{
  "publisher": "Miller Trust Guide",
  "page": "https://millertrustguide.com/miller-trust-states",
  "description": "Whether each US state and the District of Columbia uses a Qualified Income Trust (Miller Trust, 42 U.S.C. § 1396p(d)(4)(B)) for Medicaid long-term care. usesMillerTrust is \"yes\", \"in-home-waiver-only\", or \"no\". Informational only — not legal advice.",
  "disclaimer": "Classifications come from each state Medicaid agency's own published policy (see source.url). Medicaid rules change; the state agency is the authority.",
  "reviewed": "2026-10-20",
  "counts": {
    "yes": 24,
    "inHomeWaiverOnly": 1,
    "no": 26
  },
  "jurisdictions": [
    {
      "name": "Alabama",
      "abbreviation": "AL",
      "usesMillerTrust": "yes",
      "stateTerm": "Qualifying Income Trust",
      "summary": "Alabama uses a Qualified Income Trust (called a Qualifying Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Alabama Medicaid Agency",
        "abbreviation": "Alabama Medicaid"
      },
      "source": {
        "label": "Alabama Medicaid Ala. Admin. Code r. 560-X-25-.10",
        "url": "https://medicaid.alabama.gov/documents/9.0_Resources/9.2_Administrative_Code/9.2_Adm_Code_Chap_25_Eligibility_7-15-23.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/alabama",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#alabama"
    },
    {
      "name": "Alaska",
      "abbreviation": "AK",
      "usesMillerTrust": "yes",
      "stateTerm": "Qualifying Income Trust",
      "summary": "Alaska uses a Qualified Income Trust (called a Qualifying Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Alaska Department of Health, Division of Public Assistance (DPA) -- determines Medicaid long-term-care financial eligibility, including Qualifying Income Trust review and approval, through DPA's Policy & Program Development Team (hss.dpa.policy@alaska.gov) and DPA regional/program offices.",
        "abbreviation": "DPA"
      },
      "source": {
        "label": "DPA 7 AAC 100.604 / 100.610",
        "url": "https://www.law.cornell.edu/regulations/alaska/7-AAC-100.604"
      },
      "guideUrl": "https://millertrustguide.com/states/alaska",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#alaska"
    },
    {
      "name": "Arizona",
      "abbreviation": "AZ",
      "usesMillerTrust": "yes",
      "stateTerm": "Income-Only Trust",
      "summary": "Arizona uses a Qualified Income Trust (called a Income-Only Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Arizona Health Care Cost Containment System",
        "abbreviation": "AHCCCS"
      },
      "source": {
        "label": "AHCCCS EPM 803-C",
        "url": "https://epm.azahcccs.gov/epmplus/Policy/Chapter_800_Trusts/803_Special_Treatment_Trusts/C_Income_Only_Trusts.htm"
      },
      "guideUrl": "https://millertrustguide.com/states/arizona",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#arizona"
    },
    {
      "name": "Arkansas",
      "abbreviation": "AR",
      "usesMillerTrust": "yes",
      "stateTerm": "Income Trust",
      "summary": "Arkansas uses a Qualified Income Trust (called a Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Arkansas Department of Human Services",
        "abbreviation": "Arkansas DHS"
      },
      "source": {
        "label": "Arkansas DHS Medical Services Policy Manual §H-110–H-116",
        "url": "https://humanservices.arkansas.gov/wp-content/uploads/Medical_Services_Policy_Manual.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/arkansas",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#arkansas"
    },
    {
      "name": "California",
      "abbreviation": "CA",
      "usesMillerTrust": "no",
      "stateTerm": "Share of Cost",
      "summary": "California does not use a Miller Trust. Medi-Cal uses a Share of Cost instead: a resident of a Medi-Cal certified nursing facility pays their share of cost, the countable income above the Maintenance Need Level, to the facility, and Medi-Cal pays the difference between that share and the facility's daily rate.",
      "agency": {
        "name": "California Department of Health Care Services (DHCS)",
        "url": "https://www.dhcs.ca.gov/"
      },
      "source": {
        "label": "DHCS, Share of Cost guidance (rev. 2020)",
        "url": "https://www.dhcs.ca.gov/services/ltc/Documents/Share-of-Cost-Guidance-Revised-3.16.2020.docx"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#california"
    },
    {
      "name": "Colorado",
      "abbreviation": "CO",
      "usesMillerTrust": "yes",
      "stateTerm": "Income Trust",
      "summary": "Colorado uses a Qualified Income Trust (called a Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Colorado Department of Health Care Policy and Financing",
        "abbreviation": "HCPF"
      },
      "source": {
        "label": "HCPF 10 CCR 2505-10 §8.100.7.E.6.a",
        "url": "https://hcpf.colorado.gov/sites/hcpf/files/HCPF%20OM%2024-044%20Income%20Trusts%20-%20Revised%20Forms%20and%20Additional%20Guidance.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/colorado",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#colorado"
    },
    {
      "name": "Connecticut",
      "abbreviation": "CT",
      "usesMillerTrust": "no",
      "stateTerm": "spend-down",
      "summary": "Connecticut does not use a Miller Trust. People whose income is above its Medicaid limits may still qualify by \"spending down\" the excess on medical bills, and a Medicaid-covered nursing home resident generally turns over their monthly income, less a personal needs allowance, to the home, with Medicaid paying the difference.",
      "agency": {
        "name": "Connecticut Department of Social Services (DSS)",
        "url": "https://portal.ct.gov/dss"
      },
      "source": {
        "label": "Connecticut Office of Legislative Research, Report 2015-R-0215; DSS form W-1LTC",
        "url": "https://www.cga.ct.gov/2015/rpt/2015-R-0215.htm"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#connecticut"
    },
    {
      "name": "Delaware",
      "abbreviation": "DE",
      "usesMillerTrust": "yes",
      "stateTerm": "Miller Trust",
      "summary": "Delaware uses a Qualified Income Trust (called a Miller Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Delaware Health and Social Services (DHSS), Division of Medicaid and Medical Assistance (DMMA) -- determines Medicaid long-term-care financial eligibility, including Miller Trust review, through the Medicaid Central Intake Unit.",
        "abbreviation": "DHSS/DMMA"
      },
      "source": {
        "label": "DHSS/DMMA DSSM Sec 20400.11",
        "url": "https://regulations.delaware.gov/AdminCode/title16/20000"
      },
      "guideUrl": "https://millertrustguide.com/states/delaware",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#delaware"
    },
    {
      "name": "District of Columbia",
      "abbreviation": "DC",
      "usesMillerTrust": "no",
      "stateTerm": "Spend Down",
      "summary": "The District of Columbia does not use a Miller Trust. An applicant for long-term care services whose income is over the Medicaid income standard may still become eligible through \"Spend Down,\" which uses the person's medical bills to reduce the excess income.",
      "agency": {
        "name": "DC Department of Health Care Finance (DHCF)",
        "url": "https://dhcf.dc.gov/"
      },
      "source": {
        "label": "DHCF, Long-Term Care Services and Supports Spend Down notice",
        "url": "https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/documents/%2317%20LTCSS%20Spend%20Down%20Notice.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#district-of-columbia"
    },
    {
      "name": "Florida",
      "abbreviation": "FL",
      "usesMillerTrust": "yes",
      "stateTerm": "Qualified Income Trust",
      "summary": "Florida uses a Qualified Income Trust (called a Qualified Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Florida Department of Children and Families",
        "abbreviation": "DCF"
      },
      "source": {
        "label": "DCF ESS Manual 1840.0110",
        "url": "https://ffic.myflfamilies.com/manual/1830.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/florida",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#florida"
    },
    {
      "name": "Georgia",
      "abbreviation": "GA",
      "usesMillerTrust": "yes",
      "stateTerm": "Qualified Income Trust",
      "summary": "Georgia uses a Qualified Income Trust (called a Qualified Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Georgia Department of Community Health",
        "abbreviation": "DCH"
      },
      "source": {
        "label": "DCH Section 2407",
        "url": "https://pamms.dhs.ga.gov/dfcs/medicaid/2407/"
      },
      "guideUrl": "https://millertrustguide.com/states/georgia",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#georgia"
    },
    {
      "name": "Hawaii",
      "abbreviation": "HI",
      "usesMillerTrust": "no",
      "stateTerm": "medically needy spenddown",
      "summary": "Hawaii does not use a Miller Trust. Its medically needy spenddown rule sets no maximum income for an aged, blind, or disabled applicant: income above the medically needy standard becomes a spenddown amount, met by incurring medical expenses.",
      "agency": {
        "name": "Hawaii Department of Human Services, Med-QUEST Division",
        "url": "https://medquest.hawaii.gov/"
      },
      "source": {
        "label": "Haw. Admin. Rules § 17-1730.1-11 (Medically Needy Spenddown)",
        "url": "https://humanservices.hawaii.gov/wp-content/uploads/2013/10/HAR-17-1730.1-MEDICALLY-NEEDY-SPENDDOWN-06.06.13-Final-kmney.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#hawaii"
    },
    {
      "name": "Idaho",
      "abbreviation": "ID",
      "usesMillerTrust": "yes",
      "stateTerm": "Income Trust",
      "summary": "Idaho uses a Qualified Income Trust (called a Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Idaho Department of Health and Welfare (IDHW), Division of Self-Reliance -- determines Medicaid long-term-care financial eligibility, including Income Trust review, through DHW field/regional offices and the idalink.idaho.gov online portal.",
        "abbreviation": "IDHW"
      },
      "source": {
        "label": "IDHW IDAPA 16.03.05.872.02",
        "url": "https://adminrules.idaho.gov/rules/current/16/160305.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/idaho",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#idaho"
    },
    {
      "name": "Illinois",
      "abbreviation": "IL",
      "usesMillerTrust": "no",
      "stateTerm": "spenddown",
      "summary": "Illinois does not use a Miller Trust. A nursing-home or supportive-living resident whose countable income is over the AABD medical standard becomes a spenddown case, and the facility's charges, counted at the private rate, are applied toward the spenddown.",
      "agency": {
        "name": "Illinois Department of Human Services / Healthcare and Family Services",
        "url": "https://hfs.illinois.gov/"
      },
      "source": {
        "label": "Illinois DHS Policy Manual PM 15-02-03-b, Nursing Home/Supportive Living Facility Spenddown",
        "url": "https://www.dhs.state.il.us/page.aspx?Item=16336"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#illinois"
    },
    {
      "name": "Indiana",
      "abbreviation": "IN",
      "usesMillerTrust": "yes",
      "stateTerm": "Miller Trust",
      "summary": "Indiana uses a Qualified Income Trust (called a Miller Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Indiana Family and Social Services Administration",
        "abbreviation": "FSSA"
      },
      "source": {
        "label": "FSSA 405 IAC 2-3-29",
        "url": "https://www.in.gov/fssa/ompp/files/2615.75.15-Certain-Trusts-Receiving-Special-Consideration.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/indiana",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#indiana"
    },
    {
      "name": "Iowa",
      "abbreviation": "IA",
      "usesMillerTrust": "yes",
      "stateTerm": "Medical Assistance Income Trust",
      "summary": "Iowa uses a Qualified Income Trust (called a Medical Assistance Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Iowa Health and Human Services (Iowa HHS) -- Bureau of Medicaid Eligibility Policy sets the eligibility rules; trust review, approval, and annual reporting is handled by the Medicaid Trust Program within Iowa HHS Revenue Collections. A local Iowa HHS income-maintenance caseworker is the intake point for a Medicaid application; the trust document itself is forwarded to the Medicaid Trust Program for review.",
        "abbreviation": "Iowa HHS"
      },
      "source": {
        "label": "Iowa HHS Iowa Code 633C.3",
        "url": "https://www.legis.iowa.gov/docs/code/2026/633C.html"
      },
      "guideUrl": "https://millertrustguide.com/states/iowa",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#iowa"
    },
    {
      "name": "Kansas",
      "abbreviation": "KS",
      "usesMillerTrust": "no",
      "stateTerm": "patient liability; Medically Needy spenddown",
      "summary": "Kansas does not use a Miller Trust. A nursing-home resident's share of cost is called patient liability; when that share would be more than the cost of care, Kansas's Medically Needy spenddown applies, and nursing-facility charges up to the private rate count toward it. For home and community-based services, the share of cost is called the client obligation.",
      "agency": {
        "name": "KanCare (Kansas Department of Health and Environment)",
        "url": "https://kancare.ks.gov/"
      },
      "source": {
        "label": "KanCare, Share of Cost fact sheet; KEESM 7532",
        "url": "https://kancare.ks.gov/home/showpublisheddocument/226/638474905209970000"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#kansas"
    },
    {
      "name": "Kentucky",
      "abbreviation": "KY",
      "usesMillerTrust": "yes",
      "stateTerm": "Qualifying Income Trust",
      "summary": "Kentucky uses a Qualified Income Trust (called a Qualifying Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Kentucky Department for Medicaid Services",
        "abbreviation": "DMS"
      },
      "source": {
        "label": "DMS 907 KAR 20:030, Sec. 3(5)",
        "url": "https://apps.legislature.ky.gov/law/kar/titles/907/020/030/"
      },
      "guideUrl": "https://millertrustguide.com/states/kentucky",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#kentucky"
    },
    {
      "name": "Louisiana",
      "abbreviation": "LA",
      "usesMillerTrust": "no",
      "stateTerm": "Long Term Care Spend-Down Medically Needy Program",
      "summary": "Louisiana does not use a Miller Trust. A nursing-facility or ICF/IID resident whose income is over the Special Income Limit may qualify through the Long Term Care Spend-Down Medically Needy Program, which counts the projected monthly cost of facility care as a medical expense toward the spend-down. A parallel spend-down covers several home and community-based waivers (LDH Medicaid Eligibility Manual H-1050).",
      "agency": {
        "name": "Louisiana Department of Health (LDH)",
        "url": "https://ldh.la.gov/"
      },
      "source": {
        "label": "LDH Medicaid Eligibility Manual H-1040, Long Term Care Spend-Down Medically Needy Program",
        "url": "https://ldh.la.gov/assets/medicaid/MedicaidEligibilityPolicy/H-1040.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#louisiana"
    },
    {
      "name": "Maine",
      "abbreviation": "ME",
      "usesMillerTrust": "no",
      "stateTerm": "deductible",
      "summary": "Maine does not use a Miller Trust. A nursing-facility resident whose gross income is over MaineCare's categorically needy limit but below the facility's private rate for a semi-private room can qualify by meeting a deductible, which is met by incurring the facility's Medicaid or private rate.",
      "agency": {
        "name": "Maine Department of Health and Human Services (MaineCare)",
        "url": "https://www.maine.gov/dhhs/"
      },
      "source": {
        "label": "MaineCare Eligibility Manual, 10-144 C.M.R. ch. 332, Part 14",
        "url": "https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-files/144c332-2025-101%20(AMD)_0.docx"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#maine"
    },
    {
      "name": "Maryland",
      "abbreviation": "MD",
      "usesMillerTrust": "no",
      "stateTerm": "cost of care test; spend-down",
      "summary": "Maryland does not use a Miller Trust. For a nursing-facility resident, Maryland compares available income, after allowable deductions, with the monthly cost of care: if income is less, the person is eligible and Medical Assistance helps pay toward that cost.",
      "agency": {
        "name": "Maryland Department of Health",
        "url": "https://health.maryland.gov/mmcp/"
      },
      "source": {
        "label": "Maryland Medical Assistance Manual, Section 1000 (Eligibility for Institutionalized Persons)",
        "url": "https://health.maryland.gov/mmcp/Medicaid%20Manual/Section%201000-Eligibility%20for%20Institutionalized%20Persons.Final%205-15-14.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#maryland"
    },
    {
      "name": "Massachusetts",
      "abbreviation": "MA",
      "usesMillerTrust": "no",
      "stateTerm": "patient-paid amount",
      "summary": "Massachusetts does not use a Miller Trust. MassHealth sets no countable income limit for members in a long-term-care facility; instead the member pays part of their income to the facility each month as the \"patient-paid amount,\" after deductions such as a personal-needs allowance.",
      "agency": {
        "name": "MassHealth",
        "url": "https://www.mass.gov/masshealth"
      },
      "source": {
        "label": "MassHealth Board of Hearings decision citing 130 CMR 520.009(A)(3) and 520.026",
        "url": "https://www.mass.gov/doc/appeal-2501664/download"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#massachusetts"
    },
    {
      "name": "Michigan",
      "abbreviation": "MI",
      "usesMillerTrust": "no",
      "stateTerm": "Group 2 deductible; patient-pay amount",
      "summary": "Michigan does not use a Miller Trust. Under its Group 2 Medicaid rules, someone with excess income is income-eligible for any month in which allowable expenses, including long-term care costs, equal or exceed the excess income; a nursing-home resident then pays a patient-pay amount toward care.",
      "agency": {
        "name": "Michigan Department of Health and Human Services (MDHHS)",
        "url": "https://www.michigan.gov/mdhhs"
      },
      "source": {
        "label": "MDHHS Bridges Eligibility Manual BEM 545 (MA Group 2 Income Eligibility); BEM 546",
        "url": "https://mdhhs-pres-prod.michigan.gov/olmweb/ex/BP/Public/BEM/545.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#michigan"
    },
    {
      "name": "Minnesota",
      "abbreviation": "MN",
      "usesMillerTrust": "no",
      "stateTerm": "LTC spenddown",
      "summary": "Minnesota does not use a Miller Trust. For someone in a long-term care facility, Medical Assistance runs a long-term-care income calculation that sets an \"LTC spenddown,\" the amount the person contributes from their income toward the cost of care. For the Elderly Waiver, a person with income above the special income standard and no community spouse can use the cost of their long-term care services to meet a medical spenddown (Eligibility Policy Manual 2.4.2.5).",
      "agency": {
        "name": "Minnesota Department of Human Services",
        "url": "https://mn.gov/dhs/"
      },
      "source": {
        "label": "Minnesota Health Care Programs Eligibility Policy Manual 2.4.2.5",
        "url": "https://hcopub.dhs.state.mn.us/epm/2_4_2_5.htm"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#minnesota"
    },
    {
      "name": "Mississippi",
      "abbreviation": "MS",
      "usesMillerTrust": "yes",
      "stateTerm": "Income Trust",
      "summary": "Mississippi uses a Qualified Income Trust (called a Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Mississippi Division of Medicaid",
        "abbreviation": "Mississippi Medicaid"
      },
      "source": {
        "label": "Mississippi Medicaid 23 Miss. Admin. Code Pt. 103, R. 5.17",
        "url": "https://medicaid.ms.gov/wp-content/uploads/2025/07/Title-23-Part-103-Resources-eff-7.1.2025.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/mississippi",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#mississippi"
    },
    {
      "name": "Missouri",
      "abbreviation": "MO",
      "usesMillerTrust": "in-home-waiver-only",
      "stateTerm": "Qualified Income Trust",
      "summary": "Missouri uses a Qualified Income Trust only for its Home and Community-Based (in-home) waiver; its nursing-facility Medicaid uses a spend-down instead.",
      "agency": {
        "name": "Missouri Family Support Division",
        "abbreviation": "Missouri FSD"
      },
      "source": {
        "label": "Missouri FSD MHABD Manual §0825.030.35",
        "url": "https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and-disabled/0825-000-00/0825-030-00/0825-030-35/"
      },
      "guideUrl": "https://millertrustguide.com/states/missouri",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#missouri"
    },
    {
      "name": "Montana",
      "abbreviation": "MT",
      "usesMillerTrust": "no",
      "stateTerm": "medically needy",
      "summary": "Montana does not use a Miller Trust. An otherwise eligible nursing-home resident is income-eligible, as categorically or medically needy, as long as their monthly nursing-home costs equal or exceed their monthly income; the amount they apply toward their care is calculated separately.",
      "agency": {
        "name": "Montana Department of Public Health and Human Services (DPHHS)",
        "url": "https://dphhs.mt.gov/"
      },
      "source": {
        "label": "DPHHS Medicaid manual ABD 013, Nursing Home Residents: Income",
        "url": "https://www.dphhs.mt.gov/assets/hcsd/mamanual/ABD013.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#montana"
    },
    {
      "name": "Nebraska",
      "abbreviation": "NE",
      "usesMillerTrust": "no",
      "stateTerm": "Medically Needy share of cost",
      "summary": "Nebraska does not use a Miller Trust. Someone whose income is over Nebraska's limits can be eligible as medically needy with a share of cost; for a resident of a medical institution, a projection of institutional expenses establishes the medical need, and the share of cost is calculated from there. The same medically needy route applies to home and community-based services, using a hypothetical amount of services (477 NAC 25-003.02).",
      "agency": {
        "name": "Nebraska Department of Health and Human Services",
        "url": "https://dhhs.ne.gov/Pages/Share-of-Cost.aspx"
      },
      "source": {
        "label": "477 NAC Chapter 25, Budgeting for the Medically Needy, § 003.03",
        "url": "https://dhhs.ne.gov/Documents/477%20NAC%2025.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#nebraska"
    },
    {
      "name": "Nevada",
      "abbreviation": "NV",
      "usesMillerTrust": "yes",
      "stateTerm": "Qualified Income Trust",
      "summary": "Nevada uses a Qualified Income Trust (called a Qualified Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Division of Social Services (DSS), Nevada Department of Human Services -- known until July 2025 as the Division of Welfare and Supportive Services (DWSS)",
        "abbreviation": "DSS"
      },
      "source": {
        "label": "DSS MAM F-520.6",
        "url": "https://www.dss.nv.gov/siteassets/dwss.nv.gov/content/medical/F-500_-_Treatment_of_Trusts.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/nevada",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#nevada"
    },
    {
      "name": "New Hampshire",
      "abbreviation": "NH",
      "usesMillerTrust": "no",
      "stateTerm": "medically needy (nursing facility)",
      "summary": "New Hampshire does not use a Miller Trust. An applicant for nursing facility care whose monthly gross income exceeds the nursing facility cap (300% of the maximum SSI benefit) is income-eligible as medically needy when their net income is at or below the monthly Medicaid nursing facility rate. For its home and community-based waivers (including Choices for Independence), applicants over the cap are medically needy when net income is at or below the protected income level, with a spend-down route above that (He-W 858.06).",
      "agency": {
        "name": "New Hampshire Department of Health and Human Services",
        "url": "https://www.dhhs.nh.gov/"
      },
      "source": {
        "label": "N.H. Admin. Rules He-W 858.05, Eligibility for Adult Category Medical Assistance Nursing Care",
        "url": "https://www.gc.nh.gov/rules/state_agencies/he-w800.html"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#new-hampshire"
    },
    {
      "name": "New Jersey",
      "abbreviation": "NJ",
      "usesMillerTrust": "yes",
      "stateTerm": "Qualified Income Trust",
      "summary": "New Jersey uses a Qualified Income Trust (called a Qualified Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "New Jersey Division of Medical Assistance and Health Services",
        "abbreviation": "DMAHS"
      },
      "source": {
        "label": "DMAHS QIT FAQ and model instrument",
        "url": "https://www.nj.gov/humanservices/dmahs/individuals-families/mtrusts.shtml"
      },
      "guideUrl": "https://millertrustguide.com/states/new-jersey",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#new-jersey"
    },
    {
      "name": "New Mexico",
      "abbreviation": "NM",
      "usesMillerTrust": "yes",
      "stateTerm": "Income Diversion Trust",
      "summary": "New Mexico uses a Qualified Income Trust (called a Income Diversion Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "New Mexico Health Care Authority (HCA) -- the Medical Assistance Division (MAD) sets Medicaid eligibility policy; the Income Support Division (ISD) makes eligibility determinations and is the applicant's point of contact through the local ISD field office. HCA was created July 1, 2024 by merging the former Human Services Department (HSD) with several other state programs; MAD and ISD continue as HCA divisions.",
        "abbreviation": "HCA"
      },
      "source": {
        "label": "HCA 8.281.510.11(C) NMAC",
        "url": "https://www.srca.nm.gov/parts/title08/08.281.0510.html"
      },
      "guideUrl": "https://millertrustguide.com/states/new-mexico",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#new-mexico"
    },
    {
      "name": "New York",
      "abbreviation": "NY",
      "usesMillerTrust": "no",
      "stateTerm": "excess income (spenddown); NAMI",
      "summary": "New York does not use a Miller Trust. New York Medicaid treats income above the Medicaid level as \"excess income,\" which works like a deductible, and a nursing-home resident pays their Net Available Monthly Income (NAMI) toward the cost of care while Medicaid pays the rest.",
      "agency": {
        "name": "New York State Department of Health",
        "url": "https://www.health.ny.gov/health_care/medicaid/"
      },
      "source": {
        "label": "NYS DOH, Medicaid Excess Income (\"Spenddown\") Program; NAMI overview",
        "url": "https://www.health.ny.gov/health_care/medicaid/excess_income.htm"
      },
      "guideUrl": "https://millertrustguide.com/pooled-income-trust/new-york",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#new-york"
    },
    {
      "name": "North Carolina",
      "abbreviation": "NC",
      "usesMillerTrust": "no",
      "stateTerm": "patient monthly liability; Medicaid deductible",
      "summary": "North Carolina does not use a Miller Trust. When a long-term-care applicant's gross income is above the facility's Medicaid rate, the county compares net income with the facility's private rate; at or below that rate the person is financially eligible, and the resident then pays a patient monthly liability toward care.",
      "agency": {
        "name": "NC Department of Health and Human Services (NC Medicaid)",
        "url": "https://medicaid.ncdhhs.gov/"
      },
      "source": {
        "label": "NC Aged, Blind and Disabled Medicaid Manual MA-2270, Long Term Care Need and Budgeting",
        "url": "https://policies.ncdhhs.gov/wp-content/uploads/MA-2270-LTC-Need-and-Budgeting-ADA-Tested.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#north-carolina"
    },
    {
      "name": "North Dakota",
      "abbreviation": "ND",
      "usesMillerTrust": "no",
      "stateTerm": "recipient liability (client share)",
      "summary": "North Dakota does not use a Miller Trust. Its Medicaid program applies a \"nursing care income level\" to nursing-facility residents, and a member whose net income is above the Medicaid income level pays a monthly recipient liability, which works like a deductible, before Medicaid pays. Medically needy income levels also apply when someone screened as needing nursing care chooses home and community-based services (Eligibility Policy Manual 510-05-85-40).",
      "agency": {
        "name": "North Dakota Department of Health and Human Services",
        "url": "https://www.hhs.nd.gov/healthcare/medicaid"
      },
      "source": {
        "label": "ND Medicaid Eligibility Policy Manual 510-05-85-40; Recipient Liability policy",
        "url": "https://www.hhs.nd.gov/sites/default/files/documents/medicaid-policies/recipient-liability.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#north-dakota"
    },
    {
      "name": "Ohio",
      "abbreviation": "OH",
      "usesMillerTrust": "yes",
      "stateTerm": "Miller Trust",
      "summary": "Ohio uses a Qualified Income Trust (called a Miller Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Ohio Department of Medicaid",
        "abbreviation": "ODM"
      },
      "source": {
        "label": "ODM OAC 5160:1-6-03.2",
        "url": "https://codes.ohio.gov/ohio-administrative-code/rule-5160:1-6-03.2"
      },
      "guideUrl": "https://millertrustguide.com/states/ohio",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#ohio"
    },
    {
      "name": "Oklahoma",
      "abbreviation": "OK",
      "usesMillerTrust": "yes",
      "stateTerm": "Medicaid Income Pension Trust",
      "summary": "Oklahoma uses a Qualified Income Trust (called a Medicaid Income Pension Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Oklahoma Health Care Authority",
        "abbreviation": "OHCA"
      },
      "source": {
        "label": "OHCA OAC 317:35-5-41.6(6)(B)",
        "url": "https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-assistance-for-adults-and-children-eligibility/eligibility-and-countable-income/countable-income-and-resources/trust-accounts.html"
      },
      "guideUrl": "https://millertrustguide.com/states/oklahoma",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#oklahoma"
    },
    {
      "name": "Oregon",
      "abbreviation": "OR",
      "usesMillerTrust": "yes",
      "stateTerm": "Income Cap Trust",
      "summary": "Oregon uses a Qualified Income Trust (called a Income Cap Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Oregon Department of Human Services (ODHS), Aging and People with Disabilities (APD) -- handles Medicaid long-term-care financial eligibility determination and Income Cap Trust review via local APD/Area Agency on Aging (AAA) offices. The Oregon Health Authority (OHA) administers the broader Oregon Health Plan (OHP)/Coordinated Care Organization (CCO) medical side and coordinates with APD/AAA on long-term services and supports, but is not the eligibility determiner for the trust itself.",
        "abbreviation": "ODHS APD"
      },
      "source": {
        "label": "ODHS APD OAR 461-145-0540(9)(c)",
        "url": "https://ch461rules.odhs.oregon.gov/rules/461-145-0540.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/oregon",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#oregon"
    },
    {
      "name": "Pennsylvania",
      "abbreviation": "PA",
      "usesMillerTrust": "no",
      "stateTerm": "Medically Needy Only (MNO) spend-down",
      "summary": "Pennsylvania does not use a Miller Trust. A nursing-facility applicant whose income is above the special income limit can qualify through the Medically Needy Only spend-down, where the projected cost of care at the facility's private rate, for up to six months, counts toward the spend-down.",
      "agency": {
        "name": "Pennsylvania Department of Human Services, Office of Long-Term Living",
        "url": "https://www.pa.gov/agencies/dhs/resources/aging-physical-disabilities"
      },
      "source": {
        "label": "55 Pa. Code § 181.14, Eligibility under MNO-MA spend-down",
        "url": "https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/055/chapter181/s181.14.html"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#pennsylvania"
    },
    {
      "name": "Rhode Island",
      "abbreviation": "RI",
      "usesMillerTrust": "no",
      "stateTerm": "Medically Needy LTSS pathway",
      "summary": "Rhode Island does not use a Miller Trust. Its Medically Needy pathway for long-term services and supports (formerly the Flexible Test of Income) lets someone with income above the federal benefit cap qualify when the projected cost of care at the private-pay rate absorbs their excess income. The pathway applies to both institutional and home and community-based settings (210-RICR-50-00-2).",
      "agency": {
        "name": "Rhode Island Executive Office of Health and Human Services (EOHHS)",
        "url": "https://eohhs.ri.gov/"
      },
      "source": {
        "label": "210-RICR-50-00-2, Medicaid LTSS: Medically Needy Eligibility Pathway",
        "url": "https://rules.sos.ri.gov/Regulations/part/210-50-00-2"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#rhode-island"
    },
    {
      "name": "South Carolina",
      "abbreviation": "SC",
      "usesMillerTrust": "yes",
      "stateTerm": "Income Trust",
      "summary": "South Carolina uses a Qualified Income Trust (called a Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "South Carolina Department of Health and Human Services",
        "abbreviation": "SCDHHS"
      },
      "source": {
        "label": "SCDHHS DHHS Form 905",
        "url": "https://www.scdhhs.gov/members/program-eligibility-and-income-limits"
      },
      "guideUrl": "https://millertrustguide.com/states/south-carolina",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#south-carolina"
    },
    {
      "name": "South Dakota",
      "abbreviation": "SD",
      "usesMillerTrust": "yes",
      "stateTerm": "Medicaid Income Trust",
      "summary": "South Dakota uses a Qualified Income Trust (called a Medicaid Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "South Dakota Department of Social Services (DSS) -- the Division of Economic Assistance administers Medicaid LTC eligibility (state-administered, not county); the Department of Human Services (DHS), Division of Long Term Services and Supports (LTSS), operates the HOPE Waiver.",
        "abbreviation": "DSS"
      },
      "source": {
        "label": "DSS ARSD 67:46:05:33.01",
        "url": "https://sdlegislature.gov/Rules/Administrative/67:46:05:33.01"
      },
      "guideUrl": "https://millertrustguide.com/states/south-dakota",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#south-dakota"
    },
    {
      "name": "Tennessee",
      "abbreviation": "TN",
      "usesMillerTrust": "yes",
      "stateTerm": "Qualified Income Trust",
      "summary": "Tennessee uses a Qualified Income Trust (called a Qualified Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "TennCare (Division of TennCare, Tennessee Department of Finance and Administration)",
        "abbreviation": "TennCare"
      },
      "source": {
        "label": "TennCare ABD Trusts Policy 110.055 §4.h",
        "url": "https://www.tn.gov/content/dam/tn/tenncare/documents/ABDTrusts.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/tennessee",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#tennessee"
    },
    {
      "name": "Texas",
      "abbreviation": "TX",
      "usesMillerTrust": "yes",
      "stateTerm": "Miller Trust",
      "summary": "Texas uses a Qualified Income Trust (called a Miller Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Texas Health and Human Services Commission",
        "abbreviation": "HHSC"
      },
      "source": {
        "label": "HHSC Appendix XXXVI",
        "url": "https://www.hhs.texas.gov/handbooks/medicaid-elderly-people-disabilities-handbook/appendix-xxxvi-qits-mepd-information"
      },
      "guideUrl": "https://millertrustguide.com/states/texas",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#texas"
    },
    {
      "name": "Utah",
      "abbreviation": "UT",
      "usesMillerTrust": "no",
      "stateTerm": "cost-of-care contribution; spenddown",
      "summary": "Utah does not use a Miller Trust. Nursing-facility residents pay a cost-of-care contribution from their income after allowed deductions, and Utah's medically needy programs let a person qualify by making a spenddown payment to reduce countable income. Some recipients on home and community-based waivers must spend down to the medically needy income limit (Utah Medicaid Policy Manual § 463).",
      "agency": {
        "name": "Utah Department of Health and Human Services (Medicaid)",
        "url": "https://medicaid.utah.gov/medicaid-long-term-care-and-waiver-programs/"
      },
      "source": {
        "label": "Utah Medicaid Policy Manual §§ 463 and 461",
        "url": "https://oepmanuals.dhhs.utah.gov/400/463_Payments_for_Long-Term_Care.htm"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#utah"
    },
    {
      "name": "Vermont",
      "abbreviation": "VT",
      "usesMillerTrust": "no",
      "stateTerm": "LTC Medicaid spenddown; patient share",
      "summary": "Vermont does not use a Miller Trust. When a long-term-care applicant's gross income is above the Institutional Income Standard, the Department of Vermont Health Access works out a monthly spenddown that the cost of care can meet, and the person then pays a monthly patient share toward care. The same spenddown procedure applies in home-based waiver and enhanced residential care settings.",
      "agency": {
        "name": "Department of Vermont Health Access (DVHA)",
        "url": "https://dvha.vermont.gov/"
      },
      "source": {
        "label": "DVHA, Long-Term Care Monthly Spenddown Procedures",
        "url": "https://dvha.vermont.gov/sites/dvha/files/documents/Long-Term%20Care%20Monthly%20Spenddown%20Procedures.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#vermont"
    },
    {
      "name": "Virginia",
      "abbreviation": "VA",
      "usesMillerTrust": "no",
      "stateTerm": "Medically Needy spenddown",
      "summary": "Virginia does not use a Miller Trust. An institutionalized applicant whose gross income is over the 300%-of-SSI limit is evaluated as medically needy instead, with the excess becoming a \"spenddown liability\" that the cost of facility care can meet. Some waivers differ: the CCC Plus Waiver allows either the 300% limit or the medically needy spenddown, but under the Community Living Waiver, medically needy individuals are not eligible and income over 300% of SSI makes a person ineligible (Medical Assistance Eligibility Manual M1440).",
      "agency": {
        "name": "Virginia Department of Medical Assistance Services (DMAS)",
        "url": "https://www.dmas.virginia.gov/"
      },
      "source": {
        "label": "Virginia Medical Assistance Eligibility Manual, Chapter M14 (M1460.600, M1460.410)",
        "url": "https://www.dmas.virginia.gov/media/hksogjdf/chapter-m14-long-term-care.pdf"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#virginia"
    },
    {
      "name": "Washington",
      "abbreviation": "WA",
      "usesMillerTrust": "no",
      "stateTerm": "SSI-related medically needy program",
      "summary": "Washington does not use a Miller Trust. A person in a medical institution whose gross income is above the special income level can qualify for institutional services under the SSI-related medically needy program. A medically needy path also exists for home and community-based waiver services (Washington Administrative Code chapter 182-515, section 1508).",
      "agency": {
        "name": "Washington State Health Care Authority (Apple Health)",
        "url": "https://www.hca.wa.gov/"
      },
      "source": {
        "label": "Washington Administrative Code chapter 182-513, section 1395",
        "url": "https://app.leg.wa.gov/wac/default.aspx?cite=182%2D513%2D1395"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#washington"
    },
    {
      "name": "West Virginia",
      "abbreviation": "WV",
      "usesMillerTrust": "no",
      "stateTerm": "Medically Needy",
      "summary": "West Virginia does not use a Miller Trust. People with income over the 300%-of-SSI limit for nursing-home Medicaid may qualify if their monthly nursing care costs exceed the Medicaid Medically Needy Income Limit, and they then contribute income toward the cost of care.",
      "agency": {
        "name": "West Virginia Department of Human Services, Bureau for Family Assistance",
        "url": "https://bfa.wv.gov/"
      },
      "source": {
        "label": "WV Bureau for Family Assistance, Medicaid for Long Term Care: Eligibility and Requirements",
        "url": "https://bfa.wv.gov/media/2406/download"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#west-virginia"
    },
    {
      "name": "Wisconsin",
      "abbreviation": "WI",
      "usesMillerTrust": "no",
      "stateTerm": "institutional medically needy (monthly need test)",
      "summary": "Wisconsin does not use a Miller Trust. An applicant with income over the institutional categorically needy limit can qualify as medically needy when their monthly need, which includes the private rate of the nursing home where they live, is greater than their income.",
      "agency": {
        "name": "Wisconsin Department of Health Services",
        "url": "https://www.dhs.wisconsin.gov/"
      },
      "source": {
        "label": "Wisconsin Medicaid Eligibility Handbook 27.5.2 and 27.6",
        "url": "https://www.emhandbooks.wisconsin.gov/meh-ebd/policy_files/27/27.5.htm"
      },
      "guideUrl": null,
      "pageUrl": "https://millertrustguide.com/miller-trust-states#wisconsin"
    },
    {
      "name": "Wyoming",
      "abbreviation": "WY",
      "usesMillerTrust": "yes",
      "stateTerm": "Income Trust",
      "summary": "Wyoming uses a Qualified Income Trust (called a Income Trust there) so an applicant whose income is over the Medicaid long-term-care limit can qualify.",
      "agency": {
        "name": "Wyoming Department of Health (WDH), Division of Healthcare Financing (DHCF) -- determines Medicaid long-term-care financial eligibility, including Income Trust review, through county Department of Family Services (DFS) offices and the Wyoming Eligibility System (WES) online portal.",
        "abbreviation": "WDH"
      },
      "source": {
        "label": "WDH Chapter 18 §18-8(c)(iii)",
        "url": "https://health.wyo.gov/wp-content/uploads/2024/04/DOH-Medicaid-Chapter-18.pdf"
      },
      "guideUrl": "https://millertrustguide.com/states/wyoming",
      "pageUrl": "https://millertrustguide.com/miller-trust-states#wyoming"
    }
  ]
}