A Miller trust, also called a Qualified Income Trust, lets a parent qualify for Medicaid long-term care when their income is above the state's income limit. In 2026 that limit is often the special income limit of $2,982 per month, which is 300% of the SSI federal benefit rate. Income deposited into the trust does not count toward eligibility. Miller trusts are only needed in "income-cap" states.
Medicaid
What Is a Miller Trust (QIT) and When Does a Parent Need One for Medicaid? (2026)
By Chuck Brodsky, Co-Founder, MediNav — Updated July 2026 — 6 min read
Quick answer
If a parent's income is modest but still slightly too high for Medicaid, families are often told they are "over the limit" and assume nothing can be done. In income-cap states, a Miller trust is the tool that solves exactly this problem — it is a legal structure, not a loophole, and it is used routinely.
The problem a Miller trust solves
Some states are "income-cap" states: a parent whose monthly income exceeds the Medicaid long-term-care limit is ineligible, even by a few dollars, with no spend-down option. In 2026 that cap is commonly the special income limit of $2,982 per month, equal to 300% of the SSI federal benefit rate. A parent whose income is a few hundred dollars over the cap would be ineligible and unable to qualify — until the income is routed through a Qualified Income Trust.
How a Miller trust works
The parent (or their representative) sets up a Qualified Income Trust and deposits income into it each month. Income that flows through the trust is not counted toward the Medicaid income limit, so the parent can qualify. The trust then pays out in a required order — a personal needs allowance, an allowance for a community spouse if any, and the rest toward the cost of care. The state must be named to receive whatever remains in the trust at the parent's death, up to the amount Medicaid paid.
What a Miller trust is not
A Miller trust does not shelter or protect assets, and it does not reduce what the parent contributes to their care — most of the income still goes toward the care bill. It only fixes the income-eligibility problem in income-cap states. It also does not help with the resource (asset) test; that is a separate calculation. And it is unnecessary in states that allow a medically needy spend-down instead of a hard income cap.
Getting the details right
Miller trusts are unforgiving of mistakes. The trust must be set up correctly, funded every month, and administered in the right payment order, or eligibility can be lost. This is why families typically use an elder-law attorney to establish one. It also interacts with other Medicaid rules — the look-back period on transfers and, for married couples, the community spouse resource allowance.
What a caregiver should do
First, find out whether your parent's state is an income-cap state — a parent turned down purely for being slightly over the income limit is the classic sign one is needed. Then set the trust up with legal help, and build a simple monthly routine to deposit the right income. Handled correctly, a Miller trust turns an over-income denial into an approval, and it pairs with the broader Medicaid picture including estate recovery after death.
When to call MediNav
- Free: Ask a specific question — tell us your parent's income and state and get a straight answer on whether a Miller trust is needed.
- Free: Run the coverage check — in about two minutes, see what a parent is likely eligible for with 2026 figures for your state.
- Paid ($9–$19/mo): MediNav Watch and Watch+ re-check the figures as they change each year and remind you before deadlines, so nothing lapses unnoticed.
Related guides
- Medicaid Look-Back Period Explained — the transfer rules
- Medicaid Estate Recovery After Death — what happens to assets later
- Community Spouse Resource Allowance — married-couple protections
- Is My Parent Dual-Eligible? — how the programs combine
Frequently asked questions
What if my parent's income is just over the Medicaid limit?
In an income-cap state, that is exactly what a Miller trust fixes. Income routed through a Qualified Income Trust does not count toward the limit — often the $2,982 special income limit in 2026 — so a parent slightly over the cap can qualify. Set it up with an elder-law attorney and fund it monthly.
Does a Miller trust protect my parent's money?
No. A Miller trust solves an income-eligibility problem; it does not shelter assets or reduce the care contribution. Most of the income deposited still goes toward the cost of care, and the state must be repaid from any trust balance at death. It is a qualification tool, not an asset-protection device.
Do all states use Miller trusts?
No. They are needed only in income-cap states, where exceeding the income limit means automatic ineligibility. States that allow a medically needy spend-down let a parent become eligible by spending excess income on care instead, so no trust is required. Check which approach your parent's state uses.
What income goes into the trust?
Typically enough of the parent's income — Social Security, a pension, or both — to bring countable income at or below the limit, though many attorneys route all of a source through it for simplicity. The trust then pays out in the required order. Getting the funding right each month is essential to keeping eligibility.
What happens to the trust when my parent dies?
The state must be named as a remainder beneficiary and is repaid from whatever remains in the trust, up to the total Medicaid paid for the parent's care. Because most income flows out to care each month, balances are often small, but the repayment requirement is mandatory for a valid Qualified Income Trust.
Can I set one up myself?
It is strongly discouraged. The trust language, funding, and monthly payment order must meet exact requirements, and errors can cost eligibility. Nearly all families use an elder-law attorney to draft and guide a Miller trust, and the cost is small next to the Medicaid coverage it unlocks.
Sources: Medicaid.gov — Eligibility (income and trusts), 42 U.S.C. 1396p(d)(4) — trusts. Last verified July 2026.