Miller Trusts

hammer breaking a piggy bank

How a “Miller Trust” Works As a Tool–
Breaking Open Qualification for Medicaid Nursing Home Benefits

In Texas, if your income is more than the monthly amount Medicaid permits, special rules allow you to re-direct your income to a legal tool called a Miller Trust or Qualified Income Trust (QIT).  This legal planning document allows you to meet income eligibility rules for Medicaid nursing home benefits.  If you don’t set up this type of trust,  your income cannot be more $2,250 per month in order to meet Medicaid’s 2018 eligibility requirements. 

The document is known as a“Miller Trust” for the family that brought the court action resulting in this planning solution for families.

Big thing to remember: income will never disqualify you for Medicaid nursing home benefits in Texas.

How Qualified Income Trusts or Miller Trusts Work In Texas

A Qualified Income Trust or “Miller Trust” is set up for one reason and one reason only. In it’s most basic form, you use this tool to gain income eligibility for Medicaid nursing home care by depositing your income into a checking account titled in the trust name.

Here’s how it works–

  • The trust is used to process your income as a Medicaid applicant, so that you meet Medicaid’s income rules ($2,250 per month in 2018). The trust must follow special rules for managing the monthly income of the person seeking Medicaid’s help.
  • The instructions contained within the document make up the trust. Only income may be deposited into these types of trusts. The trust bank account is prohibited from accepting anything other than income. That is why these are also generically referred to as income trusts.
  • Regulations require depositing income into a “Miller Trust” checking account authorized by the trust. Rather than using an existing account, I recommend fresh bank accounts with a zero balance. You can use a current account, but it’s too risky. In our practice we always help clients set up a new account.
  • When deciding eligibility, the Medicaid caseworker ignores the income deposited into the Miller Trust bank account. Using this approach reduces countable income. The apparent income reduction helps you meet the strict income rules.
  • To wrap up, Medicaid policy limits the monthly income you can receive and still qualify for nursing home benefits. The Federal government adjusts this upper limit for inflation each year.  In 2018, the monthly limit for income is $2,250. If your income exceeds the limit, special rules allow this income to be put into a Qualified Income Trust (QIT) or “Miller Trust.”

How Your Income Flows Through the Trust

A “Miller Trust”or Qualified Income Trust (QIT) helps you qualify for Medicaid in Texas–but it doesn’t shelter income. Money deposited into the trust bank account typically flows out of the trust to pay the nursing home. It’s designed to cover part of the care costs. The balance of the nursing home payment comes from Medicaid. If any money remains in the trust after death, the state keeps it to help defray their costs. 

Here’s an Real-life Example of How a “Miller Trust” works in Texas

Let’s say your mom needs nursing home care. She gets a monthly Social Security payment of $2,400. Her income exceeds the Medicaid eligibility limit of $2,250 for a single person, but is not enough to pay for the care she needs. The rules say that she doesn’t qualify for Medicaid, but the Miller Trust provides a workaround. Here are the steps we recommend for qualifying for Medicaid nursing home benefits in this example–

  1. Hire an attorney. The first step is to hire an attorney to create a Medicaid Qualified Income Trust or “Miller Trust.”  At Weaver Firm-Attorneys , we focus  on “Miller Trusts” and have for more than two decades
  2. Deposit mom’s Social Security check into the account. This drops the amount of income the state counts against her eligibility. Her Social Security income will pay part of her care. Medicaid makes up the difference. 
  3. The Medicaid agency figures out how much of the long term care costs an individual must pay. They add up the amount of income received each month. From that they allow payments for health insurance premiums. Examples include premiums for Medicare Part B, Prescription Drug plans, group retirement health insurance and dental coverage.
  4. Payment of medical expenses not otherwise covered by Medicare and Medicaid is also allowed from through the trust. The trustee (the person managing the trust) cannot use trust funds for any other purpose–except those allowed by Medicaid. 
  5. Your mom keep $60 out of the $2,400 for her personal needs.  
  6. If your mom is married, the trust may be able to distribute part of the income to the spouse.  This allotment is called the Minimum Monthly Maintenance Needs Allowance. The size of this monthly allowance is determined by the Spousal Income Protection rules. For 2018, the largest allocation in Texas is $3,090 per month.
  7. The trust will typically distribute all deposited funds each month to cover the items detailed above. There is little chance any money will grow in the trust. It is rare for a Medicaid recipient to die with a balance left in the qualified income trust account. If it happens, the state can recover what it spent on the applicant’s care. After the state is repaid, the trustee can distribute the rest to beneficiaries named in the document.

Setting up and managing a Miller Trust is not a “do-it-yourself” project. The rules are too complicated. 

Set up the wrong way, you face a real risk of losing thousands of dollars’ worth of benefits. Bear in mind once you lose those benefits, they are lost to you forever. If you have income that’s too high to qualify for Medicaid, a Qualifying Income Trust makes sense.

Call 817-638-9016 for an appointment today with Rick Weaver, attorney, or Travis Weaver, attorney, for guidance in setting up a “Miller Trust.” If you don’t call us, find another experienced attorney to assist you. A skilled attorney will prepare the specific instructions needed for the trust. You’ll get advice on how the trust should be set up and how to fund it. It’s the best way to avoid the pitfalls and get all the benefits out of “Miller Trusts” or Qualified Income Trusts in Texas.

The Weaver Firm – Attorneys