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Miller Trust Guide
DE · Guide

What Can a Miller Trust Pay For in Delaware?

Delaware publishes no trust form. Its rule counts all income in the trust when figuring the monthly Patient Pay amount and expects the trust to pay for the person's medical care, such as Patient Pay, in monthly intervals. The personal needs allowance, medical premiums and uncovered care, and allowances for a spouse or family are deducted before Patient Pay. Every item below is cited to DHSS/DMMA's own published rules; where DHSS/DMMA says nothing about an item, this page says so instead of filling the gap. This guide is informational only and is not legal or financial advice.

Income goes into a Delaware Miller Trust each month, and the trustee may pay it out only for the purposes DHSS/DMMA allows. Paying for anything else can put eligibility at risk. Here is the list, with the DHSS/DMMA source for each item.

What DHSS/DMMA's rules allow

  • Patient Pay and other medical care

    Payments for medical care, such as Patient Pay, should be made in monthly intervals to avoid transfer-of-assets penalties.

    Source: 16 Del. Admin. Code § 20400.11.4 (DSSM)

  • Personal needs allowance

    $75 a month is protected for the recipient's direct personal needs.

    Source: DSSM 20620.1.1

  • Medical insurance premiums

    Premiums for medical insurance the recipient carries.

    Source: DSSM 20620.2.1

  • Necessary medical care not covered

    Necessary medical care not covered by the recipient's insurance, Medicaid or Medicare but recognized under state law.

    Source: DSSM 20620.2.2

  • Community spouse and family allowances

    The community spouse income allowance or home maintenance disregard, and a family allowance, if applicable.

    Source: DSSM 20620.3 and 20620.4

  • Guardianship fees

    For a nursing-facility resident with a court-appointed guardian: monthly guardianship fees up to $100, and up to $750 to establish the guardianship.

    Source: DSSM 20620.1.4

  • Other spending for the person's benefit

    Administrative fees for the trust, income tax owed by the trust, attorney fees, food, clothing or mortgage payments are exempt from transfer penalties if they're fair payments, but are not deducted when Patient Pay is figured.

    Source: DSSM 20400.11.4

  • Home and community-based care

    LTCCS recipients outside assisted living get a deduction equal to their total income, including income placed in a Miller Trust; assisted living residents get a deduction based on the Adult Foster Care rate less room and board.

    Source: DSSM 20720.1

The order payments are made in

DSSM 20620 lists the deductions as personal needs allowance, necessary medical care expenses, community spouse income allowance or home maintenance disregard, then family allowance.

Trustee and bank fees

Delaware sets no cap. Administrative fees for the trust are among the payments that escape a transfer penalty if they're fair, but the rule says they are not deducted when Patient Pay is figured (DSSM 20400.11.4).

What the trust can't be used for

The trust may hold only income; adding resources voids its Medicaid eligibility (DSSM 20400.11.1). Payments from the trust straight to the person count as their income if they could be used for food, clothing or shelter, a mortgage payment for example, while medical expenses paid on the person's behalf don't (DSSM 20400.11.5).

Timing, and money left over

When more income goes into the trust than is paid out for medical care or other items for the person's benefit, the excess is subject to a transfer-of-assets penalty (DSSM 20400.11.4). Interest that stays in the trust isn't counted as income.

Keeping the monthly record

The trustee is the one who has to show that the trust paid only these items. A month-by-month record of every deposit and every payment, checked against the bank statement, is what makes that easy to show when DHSS/DMMA asks.

Related: who can be the trustee in Delaware, what happens to the money at death, and the Miller Trust trustee guide for how the monthly cycle works in every state.

Trust not open yet? The account comes first

None of these payments can start until the trust account exists, and most branches have never opened one. Free one-pager: the questions to ask before you drive to a branch, emailed now. Then 4 more short emails over the next 10 days — then we stop.

Email only — we never ask for income, age, or family details, and never sell your address.

Common questions

What can a Delaware Miller Trust pay for?
Delaware publishes no trust form. Its rule counts all income in the trust when figuring the monthly Patient Pay amount and expects the trust to pay for the person's medical care, such as Patient Pay, in monthly intervals. The personal needs allowance, medical premiums and uncovered care, and allowances for a spouse or family are deducted before Patient Pay. The items DHSS/DMMA's rules name: Patient Pay and other medical care; Personal needs allowance; Medical insurance premiums; Necessary medical care not covered; Community spouse and family allowances; Guardianship fees; Other spending for the person's benefit; Home and community-based care.
Can the trustee be paid from a Delaware Miller Trust?
Delaware sets no cap. Administrative fees for the trust are among the payments that escape a transfer penalty if they're fair, but the rule says they are not deducted when Patient Pay is figured (DSSM 20400.11.4).
What are the timing rules for money in a Delaware Miller Trust?
When more income goes into the trust than is paid out for medical care or other items for the person's benefit, the excess is subject to a transfer-of-assets penalty (DSSM 20400.11.4). Interest that stays in the trust isn't counted as income.