What Happens to a Miller Trust When the Beneficiary Dies in Florida?
When the beneficiary of a Florida Miller Trust dies, money left in the trust does not pass to the family like an ordinary inheritance. On the individual's death, the Qualified Income Trust terminates. DCF's ESS Policy Manual (1840.0110) requires the trust to provide that the state receives the balance remaining in the trust, up to the total Medicaid benefits paid on the individual's behalf -- generic "state" language is sufficient; the trust does not need to name "State of Florida" specifically (Appendix A-22.1, Step 6). In practice, the eligibility specialist forwards the approved trust to the AHCA Third Party Liability vendor using Form CF-ES 2356 ("Third Party Recovery Transmittal"), and Florida's Medicaid Trust & Annuity Recovery Program (AHCA's recovery contractor) directs that any remaining balance be paid by check to "Agency for Health Care Administration," sent with a copy of the month-of-death bank statement, the death certificate, and the trustee's mailing address. A Florida appellate court has confirmed this kind of payback provision is "clear and unequivocal" and must be satisfied before any other distribution (AHCA v. Spence, 3D23-0552 (Fla. 3d DCA 2024), addressing an analogous Medicaid trust payback clause). No checks should be written from the account after death until the trustee is notified the Medicaid debt is satisfied. Florida does not publish a separate public residuary remittance form. Because most of the applicant's income flows through the trust each month to pay for care, the balance remaining at death is usually small. This guide is informational only and is not legal advice.
Why the money doesn't just pass to the family
A Miller Trust is the mechanism that let the applicant qualify for Medicaid despite income over the effective July 2026 cap of $2,982/month. In exchange, the trust is set up so that whatever remains when the beneficiary dies is first used to reimburse the state for the care Medicaid paid for. That is a condition of using the trust, not a penalty.
Why the trust is irrevocable
A Qualified Income Trust only works if it is irrevocable: the applicant cannot pull the money back out for other purposes, and the trustee can only make the distributions DCF allows. That is what lets the diverted income go uncounted for eligibility.
What's usually left
In practice the balance at death is often small. Most of the applicant's income flows into the trust and back out again each month to pay the personal-needs allowance and the applicant's share of care — so the trust is a pass-through, not a place where money piles up.
What about the house?
The trust payback above is a separate legal channel from Medicaid's broader estate-recovery program, which is what could otherwise reach the applicant's home. Federal law (42 U.S.C. § 1396p(b)(2)) bars a state from pursuing that broader estate recovery — against the home or anything else in the estate — for as long as the applicant has a surviving spouse. That protection is automatic; the surviving spouse does not have to apply for it, and it applies the same way in every state. It also applies while the applicant has a surviving child who is under 21, or blind or disabled at any age.
This is a deferral, not a permanent exemption: once the surviving spouse (and any protected child) has also died, the state may then pursue recovery from what remains of the estate, which can include the home. Couples who want to plan specifically for the home beyond that point should raise it with an elder-law attorney — that's a separate question from the Miller Trust this guide covers.
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Common questions
- Who gets the money left in a Florida Miller Trust after the beneficiary dies?
- On the individual's death, the Qualified Income Trust terminates. DCF's ESS Policy Manual (1840.0110) requires the trust to provide that the state receives the balance remaining in the trust, up to the total Medicaid benefits paid on the individual's behalf -- generic "state" language is sufficient; the trust does not need to name "State of Florida" specifically (Appendix A-22.1, Step 6). In practice, the eligibility specialist forwards the approved trust to the AHCA Third Party Liability vendor using Form CF-ES 2356 ("Third Party Recovery Transmittal"), and Florida's Medicaid Trust & Annuity Recovery Program (AHCA's recovery contractor) directs that any remaining balance be paid by check to "Agency for Health Care Administration," sent with a copy of the month-of-death bank statement, the death certificate, and the trustee's mailing address. A Florida appellate court has confirmed this kind of payback provision is "clear and unequivocal" and must be satisfied before any other distribution (AHCA v. Spence, 3D23-0552 (Fla. 3d DCA 2024), addressing an analogous Medicaid trust payback clause). No checks should be written from the account after death until the trustee is notified the Medicaid debt is satisfied. Florida does not publish a separate public residuary remittance form.