Medicaid long-term care
Last checked: May 2026
A Miller Trust may help when a person needs Medicaid long-term care but has too much monthly income for an income-cap state.
It is also called a Qualified Income Trust, or QIT. It is not used in every state. It must be done the way your state Medicaid office says.
Quick answer
A Miller Trust may help a person qualify for Medicaid long-term care when their monthly income is over the state limit.
This happens in some income-cap states. The person puts certain income into a special trust account each month. Medicaid then may treat that income in a special way when it decides if the person can get long-term care coverage.
A Miller Trust does not let someone keep all of their income. Much of the income may still have to go toward care costs after Medicaid approves coverage. It also does not fix asset problems, gifts, home transfer problems, or missing medical proof.
Federal Medicaid law describes a trust made only of pension, Social Security, and other income, with the state paid back from money left in the trust after death, up to the Medicaid amount paid. See Social Security Act section 1917(d)(4)(B) from the Social Security Administration.
Who this helps
This guide is for a caregiver, spouse, adult child, or helper when a loved one needs help paying for long-term care.
It may help if the person needs one of these:
- Nursing home care.
- Home care through a Medicaid home and community-based services program.
- Assisted living help through Medicaid, if your state offers it.
- PACE or similar long-term care coverage, if offered in your area.
Medicaid is a main payer for long-term services and supports in the United States. Medicaid.gov says Medicaid pays for long-term care in settings that can include institutions and home and community-based services. You can read the federal overview at Medicaid.gov long-term services and supports.
If the person only needs short-term skilled care after a hospital stay, start with what Medicare may cover. A Miller Trust is a Medicaid long-term care issue, not a Medicare issue.
What Miller Trust or QIT means
A Miller Trust is the common name. The official name in many state forms is Qualified Income Trust, or QIT.
The trust is set up for a person who needs Medicaid long-term care but has income over the state limit. The trust holds income, not assets.
New Jersey Medicaid says QITs were created under federal law at Social Security Act section 1917(d)(4)(B). New Jersey also says a QIT must contain only the person’s income, must be irrevocable, must have a trustee, and must name the state as a beneficiary for remaining funds up to the Medicaid amount paid. See the official New Jersey page on Qualified Income Trusts.
Important: a QIT is not a savings shelter
A QIT is not a way to hide money. It is not for a house sale, savings account, gift money, or other assets. It is for income only.
If your loved one has assets over the limit, recent gifts, or a home transfer, read about the Medicaid look-back period and ask for legal help before moving money.
Why income-cap states matter
Some states use an income cap for Medicaid long-term care. This means a person can be denied because monthly income is over a set limit, even when the cost of care is higher than the person’s income.
In those states, a Miller Trust may be the tool that lets the person meet the income rule.
Other states may use a medically needy or spend-down route instead. That is different. A spend-down may let a person qualify after medical costs are counted. A QIT usually means income must be placed into a trust account in the right month and in the right amount. Learn more about the difference on our Medicaid spend-down guide.
Do not guess which rule your state uses. Medicaid rules vary by state. Medicaid.gov has state Medicaid profiles with links to state Medicaid programs. Your state Medicaid long-term care office is the source that must confirm the current QIT rule.
What may pay or help
A Miller Trust does not pay for care by itself. It may help with one part of the Medicaid approval process.
| Need | Possible path | What to ask |
|---|---|---|
| Nursing home care | Medicaid long-term care | Ask if the state uses an income cap and whether a QIT is needed. |
| Care at home | Medicaid HCBS waiver or state plan long-term care service | Ask if the person must meet nursing-facility level of care and if there is a waitlist. |
| Income is over the Medicaid long-term care limit | Qualified Income Trust in income-cap states | Ask for the state QIT template, bank account rules, and monthly deposit rule. |
| Income is too high in a spend-down state | Medically needy or spend-down route, if offered | Ask how medical costs are counted and what proof is needed. |
| Family wants to be paid for care | Some Medicaid home care programs may allow paid family care | Ask the Medicaid waiver or managed care plan if family caregivers can be hired. |
For home care, start with our plain guide to Medicaid HCBS waivers. If you are trying to become a paid caregiver, also read Can I get paid to be a caregiver?.
Medicaid.gov says home and community-based services can let Medicaid members receive care at home or in the community instead of in an institution. See the federal overview of home and community-based services.
Who may qualify
A QIT may help only if all the needed Medicaid rules can still be met.
The person usually must meet rules in these areas:
- State residency.
- Citizenship or qualified immigration status.
- Medical need for long-term care.
- Income rules.
- Asset rules.
- Transfer and look-back rules.
- Any program rules for the care setting, such as nursing home, home care, assisted living, or PACE.
Medicaid.gov explains that Medicaid institutional services include nursing facility services and that states vary in what is included in payment. See Medicaid.gov institutional long-term care.
A QIT can help with income in an income-cap state. It does not make a person medically eligible. It does not erase an asset problem. It does not remove a transfer penalty.
Where to start first
Start with the state Medicaid long-term care office or the office handling the Medicaid application.
Ask these questions before you open a bank account:
- Is this an income-cap state for Medicaid long-term care?
- Does this person need a Qualified Income Trust?
- Which care program are we applying for: nursing home Medicaid, HCBS waiver, PACE, assisted living, or another program?
- What exact income must go into the QIT each month?
- Can we use the state QIT form or template?
- Who may sign the trust if the person cannot sign?
- When must the first deposit be made?
- Where do we send the trust, bank proof, and monthly statements?
You can also contact your local Area Agency on Aging through the ACL Eldercare Locator. Ask for local Medicaid long-term care help, SHIP counseling, or legal aid if you need help with the application.
Phone script for the Medicaid office
Use this when you call the Medicaid long-term care office, county eligibility office, or the worker on the case.
“Hi, I am helping my [mother/father/spouse/relative] apply for Medicaid long-term care. Their monthly income may be over the limit. Does our state require or allow a Qualified Income Trust, also called a Miller Trust, for this program?”
“If yes, can you tell me where to get the state-approved form, who can sign it, how much income must be deposited, and what proof you need each month?”
“Also, can you tell me the deadline for the first deposit so we do not lose a month of coverage?”
Documents you may need
The state may ask for more. This list is a starting point.
- Medicaid long-term care application.
- Proof of identity.
- Proof of state residency.
- Social Security card or number.
- Medicare card, if the person has Medicare.
- Health insurance cards and premium bills.
- Social Security benefit letter.
- Pension or retirement income letters.
- VA benefit letters, if any.
- Bank statements for all accounts.
- Proof of assets, such as life insurance cash value, CDs, stocks, burial funds, or property.
- Trust document, if a QIT is used.
- Proof the QIT bank account was opened.
- Proof of monthly QIT deposits.
- Power of attorney, guardianship order, or court papers, if someone else signs.
- Nursing home admission papers or care assessment papers.
- Medical records that show long-term care need.
- Any denial letter, request for proof, or notice from Medicaid.
Keep copies of every page you send. Write down the date, fax number, upload receipt, or mailing tracking number.
For more household forms, see our caregiver checklists.
What income goes into the trust
Federal law says this type of trust is made only of pension, Social Security, and other income to the person, plus income that builds up in the trust.
State rules decide the exact deposit method. One state may tell you to deposit income over the cap. Another may tell you to deposit a full income source. Another may give a minimum amount that must be deposited each month.
Florida’s official QIT sheet says a person must make deposits into the QIT account every month for as long as Medicaid is needed. It also warns that missed or too-small deposits can make the person ineligible for Medicaid payment of long-term care services for that month. See Florida DCF’s Qualified Income Trust Information Sheet.
Do not put savings, house-sale money, gifts, or other assets into a QIT unless your state Medicaid office or attorney has told you in writing that it is allowed. Many state QIT rules say the trust must hold income only.
Who manages the QIT
A trustee manages the trust account.
The trustee may be a spouse, adult child, trusted relative, friend, or another person allowed by state rules. The trustee must follow the trust terms and Medicaid rules.
The trustee’s job may include:
- Opening the correct bank account.
- Making the required monthly deposits.
- Paying only allowed expenses from the account.
- Saving bank statements and receipts.
- Sending proof to Medicaid when asked.
- Closing the account the way state rules require after death.
Do not use the QIT account like a normal checking account. Ask the caseworker what payments are allowed. Some income may go to the nursing home or care provider as the person’s share of cost. Some may be allowed for health insurance premiums, personal needs, or a spouse at home, depending on state rules.
When to get elder law help before you act
A QIT can be simple in some cases. It can also cause harm if it is done wrong.
Try to speak with an elder law attorney, legal aid, or a trusted Medicaid planning clinic if any of these are true:
- A spouse still lives at home.
- The person owns a home or other real estate.
- Money or property was given away in the last five years.
- The person sold a house, car, or land.
- There is no valid power of attorney.
- The person cannot sign legal papers.
- The person gets VA benefits.
- There was already a denial.
- A nursing home is asking for payment now.
- You are near a deadline for Medicaid coverage.
Ask the Medicaid office if it has a state-approved QIT form. Some states publish model forms. For example, Texas Health and Human Services says its QIT information helps people applying for Medicaid for the Elderly and People with Disabilities and their attorneys. See Texas HHSC QITs and MEPD information.
What usually goes wrong
- Using a generic form from the internet. Your state may require exact language.
- Opening the wrong bank account. The account title and tax ID rules may matter.
- Missing the first deposit month. Some states will not let you fix a missed month later.
- Depositing too little. If income outside the trust is still too high, Medicaid may deny or close coverage.
- Putting assets into the QIT. A QIT is for income only in many state rules.
- Letting the caregiver spend from the account without approval. The trust account is not for normal household spending.
- Ignoring the share of cost. Even after approval, the person may owe part of income to the care provider.
- Forgetting monthly proof. Medicaid may ask for statements, deposit records, and receipts.
- Assuming QIT solves every denial. The denial may be about assets, transfers, missing records, or level of care.
What to do if the first path does not work
If Medicaid says no, ask for the denial reason in writing.
Read the notice. Look for the exact reason. It may say income, assets, missing proof, transfer penalty, level of care, residency, or another issue.
Next steps after a denial or bad answer
- Ask the worker, “Is the problem income, assets, medical need, or missing proof?”
- Ask if a QIT can fix the income issue for this program.
- Ask for the state rule or form in writing.
- Send missing documents by a trackable method.
- Ask how to request a hearing or appeal before the deadline.
- Call legal aid or an elder law attorney if the person may lose care or housing.
If the denial is for a Medicare claim, use our guide on how to appeal a Medicare denial. If it is a Medicaid long-term care denial, follow the appeal steps on the Medicaid notice.
If home care is the goal and the waiver is full, ask about a waitlist, other state plan services, adult day services, respite, and local caregiver support. You can also read our guide to respite care for caregivers.
How to find the right state office
Use the state Medicaid agency, not a random web article, for the final answer.
- Go to Medicaid.gov state profiles.
- Select your state.
- Find the state Medicaid website or contact page.
- Search that site for “Qualified Income Trust,” “Miller Trust,” “income trust,” or “long-term care Medicaid.”
- Call the Medicaid long-term care office if the website is unclear.
For older adults and caregivers, the Eldercare Locator can help find local aging offices. Ask for Medicaid long-term care application help, benefits counseling, or legal aid referral.
Official sources used for this update
We checked these sources for this May 2026 update:
- Medicaid.gov: Long-Term Services and Supports.
- Medicaid.gov: Institutional Long-Term Care.
- Medicaid.gov: Home and Community-Based Services.
- Social Security Act section 1917, including section 1917(d)(4)(B).
- Medicaid.gov: State Medicaid profiles.
- ACL: Finding local services and Eldercare Locator.
- New Jersey Medicaid: Qualified Income Trusts.
- Florida DCF: Qualified Income Trust Information Sheet.
- Texas HHSC: QITs and MEPD information.
- Ohio Medicaid: Medicaid programs and Qualified Income Trusts.
State rules can change. State forms can also change. Always check the current state Medicaid page before signing or funding a QIT.
Resumen breve en español
Un Miller Trust también se llama Qualified Income Trust o QIT.
Puede ayudar si una persona necesita Medicaid para cuidado a largo plazo, pero sus ingresos mensuales son demasiado altos en un estado con límite de ingresos.
No es para esconder dinero. Normalmente es solo para ingresos, como Seguro Social o pensión. Las reglas cambian por estado.
Antes de abrir una cuenta, llame a la oficina estatal de Medicaid. Pregunte si necesita un QIT, cuánto ingreso debe depositar cada mes, qué formulario debe usar y cuándo vence el primer depósito.
About this guide
CaregiverBenefits.org writes guides for family caregivers who need benefit steps, documents, phone calls, and appeal options.
This guide is a national starting point. Miller Trust rules depend on state Medicaid rules. Your state Medicaid office must confirm the current rule for your loved one’s case.
Plain disclaimer
This guide is general information. It is not legal advice. Medicaid rules change by state and by program. Ask your state Medicaid office, legal aid, or an elder law attorney before you sign a trust or move money.
FAQ
Is a Miller Trust the same as a Qualified Income Trust?
In most caregiver and Medicaid long-term care settings, yes. Miller Trust is the common name. Qualified Income Trust, or QIT, is the name many state Medicaid offices use.
Does every state allow Miller Trusts?
No. QIT use depends on state Medicaid rules. Some states use income-cap rules for long-term care. Other states may use a spend-down or medically needy path instead.
Does a Miller Trust let my parent keep all income?
No. A QIT may help with the income test, but the income may still be used to calculate the amount owed toward care. Ask the Medicaid office how patient responsibility or share of cost works.
Can I put savings into a Miller Trust?
Usually no. A QIT is for income only. Do not put savings, home-sale money, gifts, or other assets into the account unless your state Medicaid office or attorney says to do so in writing.
Who can be the trustee?
State rules vary. A spouse, adult child, relative, friend, or other trusted person may be allowed. The trustee must follow the trust and Medicaid rules.
Can a power of attorney sign the QIT?
Maybe. The power of attorney must give enough legal authority under your state rules. Ask Medicaid or an elder law attorney before relying on it.
What happens if we miss a monthly deposit?
The person may lose Medicaid payment for long-term care for that month in some states. Ask the caseworker how to fix it, but do not assume a late deposit will count.
Can a Miller Trust help with home care?
It may, if your state uses QITs for the Medicaid home care program and the person meets the other rules. Ask about the exact program, such as an HCBS waiver, PACE, or managed long-term care.
Should we use a free QIT form online?
Use the state Medicaid form or instructions when available. A form from another state may cause a denial or delay.
What if Medicaid already denied the application?
Ask for the reason in writing. If the denial is only because income is over the limit, ask if a QIT can fix the issue. Also check the appeal deadline on the notice.
