What are the advantages of a Medicaid Qualified Trust, or a Miller's Trust?

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You pay it back later, so it just pre-qualifies you, right? In other words, it doesn't protect my mom's assets from Medicaid, but helps the trustee manage and prepare for the day when all the assets are gone? I will talk to an elder law attorney about this, but am finding that the lawyers that deal with Medicaid issues are sometimes hard to find as it is somewhat of a specialized area that is in demand. I will keep trying!

Answers 1 to 7 of 7
A Miller's Trust is a type of Qualified Income Trust. Medicaid rules vary a LOT from state to state. Putting a house in an irrevocable trust with a parent as Life Tenant used to protect the asset. Not so anymore. NY has passed legislation allowing Medicaid to go after trusts. Old Filial Responsibility laws in PA have been resurrected to go after children. Some states only go after the assets that pass through probate. Others, like NY and PA go after everything. Good Luck on your search.
Since my parents live in Washington State, I need to learn how that state looks at these things since I know that states do vary. Still, I'm not clear why people do these Miller's Trusts, or Medicaid qualified trusts except to begin the record keeping and control of assists ahead of the need and to make the transition to Medicaid smoother later, when it is needed (?).
Top Answer
If you want to find an elder law attorney in Washington state, try googling for contact information for the Washington State Bar Association, or the bar association in the county in which your parents live. They won't tell you who's good or who's not, but at least it would narrow down the list to those who specialize in elder law.

Another option is to use the Bar Assocation in your state to find a good elder law attorney, and request that he/she work with a Washington state attorney on the trust issues. It's not unusual for attorneys to do this.

Be sure to check out any recommended law firm's websites to see if Medicaid planning is included in their practice areas of elder law. Some elder law attorneys focus more on revocable, irrevocable, charitable and other trusts than on Medicaid qualification.
Thanks for those suggestions for finding a lawyer who does this. I will give them a try.
DD - you kinda need to realize how Medicaid is done for NH and what preplanning can be done on your own or needs an elder law attorney to do (like Miller). Your state Dept of Health & Human Services should have a website with info on Medicaid and then specifically for Medicaid for the aged & elderly.

My suggestion is to first of all find out exactly what your state has as it's ceiling for assets & income for Medicaid. They are 2 different things and may be the same amount but perhaps not. Then roughly figure out how much time there is before your parent doing their regular pattern of spending will be at the point of being "at-need" to qualify for Medicaid. Now although most issues center around their being financially "at-need" for Medicaid, they also will need to show being medically "at need" for NH skilled nursing care - just being old or needing help going to the store, etc isn't enough to qualify for NH Medicaid. If your parent is still healthy & living on their own, then you have time to plan for 6 years from now but if you are looking at needing a NH soon you (in my experience) just have to do a legit spend-down of their nest-egg. There flat just isn't the time to do creative finance needed to move asset funds around. You may be able to do things with their income like a Miller Trust but the assets will just have to be spent-down.

My mom is in TX and when she applied for NH Medicaid, the asset ceiling was 2K but the income ceiling was $ 2,094.00. Now my mom's income is $ 1,800 a mo so for her she qualifies for TX Medicaid income levels; she pays the NH $ 1,740 a mo as her required co-pay (this is called the "SOC" or share of cost) and gets $ 60 a month to keep as her personal needs allowance. The p.n.a. varies by state from $ 35 - 90 a mo. & is barely enough for some clothing replacement & hair salon.

BUT say mom instead got $ 2,300 a mo income, she would be a measly $ 206 OVER the Medicaid ceiling and would be denied Medicaid. Now the $ 206 is just not enough to pay the 5K - 15K for NH but she has no other resources. SO what to do??…….a Miller Trust!!. What Miller does is enable those who otherwise would qualify for Medicaid a way to divert the excess income to the Miller Trust so that they now are within Medicaid income. Now Miller requires that the income is of a certain type - like income that is guaranteed or "qualified" for being there long term. Now the beneficiary of the trust is the state, so family will not ever get the excess funds. Just how Miller runs will be determined by your state laws. Some states have the Miller as a pass through in which the excess income is paid to the NH, so there is no after death trust to deal with while other states have it as a trust that exists & builds each month by the excess income and then once they die becomes the property of the state. Miller is NOT ever a DIY project either (imho) as it needs to be flexible for changes in income and within your state law for death & probate. You really can't do it till they are ready to go onto Medicaid. But again the beneficiary for Miller is the state, family or other heirs do NOT get the $$.

perchance is any of this railroad retirement?
Also there was a posting a couple of months back from someone who just did Miller for their mom in FL. The attorney fees were $ 1500 and it was set up as a pass through so the NH got the parents total monthly income. Now the good part about that is there will be no after death Miller stuff for family.

But a possible downside when the NH gets their income directly is that when family goes to withdraw some of the monthly personal needs allowance (this seems to be called the resident trust fund @ the NH); they have to go to the business office and sign off to get cash to go to the store to buy things for their parent. A lot of the time family just doesn't get any of the funds from the resident fund and it just sits there building a bit each month. Then when they die, if family doesn't ask for it, it goes to the state.

Neither the Medicare or Medicaid program is simple or ideal, but everyday I am so grateful that both exist for my mom and for others. Really if they live long enough they will run out of money (unless they are generationally wealthy) and their caregivers / family will run out of ability and they will need to go to a NH and onto Medicaid.
Wow, this answered a lot of my questions, and filled me in on some things I didn't know. Thank you so much for taking the time to share your experience and understanding of these topics! I know that the elder law attorney will help with the specifics of Washington State law, but this gives me a better general understanding of the Miller trust and related topics. I love this website! I get so much input, so quickly, from people like you who have been grappling with the same questions. Thanks again.

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