What Is a Miller Income Trust? Your Florida Guide to Qualifying for Medicaid Long-Term Care

If you or a loved one needs help paying for nursing home care, in-home care, or adult day programs in Florida — and your income is above the limit — a Miller Income Trust may be the key to getting covered.

If you've been looking into Medicaid for long-term care in Florida, you've probably run into some confusing terminology. There are revocable trusts, irrevocable trusts, asset protection trusts, special needs trusts — and people tossing around phrases like "Medicaid trust" without always being clear about what they mean. It can get overwhelming fast.

So let's cut through the noise and talk specifically about one type of trust that comes up all the time in Medicaid planning: the Miller Income Trust.

First, a Quick Word of Caution About "Medicaid Trusts"

Here's something worth knowing right up front: the phrase "Medicaid trust" is not actually a specific legal term. It's a catch-all that people use to refer to different kinds of trusts that might come into play during Medicaid planning. But a Miller Income Trust? That refers to one very particular, well-defined type of trust — and it serves a very specific purpose.

Mixing these up can lead to real confusion (and real problems), so let's get clear on what a Miller Income Trust actually is and when you'd need one.

What Is a Miller Income Trust?

A Miller Income Trust is a legal tool used in Florida Medicaid planning. Its job is to help someone whose income is too high to qualify for Medicaid still be able to access long-term care benefits — whether that's nursing home care, care at home, or participation in an adult day program through Florida's PACE (Program of All-inclusive Care for the Elderly) program.

Here's the situation it solves: Florida Medicaid has an income cap. In 2026, that cap is $2,982 per month. (If you're reading this in a later year, that number will have changed — give our office a call to get the current figure.) If a Medicaid applicant's income comes in above that cap, they can't qualify for long-term care Medicaid — unless they set up a Miller Income Trust.

The simple version: A Miller Income Trust is for people who want Medicaid's help with long-term care costs but whose monthly income puts them over Florida's income limit. The trust is the legal mechanism that makes qualifying possible.

What Goes Into a Miller Income Trust?

This is where a lot of people breathe a sigh of relief. A Miller Income Trust is not about shifting a big chunk of savings or assets into a trust. You're not moving your investments or your house into it. This isn't about protecting a large sum of money.

What actually goes into the trust is just the portion of the applicant's monthly income that exceeds the income cap. That's it. If someone receives $3,500 per month in Social Security and pension income, and the cap is $2,982, only the excess amount needs to be directed into the trust each month. The trust is the vehicle that allows that overage to be handled in a way that still permits Medicaid eligibility.

Think of it less like a savings account and more like a structured monthly deposit that satisfies Florida's Medicaid rules.

Who Actually Needs One?

A Miller Income Trust is for Medicaid applicants who are seeking long-term care services and whose gross monthly income is above the current income cap. This most commonly includes people who have Social Security income, pension payments, or other monthly income sources that, when added together, push them past the Medicaid threshold. They may genuinely need help paying for a nursing facility or in-home care — but on paper, their income appears too high. A Miller Income Trust bridges that gap.

It's worth noting this trust applies specifically to long-term care Medicaid in Florida — not every Medicaid program. This is an important distinction, and it's one of the reasons working with a Florida-based attorney who focuses on elder law and Medicaid planning matters so much.

The Many Names for the Same Thing

One of the most common points of confusion around this topic is all the different names people use for the exact same trust. If you've heard any of the following terms, they all refer to the Miller Income Trust:

— Miller Trust — Income Trust — Qualified Income Trust — QIT — Miller Income Trust

So if you've been doing research and keep running into slightly different names, don't worry — you're not looking at different tools. You're looking at the same one, just described differently by different sources.

What a Miller Income Trust Is NOT

It's worth being direct about this: a Miller Income Trust is not a general-purpose "Medicaid trust." That term gets used so loosely that it's nearly meaningless on its own. In a full Medicaid planning situation, there may be multiple different types of trusts at play depending on the circumstances — asset protection trusts, special needs trusts, and others. Each one does something different.

A Miller Income Trust has one job: addressing the income cap problem for long-term care Medicaid applicants in Florida. If your situation involves asset issues, look-back periods, or protecting a spouse's finances, those are separate conversations requiring different tools.

Why This Matters in Florida

Florida follows federal Medicaid guidelines but also has its own state-specific rules and income thresholds. The income cap for long-term care Medicaid is set each year, and getting it wrong — or assuming your situation doesn't require a Miller Income Trust when it does — can mean a denial of benefits and a very costly gap in care coverage.

This is also why working with someone who handles Florida Medicaid planning specifically is so important. General estate planning knowledge isn't always enough. The rules are detailed, the timelines matter, and the documentation has to be done correctly. A trust that's improperly drafted won't solve the income problem — it'll just create a new one.

A Friendly Reminder: Medicaid Planning Takes Time

If you or a family member is approaching the point of needing long-term care, the sooner you start the planning process, the better. Medicaid has look-back periods and application timelines that can catch families off guard when they wait too long. A Miller Income Trust may be just one piece of a larger plan — and figuring out what that plan looks like for your specific situation is where professional guidance pays for itself many times over.

Want to Go Deeper? Check Out the Book

If you want to get a solid grounding in how Medicaid works for long-term care — including how to plan ahead, what the rules are, and how to make the most of your options — pick up a copy of Medicaid: How to Get Some of Your Long-Term Expenses Paid. It's a practical, plain-language guide written specifically for families who are trying to figure out how to make long-term care more affordable without going broke in the process.

Get the book on Amazon: https://www.amazon.com/Medicaid-some-your-long-term-expenses/dp/1513634712

Ready to Talk Through Your Situation?

Every family's circumstances are different. Whether you're just starting to think about long-term care planning or you're in the middle of a Medicaid application and running into the income cap issue, we're here to help you figure out the right path forward.

Visit us at: Elder Needs Law — https://elderneedslaw.com Medicaid Planning Resource — https://medicaidplanninglawyer.com

Medicaid planning doesn't have to be as intimidating as it looks. Once you understand the specific tools involved — like the Miller Income Trust — and how they're used, the picture becomes a lot clearer. And with the right guidance, getting access to the long-term care benefits your family needs is very much within reach.

Disclaimer: This article is for informational purposes only and does not constitute legal advice. Medicaid rules and income caps change regularly. Please consult a qualified Florida elder law attorney regarding your specific situation. The income cap figure referenced ($2,982) reflects the 2026 threshold and may differ in subsequent years.