Who Can Be the Trustee of a Qualifying Income Trust in Kentucky?
In Kentucky, the trustee of a Miller Trust (Qualified Income Trust) is whoever manages the trust account — depositing the applicant's income each month and paying out only what DMS allows. Kentucky's regulation (907 KAR 20:030) never states who may, or may not, serve as trustee of a Qualifying Income Trust, and never addresses whether the individual can serve as their own trustee -- the word "trustee" doesn't appear anywhere in the QIT-specific subsection at all. What the regulation does require is that every expenditure from the trust be verified by the department as allowable before it's paid (Section 3(5)(e)). DCBS's own internal procedures manual goes further than the regulation's text and frames this as an ongoing trustee obligation: "the trustee must consult with Medicaid on payments from the trust before they are made" (DCBS Ops Manual Vol. IVA, MS 3505 SS A(6)) -- but that's the department's operational gloss, not language in the regulation itself. In practice, most families name a third party (a spouse, adult child, or agent under power of attorney) rather than the individual themselves. Confirm the trustee question directly with your drafting attorney -- this guide does not treat self-trusteeship as either confirmed permitted or barred by Kentucky's rule text. The trustee does not have to be a lawyer or a professional; for the core setup this is a role most families fill themselves. For a complex situation, consult a Kentucky-licensed elder-law attorney. This guide is informational only and is not legal advice.
What usually happens
Kentucky doesn't publish a fill-in form, so the trust has to be drafted to DMS's requirements, and an elder-law attorney quotes $1,000–$2,500 to research and draft it. Once it's signed, you take it to the bank, where the branch has never opened one of these and says no.
Meanwhile the month is running out. In Kentucky, coverage can't start before the month the trust is funded, so a month that slips is another month of private-pay nursing care at $9,718–$11,254.
This applies when the person who needs care has gross monthly income over Kentucky's income cap of $2,982, whether you're their child, their spouse, or a professional helping them.
Free: the questions to ask a Kentucky bank before your first visit
6 questions for a five-minute phone call, so you find out whether a branch knows how to open this account before you make the drive. Emailed now, then 4 short follow-ups over the next 10 days — then we stop.
The trustee does not have to be an attorney or a professional fiduciary. Managing a Qualified Income Trust is an operational job, not a legal one: open the account, move the applicant's income through it each month, and pay out only what DMS allows — the same short list of tasks every month.
What the trustee does each month
- Deposits the applicant's income — Social Security, pension, and any other named sources — into the dedicated trust account.
- Pays out only the amounts DMS permits: typically the applicant's personal-needs allowance of $60/month, any spousal allowance, and the applicant's share of medical and care costs.
- Keeps simple records of what went in and what came out, so the trust stays compliant and Medicaid has no reason to question it.
Name a backup trustee
Many families name a successor trustee when they set the trust up, so that if the first trustee cannot continue, the trust keeps running without interruption. Either way the Kentucky setup is the same — see the step-by-step setup and what to say at the bank.
Whoever you name will need this
The trustee is the one who opens the account — and most banks have never seen this type of trust before. Free one-pager: the questions to ask before that first visit, emailed now. Then 4 more short emails over the next 10 days — then we stop.