After the trust is set up

Miller Trust Trustee Duties: What the Trustee Does Each Month

The trustee of a Miller Trust (Qualified Income Trust) has four recurring jobs: move the applicant's income into the trust account every month, pay it out only for the purposes the state allows, keep a record of every deposit and payment, and, when the beneficiary dies, see that the state is repaid from what's left before anyone else. What the trust may pay for is set by each state's own rules, not by general practice, so the state's list is the one that counts.

The monthly cycle

1. The income goes in. The applicant's income named in the trust is deposited into the trust account in the month it's received. Income that doesn't go through the trust is counted like any other income, so a missed or short deposit can push that month over the limit.
2. The allowed payments go out. The trustee pays only the items the state's rules name, in the amounts they set.
3. Everything gets written down. Each deposit and each payment, checked against the bank statement, so the account can be explained line by line if the state asks.

What the trust can pay for

Most states draw their list from the same post-eligibility budget: the resident's personal needs allowance, allowances for a spouse or dependent family member at home where they apply, certain medical costs Medicaid doesn't cover, and the remainder toward the cost of care. Missouri, which uses its trust only for an in-home waiver, works differently. The amounts differ by state, and so do the rules on trustee and bank fees, the order of payments, and whether money may stay in the account. Each state's page lists its own rules, with the source for every item:

• Alabama 6 items, each cited to Alabama Medicaid
• Alaska 6 items, each cited to DPA
• Arizona 6 items, each cited to AHCCCS
• Arkansas 7 items, each cited to Arkansas DHS
• Colorado 5 items, each cited to HCPF
• Delaware 8 items, each cited to DHSS/DMMA
• Florida 3 items, each cited to DCF
• Georgia 5 items, each cited to DCH
• Idaho 9 items, each cited to IDHW
• Indiana 8 items, each cited to FSSA
• Iowa 8 items, each cited to Iowa HHS
• Kentucky 7 items, each cited to DMS
• Mississippi 7 items, each cited to Mississippi Medicaid
• Missouri 7 items, each cited to Missouri FSD
• Nevada 7 items, each cited to DSS
• New Jersey 6 items, each cited to DMAHS
• New Mexico 8 items, each cited to HCA
• Ohio 6 items, each cited to ODM
• Oklahoma 6 items, each cited to OHCA
• Oregon 10 items, each cited to ODHS APD
• South Carolina 9 items, each cited to SCDHHS
• South Dakota 6 items, each cited to DSS
• Tennessee 6 items, each cited to TennCare
• Texas 7 items, each cited to HHSC
• Wyoming 8 items, each cited to WDH

Trustee and bank fees

Whether the trustee may be paid from the trust, and how much, is one of the places states differ most. Some set a dollar or percentage limit on trustee or administrative fees; others are silent. A bank's monthly service charge is a separate question that some states address directly. The state's page above says which applies, or that the state doesn't say.

Records and renewal

Medicaid eligibility is renewed at least once a year (42 CFR § 435.916), and the trust account is part of what the state can look at. A month-by-month record that ties each deposit to the income it came from, and each payment to the item it covered, is what lets the trustee answer a question about the account without reconstructing a year of bank statements.

When the beneficiary dies

Federal law requires every Qualified Income Trust to provide that the state receives what remains in the trust at the beneficiary's death, up to the total Medicaid paid for their care (42 U.S.C. § 1396p(d)(4)(B)(ii)). How that payment is made, and to which office, is set by each state. Each state's "what happens to the money" page covers its process, for example Alabama, Alaska, Arizona, and every other state in the list above.

Who can be the trustee

The trustee doesn't have to be a lawyer or a professional. States differ on who may serve, and several don't let the applicant be their own trustee. Each state's "who can be the trustee" page gives its rule, in the state's own words.

Miller Trust Guide is an informational publisher, not a law firm. This page is not legal advice; for a specific situation, consult a licensed elder-law attorney in your state. See also What Is a Miller Trust?, How to Set Up a Miller Trust, and which states use one.