What Can an Income Trust Pay For in Mississippi?
Mississippi's trust works differently from most states. When a nursing-facility resident's income is less than their cost of care, all of it, less authorized deductions, is paid directly to the facility and nothing stays in the trust. Income above the cost of care is kept in the trust account, and the trustee pays the accumulated amount to the Division of Medicaid when it asks. In the home and community-based waiver trust, the trustee may release up to $1 less than the Medicaid income limit each month for the person's benefit. Every item below is cited to Mississippi Medicaid's own published rules; where Mississippi Medicaid 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.
Checked October 21, 2026: The Mississippi Division of Medicaid's website is temporarily down. Its home page says the outage is affecting its web-hosting vendor, so the official documents this page links to, including the Income Trust form, won't load right now. These links are to Mississippi's own published documents and should work again once its site is restored.
Income goes into a Mississippi Income Trust each month, and the trustee may pay it out only for the purposes Mississippi Medicaid allows. Paying for anything else can put eligibility at risk. Here is the list, with the Mississippi Medicaid source for each item.
What Mississippi Medicaid's rules allow
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Payment to the nursing facility
When income is less than the cost of care, all income, less authorized deductions, is paid directly to the nursing facility.
Source: Miss. Admin. Code Title 23, Part 103, Rule 5.17
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Personal needs allowance
$44 a month; $90 for veterans and surviving spouses who receive a $90 VA pension.
Source: DOM long-term care income standards, January 2026
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Community spouse allowance
A monthly allowance less the spouse's own income; the 2026 maximum is $4,066.50.
Source: DOM long-term care income standards, January 2026
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Dependent family members
A monthly allowance for other dependent family members, based on their own income.
Source: DOM long-term care income standards, January 2026
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Health insurance premiums and medical care
Deductions for health insurance premiums the resident pays and for medically necessary care, services and items.
Source: DOM long-term care income standards, January 2026
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Income above the cost of care, to the Division
The trustee keeps income above the cost of care in the trust account; at review, DOM tells the trustee how much should have accumulated and requests payment of it, up to what Medicaid has spent that hasn't been repaid.
Source: DOM Appendix A-8-1, Long-Term Care Income Trust Document
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Home and community-based waiver trust
The trustee may distribute to or for the person amounts DOM allows, up to $1 less than the current Medicaid income limit each month; income over the limit is payable to the Division.
Source: DOM Appendix A-9-1, HCBS Income Trust Document; Rule 5.17
Trustee and bank fees
No trustee fee is allowed. When funds are kept in the trust, administrative fees are limited to $10 a month and are meant to cover bank charges for the account (Miss. Admin. Code Title 23, Part 103, Rule 5.17); DOM's trust documents say reasonable bank charges are allowed.
What the trust can't be used for
Any disbursement not approved by the Division of Medicaid or provided for by the trust agreement results in loss of the trust exemption (Rule 5.17), and failing to make a payment the Division requests results in loss of eligibility (Appendix A-8-1).
Timing, and money left over
In the nursing-facility trust, the income above the cost of care builds up in the account until the Division requests payment. When the trust ends, accumulated income goes to the Division up to what Medicaid has paid (Appendix A-8-1).
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 Mississippi Medicaid asks.
Related: who can be the trustee in Mississippi, 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.