What Is a Miller Trust (Qualified Income Trust) — And Do You Need One for Florida Medicaid?

If you or a loved one is trying to get help paying for care at home, in an assisted living facility, through the PACE program, or in a nursing home, Florida Medicaid may be the answer. But here's a situation that catches a lot of families off guard: you can have very little money in the bank and still be turned away from Medicaid — simply because your monthly income is too high.

That's where a Miller trust comes in.

Jason Neufeld, founder of Elder Needs Law and a board-certified elder law attorney serving clients throughout Florida, breaks this down in the video above. Here's what you need to know.

Three Names, One Tool

You may hear this referred to as a Miller trust, a qualified income trust, or a QIT. Some people also call it an income-only trust. All of these terms describe the exact same legal tool. It's not a revocable trust, not a Medicaid asset protection trust, and not a special needs trust — it's its own distinct thing, and it serves a very specific purpose.

Why Would You Need One?

Florida Medicaid programs that help cover the cost of long-term care — care at home, assisted living, PACE, or nursing facility care — have what's called an income cap. This cap changes each year. If your gross monthly income from all sources exceeds that cap, you are not eligible for these programs, even if you have almost nothing saved.

For many people, Social Security alone pushes them over the income cap. That's not a disqualification — it's just a hurdle. And a qualified income trust is how you clear it.

A QIT is not relevant for other Medicaid programs like QMB or Medically Needy. It's specifically a tool for long-term care Medicaid.

How It Works

If your income exceeds the income cap, you transfer the excess amount — at minimum, everything above the cap — into a dedicated Miller trust bank account each month. You're not required to deposit all of your income, just the overage. (There are situations where depositing everything makes things simpler, and that's a conversation to have with your attorney based on your specific circumstances.)

The trustee of this account can be almost anyone — a spouse, adult child, grandchild — just not the Medicaid recipient themselves. The Medicaid recipient retains full control over the money that stays in their personal account, which must remain below $2,000.

By routing the excess income into the QIT, you satisfy Medicaid's income requirements and become eligible for the program.

How the Money Gets Spent

This is where people sometimes run into trouble. Money coming out of a qualified income trust is supposed to be spent on health or medical-related expenses. That could include Medicare premiums, co-pays, prescriptions, or the cost-share payment to the care facility.

What it's not supposed to cover: property taxes, HOA fees, credit card bills, cable, internet, and other everyday non-medical expenses.

For clients who have significant non-medical monthly expenses — particularly those receiving care at home — a pooled special needs trust may be a better fit. Jason has a separate video covering that option if it applies to your situation.

The Big Thing to Know: Medicaid Estate Recovery

Here's the part that surprises families most: anything left in a qualified income trust when the Medicaid recipient passes away is subject to Medicaid estate recovery. The account is essentially frozen at that point — no withdrawals for funeral expenses, outstanding bills, or anything else. Whatever remains is typically returned to the state.

The good news is that if the account is managed properly, this isn't a serious concern. Because the money is supposed to be spent on health-related expenses every month, the balance should be close to zero by the end of each month. Money comes in, money goes out, repeat.

Jason has seen situations where families let tens of thousands of dollars accumulate in a Miller trust account over the years — and when their loved one passed, there was nothing to be done about it. That's exactly the kind of outcome that good ongoing support from your attorney is meant to prevent.

Getting It Right From the Start

Setting up a qualified income trust is just the beginning. Managing it correctly over time, month after month, takes a clear understanding of what the account is for and how it should be used. At Elder Needs Law, the goal isn't just to get clients approved for Medicaid — it's to make sure they (and their families) feel confident managing every piece of the plan going forward.

If you'd like to go deeper on Medicaid planning in Florida, Jason also wrote a book available on Amazon: Medicaid: How to Pay for Some of Your Long-Term Expenses Without Going Broke — a practical guide for Florida families working through exactly these decisions.

Amazon Book Link: https://www.amazon.com/Medicaid-some-your-long-term-expenses/dp/1513634712

Ready to Talk?

If your income is close to or over the Florida Medicaid income cap, don't assume you're out of options. A qualified income trust may be exactly the tool your family needs.

Reach out to Elder Needs Law to get started:

Website: https://www.elderneedslaw.com

Medicaid Planning: https://medicaidplanninglawyer.com

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