What Can Come Out of a Miller Trust?

A Florida Medicaid Planning Guide for Families

If you or a loved one is receiving Florida Medicaid benefits — or working toward eligibility — you may have heard the term "Miller Trust." And a very common question that comes up is: once money goes into a Miller Trust, what can it actually be used for?

The short answer: not everything. There are real restrictions on how those funds can be spent, and knowing the rules ahead of time can save your family from costly mistakes.

This article breaks down exactly what a Miller Trust is, what expenses qualify, what doesn't, and when a different type of trust might be a better fit for your situation.

What Is a Miller Trust (Qualified Income Trust)?

A Miller Trust — also called a Qualified Income Trust — is a legal tool used in Florida Medicaid planning. The two names refer to the exact same thing.

In 2026, if a Medicaid applicant's total monthly income from all sources — including Social Security — exceeds $2,982, that excess amount must be deposited into a Miller Trust each month to maintain Medicaid eligibility. Without this step, the person would be over the income limit and could be denied benefits, even if they genuinely need long-term care.

Florida Medicaid Income Limit (2026): $2,982/month. Income above this threshold must go into a Miller Trust or a pooled special needs trust.

The trust account is typically managed by a family member who serves as the trustee. Each month, the appropriate portion of income is placed into the account and then paid out for qualifying expenses.

What Can Miller Trust Funds Be Spent On?

This is where many families run into confusion. Miller Trust funds are restricted to health and medical-related expenses. That's the guiding rule.

Allowed expenses include:

• Patient responsibility payments at a nursing home — the portion of the cost of care that Medicaid does not cover
• A portion of the cost at an assisted living facility that Medicaid doesn't pay
• Additional home care beyond what Medicaid provides
• Dental bills that Medicaid won't cover
• Therapies — physical, occupational, speech, and others — that Medicare or Medicaid doesn't pay for
• Other out-of-pocket medical and healthcare costs

If the expense is tied to the person's health or care, it generally qualifies.

What's NOT allowed:

Here's where families sometimes get tripped up. Miller Trust funds cannot be used for everyday living expenses that are not related to health or medical care, including utility bills, property taxes, entertainment, internet or cable, car insurance, and vacations.

These are perfectly normal expenses — but they fall outside the allowable uses for a Miller Trust. Spending Miller Trust funds on non-qualifying expenses can jeopardize Medicaid eligibility, so it's not a risk worth taking.

Important: Using Miller Trust funds for non-medical expenses can put your Medicaid benefits at risk. Always confirm with a Florida Medicaid planning attorney before making a payment from the trust.

What Happens When All Medical Needs Are Already Covered?

Here's a real-world situation that comes up more often than you might expect: a Medicaid recipient's healthcare needs are fully covered between Medicare and Medicaid. They don't have extra medical bills to pay. But their income still exceeds the Florida threshold — so they're required to use some kind of income trust.

So what does the trustee do with the money sitting in the Miller Trust if there are no health or medical expenses to cover?

This is exactly the kind of problem a Florida Medicaid planning attorney can help you solve — because there is a legitimate alternative.

The Alternative: Pooled Special Needs Trusts

If the Miller Trust's spending restrictions create a problem for your situation, a pooled special needs trust may be a much better option.

A pooled special needs trust is managed by a professional nonprofit organization — not a family member. The nonprofit serves as the trustee, pooling together funds from multiple beneficiaries for investment purposes while keeping individual accounts separate.

Importantly, a pooled special needs trust can hold both income and assets. And unlike a Miller Trust, there are no restrictions on how the funds are spent — as long as the money is used for the benefit of the Medicaid recipient. That means it can cover property taxes, utility bills, entertainment, internet, car insurance, vacations, and virtually any personal expense that benefits the person.

Pooled special needs trusts do charge fees, but they tend to be reasonable — and for many families, the flexibility is well worth it.

Key Comparison: Miller Trust = restricted to health and medical expenses. Pooled Special Needs Trust = flexible spending, professionally managed, small fees apply.

Choosing the Right Option for Your Family

The right choice depends entirely on your individual situation — specifically, what your healthcare expenses look like and whether the spending restrictions of a Miller Trust will create problems.

If you have regular out-of-pocket medical costs that Medicaid doesn't cover, a Miller Trust is likely straightforward and workable. But if your healthcare is fully covered and you're wondering what to do with excess income in a trust, a pooled special needs trust gives you far more flexibility to use those funds on things that genuinely improve your loved one's quality of life.

Florida Medicaid rules are specific, and a mistake in how trust funds are managed can affect eligibility. Working with a Florida estate planning and elder law attorney who handles Medicaid planning is the best way to protect the benefits your family has worked hard to secure.

Get Help with Florida Medicaid Planning

Whether you need help setting up a Miller Trust, determining if a pooled special needs trust is a better fit, or simply figuring out where to start with Medicaid eligibility, our firm is here to help. We work with Florida families on Medicaid planning, estate planning, probate, and elder law — and we'd be glad to schedule a consultation to walk through your specific situation.

Visit us: elderneedslaw.com | medicaidplanninglawyer.com

Recommended Reading

Want to go deeper? Check out Medicaid: Can It Pay Some of Your Long-Term Care Expenses? — a practical guide written for families trying to make sense of Medicaid and long-term care planning in plain language.

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