Miller Trust (Qualified Income Trust): How to Qualify for Nursing Home Medicaid Over the Income Cap
About half the states use a hard income cap for nursing home and waiver Medicaid: 300% of the SSI federal benefit rate, which is $2,982 per month in 2026. A dollar over and you are ineligible, no matter how high the nursing home bill is. The fix Congress created is the Qualified Income Trust, usually called a Miller trust.
How it works
Each month, income above the cap (or all income, depending on the state) is deposited into the trust. The trustee, typically a family member, pays the nursing home and allowed expenses from it. Because the deposited income is no longer counted, you fall under the cap and qualify. When you die, any money left in the trust goes to the state up to the amount Medicaid paid.
Which states require one
Income-cap states include Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Nevada, New Jersey, New Mexico, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas and Wyoming. States such as New York, California, Illinois and Pennsylvania are "medically needy" states and do not use the trust.
What the trust can pay
- The patient's share of cost to the nursing home
- A personal needs allowance (about $30–$200 per month by state)
- An income allowance to the community spouse
- Medicare and other health insurance premiums
- Trustee bank fees
Setting one up
The trust must be irrevocable, name the state as remainder beneficiary, and hold only income, never assets. Most states provide a template; an attorney typically charges a few hundred dollars to prepare it. The bank account must be opened and funded before the month you want coverage to begin.
What to do next
- Compare gross monthly income to your state's cap on the seniors page of this site.
- If over, ask the state agency for its QIT template and a list of approved uses.
- Open a dedicated checking account in the trust's name and make the first deposit before applying.