What Is a Miller Trust? (Qualified Income Trust / QIT)

Frequently asked questions

▸ What is a Miller Trust?

A Miller Trust — also called a Qualified Income Trust (QIT) or Income Trust, depending on the state — is an irrevocable trust used in income-cap states to qualify a Medicaid long-term-care applicant whose monthly income is over the state's limit. Income deposited into the trust is not counted toward that limit, so an applicant who would otherwise be denied for having too much income can still qualify.

▸ What is a QIT?

QIT stands for Qualified Income Trust — the formal federal term (42 U.S.C. § 1396p(d)(4)(B)) for what several states informally call a Miller Trust and others call a plain Income Trust. All three names refer to the same legal mechanism: an irrevocable trust that lets a Medicaid long-term-care applicant qualify despite having monthly income over the state's limit, by redirecting the excess into the trust instead of counting it toward the cap.

▸ Why do states use three different names for the same thing?

The trust is named after Miller v. Ibarra, the 1990 federal case that established it, and federal law (42 U.S.C. § 1396p(d)(4)(B)) calls it a "qualifying trust." States picked their own label when they wrote it into policy — Texas and Ohio call it a Miller Trust, most call it a Qualified Income Trust, and a handful (Arkansas, Colorado, Mississippi, South Carolina) call it a plain Income Trust. It is the same legal mechanism under every name; some searchers also land here looking for an "income cap trust" or a "Miller's Trust" — neither is the official name any state actually uses, but both mean the same thing described elsewhere on this page.

▸ What can the money in a QIT/Miller Trust be used for?

Each month, the trustee uses the money in the trust to pay the applicant's Personal Needs Allowance, any allowance for a community spouse, and the remaining balance to the nursing facility as the applicant's share of the cost of care — an order the state's post-eligibility budget sets, not the trustee's discretion. It is not a general-purpose account the applicant or trustee can spend freely; using it outside that distribution order risks the trust's Medicaid compliance. Each state guide on this site walks through the exact distribution order and amounts.

▸ What is a Qualified Income Trust account?

It's a dedicated checking account titled in the name of the trust, with the trustee (not the applicant) as the authorized signer — the trust document is the legal instrument, and the account is where the applicant's income is actually deposited and paid out each month. Opening one is often the hardest practical step, since most bank branches have never opened this account type before. Each state guide on this site has a dedicated walkthrough for what to say at the bank in that state.

▸ Which states use a Miller Trust?

Income-cap states require one whenever an applicant's income exceeds the limit; "medically needy" spend-down states (Louisiana is the clearest example) do not use one at all, because they qualify over-income applicants a different way. A few states are hybrids — Missouri's trust exists only for its in-home Home and Community-Based waiver, not for nursing-facility Medicaid, which uses a spend-down instead.

▸ Is a Miller Trust the same thing as a Medicaid Asset Protection Trust?

No. A Miller Trust fixes an income problem — it exists so a real-time paycheck or pension that's too large doesn't disqualify someone who needs care now. A Medicaid Asset Protection Trust fixes a different problem entirely: it's set up years in advance, holds savings or property (not monthly income), and is meant to shield those assets from Medicaid's five-year look-back and estate recovery. They're both irrevocable trusts used in Medicaid planning, which is why the two get confused, but one answers "my income is too high right now" and the other answers "I want to protect assets before I ever need care." See our full Medicaid Asset Protection Trust guide for the cost, the look-back rule, and why we explain it rather than sell a kit for it.

▸ What's the 5-year look-back, and does it apply to a Miller Trust?

The look-back is Medicaid's rule that examines the 60 months before an application for gifts or below-market asset transfers, and penalizes ones it finds. It governs assets given away — it has nothing to do with funding a Miller Trust, because a Miller Trust holds the applicant's own current income, not a gift of past assets. Confusing the two is common because both come up in the same Medicaid-planning conversation; they're answered by different rules. The look-back matters most for a Medicaid Asset Protection Trust, which our separate guide covers in detail.

▸ How much does a Miller Trust cost to set up?

An elder-law attorney typically charges $1,000–$2,500 to handle it. For the core setup — completing the state's own published template (where one exists) and opening a dedicated bank account — many families handle it themselves; each state guide on this site walks through that process and what it costs either way.

▸ Does a Miller Trust help me get off an HCBS waiver waiting list?

No — a Miller Trust affects financial eligibility, not waiting-list position, and those are two separate gates. Most states cap how many people a Home and Community-Based Services (HCBS) waiver can serve at once, and that enrollment cap is set independently of whether any individual applicant is financially eligible; nationally, HCBS waiver waiting lists held over 600,000 people as of 2025, with an average wait around 32 months (MACPAC). Someone with a properly set up Miller Trust can be fully income-eligible and still sit on a waiting list, because the list is about open slots, not about their finances. The trust is still worth setting up correctly while waiting, since eligibility has to be in place the moment a slot opens.

▸ How do I appeal a Medicaid denial?

Every state Medicaid denial notice includes the specific reason for the denial and instructions for requesting a fair hearing (sometimes called an appeal) within a stated deadline, typically 60–90 days from the notice date. Read the stated reason first — most Miller Trust-related denials on this site's own state guides trace back to a paperwork or timing issue (the trust wasn't funded in the same calendar month, the bank account wasn't titled correctly) rather than a real eligibility problem, and those are usually fixed by refiling correctly rather than by appealing. If the denial looks wrong on its face, requesting the fair hearing preserves your right to challenge it while you sort out the underlying issue — each state's guide on this site lists the specific denial reasons Medicaid can cite for a Miller Trust.