross Income Question: What Actually Counts?

One of the most misunderstood parts of QIT planning is what counts as income for Medicaid purposes. The answer: gross income from all sources — not just what gets deposited into your bank account.

Social Security is the most common example of why this matters. Many recipients have their Medicare Part B premium automatically deducted from their monthly check before it ever arrives. That deduction reduces what you actually receive — but Medicaid still counts the full gross Social Security amount when determining eligibility.

There's a silver lining worth knowing: once someone transitions onto Medicaid, Medicare Part B premiums are typically covered by Medicaid, which means their Social Security check actually increases to reflect what was previously withheld. But during the application process, that deducted amount still factors into the gross income calculation. Always use gross income — not your net deposit — when figuring out how much needs to go into the trust each month.

How Long Does a QIT Stay Active?

The QIT and the monthly transfer requirement stay in place for as long as the person wants to remain on Medicaid. For most clients, that means for the rest of their life, or for however long they're receiving Medicaid-funded care at home or in a facility. This is an ongoing commitment, not a one-time setup, which is why having a reliable, organized trustee makes such a big difference.

What If Income AND Assets Are Too High?

A QIT solves the income side of the equation. But if assets are also over the Medicaid limit, that's a separate issue — and it has solutions too.

Many families assume that getting onto Medicaid means waiting five years, spending down everything first, or selling the family home. In many cases, that simply isn't true. With the right legal planning in place, it's often possible to protect significant assets, qualify for Medicaid benefits, and avoid the five-year lookback period — all done legally and ethically. If you're dealing with both income and asset concerns, the right planning strategy addresses both together.

We Help Florida Families Across the Entire State

Whether the issue is income, assets, or both — there are real solutions available. You don't have to wait until the money runs out, and you don't have to go through this alone.

For more information, visit us at elderneedslaw.com or medicaidplanninglawyer.com. You can also pick up a copy of "Medicaid: How to Pay for Some of Your Long-Term Care Expenses," available on Amazon, for a plain-language breakdown of these planning strategies.

Reach out today to talk through your situation. Getting the right information early can make a significant difference in what options are available to you and your family.

Disclaimer: This article is for general informational purposes only and does not constitute legal advice. Laws and Medicaid rules are subject to change. Contact a licensed Florida attorney to discuss your specific situation.

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