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Jumping off Lea’s excellent post: Say a mom lives in TX and her State has a maximum mo income of $2829 & 2K in assets max for LTC Medicaid eligibility. Mom gets $2200 in SS income and mom has has a pension of $835. Mom has only $1800 in savings and is in rehab at a SNF. Mom will be discharged from being a rehab patient this coming week. Mom unable to do her ADLs so she is medically “at need” for skilled nursing care. Everyone likes this NH and they can take her as a Medicaid Pending resident. Medically she is “at need” so that part is ok for LTC Medicaid criteria.
But mom has $3,235 in income every month. She is over resource by $206! Yes that $206 keeps her ineligible as financially at need has a max of $2829. But she can do a Miller Trust - if her State allows for them - & it will solve the problem.
Her SSA $ is a guaranteed income resource. So that SSA income becomes “owned” by the Miller Trust & it pays this $ to the NH as it’s required Share of Cost. Mom now personally only has that $835 pension. Voila! Mom is under the $2829 income max so now at eligible income amount for LTC Medicaid. And this $835 income too is paid every month as her required Share of Cost to the NH. But this income will have $75 deducted from it for mom’s Personal Needs Allowance. The PNA varies by State. Moms in TX which has $75 a mo PNA. This PNA is $ to use for things Medicaid does not cover… beauty shoppe, cable, clothing. Mom pays the NH $760 a month. All custodial care costs covered by LTC Medicaid. ! Voila! Happiness all around!
Not all States allow for Miller Trusts. It’s not really ever a DIY but is usually elder law attorney work.
Go to the search bar and type in "Miller Trust". Then type in "Q.I.T. trust" and "Qualified Income trust". You will get TONS of questions on this Forum with answers, and I suggest you look for answers by IGLOO who is quite expert in these things on this particular page.
Also know that the internet is your friend. Some states don't allow Miller Trusts or Qualified Income Trusts, but most do. The internet will let you know. So on Google or other search engine type in "Miller Trust for state of ____________" and "QIT trust for state of _____________".
Many questions are repeated very often on AC, and typing in all the details over and over becomes taxing, so remember that the little magnifying glass up on the timeline, just to the left of your avatar, will bring you to "search" here and answer a multitude of questions with answers.
Welcome to the Forum. Hope you find it really informative.
A Miller Trust, also known as a Qualifying Income Trust (QIT), is a Medicaid planning tool that allows people with incomes above the Medicaid limit to qualify for long-term care benefits. The trust reduces countable income by diverting income into it. When the trust holder dies, any remaining funds reimburse the state's Medicaid program for care costs. Here's how it works: Income diversion: The trust holder's income is deposited into the trust and used to pay for care. Eligibility: Income deposited into the trust doesn't count towards Medicaid eligibility, but it does count towards determining the trust holder's share of cost. Remainder beneficiary: AHCCCS must be named as the remainder beneficiary of the trust. Trust document: An attorney must write the trust document.
There is more information online at Google and from your Elder Care attorney.
Scooter, I’m glad you asked this as being too high in income to be financially eligible for LTC Medicaid is going to be an increasingly real issue for so many.
Lots of folks make SSA retirement income max of $5,108 (age 70 filer & higher earner), or the $4,018 (FRA higher earner). Although it can seem to be a good bit of $, it’s not if NH costs 7/8K - 15K a month. Most of the States in 2025 have income max for NH LTC Medicaid at $2,901 and asset max of 2K. If not for being able to do a Miller or an income cap, folks who have spent down their savings, cashed in assets but make over $2,901 income a month who now are at the point of requiring skilled care in a NH would end up on streets or living in less than ideal circumstances.
I found in my research, those States that do not have Miller or Qualify Income Trusts do not have income caps. Meaning, if all a person has is Social Security as income, they can qualify for Medicaid. (not sure about having a pension too.
The issue with pensions is that they may or may not be a guaranteed income source. The Miller has to have whatever placed into it as 100% fully guaranteed income. SSA is (well so far & Elmo doesn’t do frickery with it) and it’s easier to just place SSA in for the Miller and be done.
Pensions can go pfft. That happened with ENRON, their pension $ went down that sinkhole.
Depends on where you live but covers only limited regions. If your region matches what is on the listing for your area, please contact the Area of Aging Counsel.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Say a mom lives in TX and her State has a maximum mo income of $2829 & 2K in assets max for LTC Medicaid eligibility. Mom gets $2200 in SS income and mom has has a pension of $835. Mom has only $1800 in savings and is in rehab at a SNF. Mom will be discharged from being a rehab patient this coming week. Mom unable to do her ADLs so she is medically “at need” for skilled nursing care. Everyone likes this NH and they can take her as a Medicaid Pending resident. Medically she is “at need” so that part is ok for LTC Medicaid criteria.
But mom has $3,235 in income every month. She is over resource by $206! Yes that $206 keeps her ineligible as financially at need has a max of $2829. But she can do a Miller Trust - if her State allows for them - & it will solve the problem.
Her SSA $ is a guaranteed income resource. So that SSA income becomes “owned” by the Miller Trust & it pays this $ to the NH as it’s required Share of Cost. Mom now personally only has that $835 pension. Voila! Mom is under the $2829 income max so now at eligible income amount for LTC Medicaid. And this $835 income too is paid every month as her required Share of Cost to the NH. But this income will have $75 deducted from it for mom’s Personal Needs Allowance. The PNA varies by State. Moms in TX which has $75 a mo PNA. This PNA is $ to use for things Medicaid does not cover… beauty shoppe, cable, clothing. Mom pays the NH $760 a month. All custodial care costs covered by LTC Medicaid. ! Voila! Happiness all around!
Not all States allow for Miller Trusts. It’s not really ever a DIY but is usually elder law attorney work.
Then type in "Q.I.T. trust" and "Qualified Income trust".
You will get TONS of questions on this Forum with answers, and I suggest you look for answers by IGLOO who is quite expert in these things on this particular page.
Also know that the internet is your friend. Some states don't allow Miller Trusts or Qualified Income Trusts, but most do. The internet will let you know. So on Google or other search engine type in "Miller Trust for state of ____________" and "QIT trust for state of _____________".
Many questions are repeated very often on AC, and typing in all the details over and over becomes taxing, so remember that the little magnifying glass up on the timeline, just to the left of your avatar, will bring you to "search" here and answer a multitude of questions with answers.
Welcome to the Forum. Hope you find it really informative.
A Miller Trust, also known as a Qualifying Income Trust (QIT), is a Medicaid planning tool that allows people with incomes above the Medicaid limit to qualify for long-term care benefits. The trust reduces countable income by diverting income into it. When the trust holder dies, any remaining funds reimburse the state's Medicaid program for care costs. Here's how it works:
Income diversion: The trust holder's income is deposited into the trust and used to pay for care.
Eligibility: Income deposited into the trust doesn't count towards Medicaid eligibility, but it does count towards determining the trust holder's share of cost.
Remainder beneficiary: AHCCCS must be named as the remainder beneficiary of the trust.
Trust document: An attorney must write the trust document.
There is more information online at Google and from your Elder Care attorney.
Lots of folks make SSA retirement income max of $5,108 (age 70 filer & higher earner), or the $4,018 (FRA higher earner). Although it can seem to be a good bit of $, it’s not if NH costs 7/8K - 15K a month. Most of the States in 2025 have income max for NH LTC Medicaid at $2,901 and asset max of 2K. If not for being able to do a Miller or an income cap, folks who have spent down their savings, cashed in assets but make over $2,901 income a month who now are at the point of requiring skilled care in a NH would end up on streets or living in less than ideal circumstances.
i understand the process better now.
Pensions can go pfft. That happened with ENRON, their pension $ went down that sinkhole.
Here is some information link:
https://www.nerdwallet.com/article/investing/estate-planning/miller-trust? msockid=0584d5016ede60290a2dc00e6f5d61bc