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Missouri Qualified Income Trust Setup Guide — Qualify a Family Member for Medicaid Before the Next Billing Cycle

For adult children, spouses, and the attorneys, paralegals, and care managers who help them — before another $5,150–$6,292 month of private-pay care goes by.

A Missouri Qualified Income Trust (Miller Trust) is an irrevocable trust used to qualify an over-income applicant for Missouri's Home and Community-Based (HCB) waiver — in-home Medicaid care for people age 63 and over. Missouri nursing-facility Medicaid uses a spend-down, so a QIT is not used there; it is the tool for the in-home waiver, whose income maximum is $1,737/month (effective July 2026). Because that limit is absolute — an over-income applicant cannot spend down to qualify — the trust is the only path: the applicant keeps income up to the maximum and moves only the excess into the trust, using the official Missouri FSD form (886-4657). A third party, not the applicant, must be trustee. Eligibility begins the month the trust is funded — there is no back-dating — and every month of delay is another month of private-pay in-home or assisted-living care ($5,150–$6,292/mo in Missouri). This is the step-by-step walkthrough most families need: $97, instant download, money-back if Missouri FSD rejects the trust because of something in the kit.

It applies when the person who needs care has gross monthly income over Missouri's HCB income maximum of $1,737, whether you're their child, their spouse, or a professional helping them.

Spouse staying at home?

Only the applicant's own income counts toward this maximum, not yours. Separate federal protections keep you from being left without enough to live on: a resource allowance and, when your own income is low, a monthly income allowance. See Medicaid spousal impoverishment protection.

Families often pay an elder-law attorney $1,000–$2,500 for this. The kit lays out every step in order, built around the official Missouri FSD template and cited to Missouri FSD's own policy. Informational only — not legal advice.

What usually happens

You find the free Missouri FSD form, and it looks simple. Then an elder-law attorney quotes $1,000–$2,500 to handle it. So you fill it in yourself, get it signed, and take it to the bank, where the branch has never opened one of these and says no. Meanwhile the month is running out. Coverage can't start before the month the trust is funded, so a month that slips is another $5,150–$6,292 of private-pay care. (Source for the funding rule: Missouri FSD, MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual §0825.030.35 (Income and Budgeting) and §1025.015.04.01.02 (Qualified Income Trusts).)

The legal document is Missouri FSD's own form. What it leaves out is the order of operations: what the bank will ask for before you walk in, and funding the trust before the month closes. Missouri's form has no tax-ID field; these accounts are generally opened with the applicant's Social Security number. The kit covers the rest: a word-for-word reply for each bank refusal and a printable letter for the branch manager, a funding worksheet built on the 2026 Missouri income maximum, and the 8 reasons Missouri FSD most often denies these, each cited to Missouri FSD's own policy.

You stay in control: you open the account at your own bank, and we never see or touch a dollar of your family's income. Money-back if Missouri FSD rejects it, or for any reason within 7 days.

Questions about the kit before you buy? Email support@millertrustguide.com.

  • Built on Missouri FSD's own .gov template
  • Every claim cited to Missouri FSD policy
  • Last verified against Missouri FSD on September 9, 2026
  • We never collect your family member's details
  • Secure checkout by Stripe
  • Money-back if the trust is rejected

What buyers say

A review from a different state — because it's real, and we'd rather show a genuine reader than fill this page with something invented. Retired attorney & CPA is exactly the kind of reader who'd catch it if this guide were sloppy, which is why we lead with it. We only publish verified customers who gave permission — no invented reviews, no stock quotes.

Your Setup Kit turned out to be extremely useful. It got us to the New Jersey QIT template right away, and that was big. We used the Kit to work through the template and the practical questions about how a QIT actually works, and we were able to draft it, get it executed, open a bank account, and submit it with the application in just two or three days. It was an essential need for us, and the Kit helped us accomplish it very quickly.

Retired attorney & CPA Verified buyer of the New Jersey Kit

Not the only one deciding? Send them this page before you dive in.

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$5,150–$6,292 a month, Missouri private-pay in-home care

Why this can't wait: until the trust is set up correctly, an over-income applicant can't be approved for the HCB in-home waiver — and because the HCB income limit is absolute, there is no spend-down fallback, so the family keeps paying privately for care. Coverage begins the calendar month the QIT is signed and funded — there is no back-dating — and Missouri private-pay in-home and assisted-living care runs $5,150–$6,292 a month, so every 30 days of delay is another month out of pocket.

The Missouri HCB income maximum

HCB income maximum
$1,737/mo
Missouri private-pay in-home care
$5,150–6,292/mo

Setting up a Qualified Income Trust in Missouri starts with one number — the HCB income maximum, the income limit for the Home and Community-Based (in-home) waiver. It is $1,737/month (effective July 2026), and it is absolute: an over-income applicant cannot spend down to qualify, so a properly signed and funded QIT — holding only the income above the maximum — is the way to become eligible. There is no nursing-facility personal-needs allowance here; the applicant keeps their income up to the maximum in their own name, and the trust spends the excess on the applicant's own care. Source: Missouri FSD MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual §0825.030.35 (Income and Budgeting) and §1025.015.04.01.02 (Qualified Income Trusts) [1].

What's in the Missouri kit

10 operational sections and 3 reference appendices. Here are the six pieces buyers tell other buyers made the difference:

  • The bank-refusal playbook. The single thing buyers tell other buyers about. Most Missouri branches have never opened a Miller Trust account and refuse on first request. The kit includes a verbatim script citing MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual §0825.030.35 (Income and Budgeting) and §1025.015.04.01.02 (Qualified Income Trusts) [1], the five most common refusals and how to respond to each, and a one-page resolution letter you can hand to the branch manager.
  • The 8 Missouri FSD denial traps and how to avoid each one. Every trap cites the exact Missouri FSD policy section behind it, so you can verify before you submit — not after the denial letter arrives.
  • A pre-filled monthly funding worksheet using the HCB income maximum of $1,737 so you know exactly how much of the excess to move into the trust each month.
  • The direct link to the official Missouri FSD .gov template and a plain-English walkthrough of every field you fill in yourself.
  • The "what to say to family" page — short script for when a sibling asks why you didn't just hire an attorney. Pre-empts the family-conflict fight before it starts.
  • The month-by-month income redirect checklist for after the account opens, so the trust stays compliant every month and Medicaid never has a reason to pull benefits.

“Isn't the QIT form free from Missouri FSD?”

It is — and the kit links you straight to it, at no charge. You're not paying for the form. You're paying for the part that actually trips families up: the same-calendar-month funding rule, the word-for-word bank-refusal script, and the 8 Missouri FSD denial traps with the policy citation behind each. The form is a couple of pages; getting it accepted is where a month of coverage gets lost.

If your spouse is the one entering care: this kit covers the Qualified Income Trust — the income side of qualifying — in full. If you're the spouse staying at home (the "community spouse"), the kit also walks you through the trust itself, and Section 9 orients you on the separate resource-allowance rules that protect your home and savings. Those resource rules are fact-specific, so for them you'll likely still want a Missouri elder-law attorney — but the kit's job is to make that a short, cheaper meeting instead of a $1,000–$2,500 one: you walk in with the trust already set up, the resource questions already identified, and the documents already gathered, so you're paying for answers, not for someone to explain the basics to you.

Before you buy

Who this kit isn't for

We'd rather you not buy something you don't need. Skip it if:

  • The income is at or under $1,737/month. A Qualified Income Trust usually isn't needed. Check the number with the free income-cap check.
  • The care is in a nursing facility. Missouri nursing-facility Medicaid uses a spend-down, so this trust isn't used there. It's for the in-home HCB waiver.
  • The obstacle is savings or property, not income. A Qualified Income Trust only deals with income. See Medicaid asset protection trusts for the asset side.
  • Money or property was given away in the last five years, or other trusts are involved. That needs a Missouri elder-law attorney.
  • You want someone to fill it in and file it for you. That's what an attorney does. This kit is for doing it yourself, or for checking someone else's work.

How it works in Missouri

  1. Confirm income is over the $1,737 HCB income maximum Gross monthly income, from every source.
  2. Fill in the official Missouri FSD template The state's own form, free from Missouri FSD.
  3. Name a trustee and open the trust account A dedicated bank account titled to the trust.
  4. Fund it in the same calendar month Eligibility starts that month, never earlier.

Full step-by-step walkthrough →

The funding-month rule

  1. September Trust not funded Private pay: $5,150–$6,292 for the month.
  2. October Sign, open, deposit Trust signed, account opened and income deposited, all this month. Eligible from October.
  3. November onward Deposit every month The income goes into the trust account every month to keep eligibility.

There is no back-dating. Funding in October can't cover September.

What it actually looks like

Sample pages from the kit

Real pages from the Missouri kit PDF. Click any page to enlarge.

Print-friendly, readable on a phone or tablet, and designed to be taken to the bank. Every operational claim cites a primary state agency or federal source.

How this compares

Yes — Missouri's own QIT form is free (that's the Free state PDF column below). The $97 is for everything the free PDF leaves you to work out alone: the bank step, the funding-month timing, and the denial traps.

This kit Elder-law attorney Free state PDF Doing nothing
Cost $97 $1,000–2,500 $0 $0, then $5,150–$6,292/mo private-pay
Time to qualified Same week 2–6 weeks If you can decode it alone Not until you act
Bank-refusal script Yes Sometimes No n/a
State agency citations Yes n/a n/a n/a
Updated for the current HCB income maximum Yes Yes If Missouri has updated PDF n/a
"What to say to family" script Yes No No n/a
Delivery time Instant download After consult + retainer Instant n/a

Attorney costs reflect typical Missouri elder-law retainers for a Miller Trust setup. Private-pay in-home and assisted-living figures reflect recent Missouri market averages.

The bank step

The bank refusal nobody warns you about

You walk into your branch with the signed trust. The teller calls a manager. The manager has never seen one. They ask for an EIN. They tell you to come back with an attorney. You drive home with an empty trust account and a Medicaid clock ticking.

This is the single most common reason Missouri families lose a month of benefits, and it has nothing to do with the trust itself — it is a bank-procedure problem. The kit's bank section gives you the exact language to cite at the counter, the Missouri FSD policy reference to read aloud, and a printable resolution letter you can hand to the branch manager so they can escalate inside their own bank instead of sending you away.

Refusals the kit walks you through:

  • Branch asks for a tax ID (EIN) for the trust.
  • Branch is unsure what kind of account this is.
  • Branch wants the applicant to be the account holder.
  • Branch has never opened an income trust account.

Each refusal has a corresponding response in the kit, with the Missouri FSD citation behind it.

The thing that saves a second trip: bring the printed Missouri FSD policy page to the counter — not just the signed trust. A teller who can read the rule in black and white escalates in minutes; one who only has your word for it sends you home. The kit tells you exactly which page to print and hand across.

If Missouri FSD rejects the trust, you pay nothing.

If the denial is because of something in the kit, email the agency's stated denial reason to support@millertrustguide.com and we refund the full purchase price within one business day. Report it within 30 days of purchase if you can. If Missouri FSD hasn't decided by then, email us anyway: the guarantee still applies once you have the denial. No phone tag, no forms, no fight. Changed your mind for any other reason? You have 7 days, no questions asked. We'd rather lose the sale than make this harder on a family already dealing with enough. Full refund policy.

Avoid these

The 8 most common Missouri denial reasons

Every denial reason below cites Missouri FSD policy. The full kit explains each one in context and the order in which to verify them before submitting the Medicaid application.

The trust is revocable, or is later altered on its own
A Qualified Income Trust must be irrevocable. The 886-4657 form is irrevocable on its face and may be changed only by regulation of the Missouri Secretary of State and the Department of Social Services. A revocable trust, or unauthorized edits to a trust FSD has already reviewed, fails the acceptance criteria. — Form 886-4657; FSD Checklist for Qualified Income "Miller" Trusts; §1025.015.04.01.02
The trust holds something other than the participant's income
The trust may be composed only of the participant's pension, Social Security, and other income (plus income that accumulates in it). Placing a resource — real or personal property, or a lump sum that is not income — into the account, or depositing anyone else's income, breaks the exemption. Keep the account income-only and separate from any account used for living expenses. — Form 886-4657 §1.3; FSD Checklist; MHABD Manual §0825.030.35
Not enough income is diverted to get below the HCB maximum
The trust works only if it lowers the applicant's countable income below the absolute HCB income maximum. If too little income is deposited to clear the maximum, the applicant is over-income and ineligible for the HCB waiver that month — Missouri does not allow a spend-down for HCB. Deposit at least the full portion of income above the maximum each month. — Form 886-4657 §1.4 / §3.1; MHABD Manual §0825.030.35
The over-the-cap income is deposited late (or assigned to the trust)
The excess income must be moved into the trust account within the same month it is received, or within 10 days if fewer than 10 days remain in the month. Just as important, the income may not be directly assigned to the trust or trustee as payee — that assignment can itself disqualify the applicant. Move the money by direct deposit or a routine transfer into the trust account instead. — Form 886-4657 §1.4 / §3.1
The applicant is named as trustee
Under Missouri's form, the beneficiary may not serve as the trustee. A trust that names the applicant as its own trustee is rejected. Name a third party — a spouse, an adult child, or another responsible person — and a successor trustee in case the first cannot continue. — Form 886-4657 §5.1
Missing or defective Medicaid-payback provision
The trust must direct that, on the beneficiary's death, the State of Missouri is reimbursed for MO HealthNet paid — payable only after wind-up costs and taxes, and including multi-state language for a beneficiary who received Medicaid in more than one state. The 886-4657 form contains this provision already; do not weaken or remove it. — Form 886-4657 §4.1; FSD Checklist
The trust is not for the sole benefit of the participant
The trust must be for the sole benefit of the participant. FSD flags common problems here — most often trust language that allows the purchase of life insurance (watch open-ended 'including but not limited to' insurance phrasing), or third-party travel that is not for the participant's benefit. Use the form's own language and do not add clauses that broaden who benefits. — FSD Checklist for Qualified Income "Miller" Trusts
A distribution the form does not allow
The trustee may spend the trust only on the allowable items in the form — the participant's own medical and care costs, health-insurance premiums other than MO HealthNet, allowable trustee and bank fees, and the like. A distribution outside that list can affect eligibility unless the trustee restores the funds, and it must be documented in the trust's monthly accounting. — Form 886-4657 §3.2 / §3.4 / §3.5

Before you go to the Missouri bank

Most wasted trips are a bank-procedure problem, not a trust problem. This free one-pager has the questions to ask on the phone before you drive to a branch — emailed now. We'll also send 4 short follow-ups over the next 10 days (what the bank will ask, why denials are paperwork not eligibility, what other buyers found, when to call an attorney) — then we stop. No ongoing newsletter.

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

The author

Who's behind this

I'm . I read every Missouri FSD policy section on these trusts and tied every step in this kit to the section it comes from, so you can check any of it yourself. I'm a researcher, not an attorney. For advice on your own situation, a Missouri-licensed attorney is the right call.

Questions

Frequently asked questions

Is the Missouri Qualified Income Trust Kit legal advice?
No. This kit is informational only and is not legal advice. We are not attorneys and we do not practice law. The kit teaches you how to use the Family Support Division's publicly published Qualified Income Trust form (886-4657). FSD publishes the form and a checklist for the public to use. For advice on your specific situation, consult a Missouri-licensed elder-law attorney.
Does a Missouri Miller Trust help with nursing-home Medicaid?
No — and this is the most important thing to understand about Missouri. Missouri nursing-facility (institutional) Medicaid uses a medically-needy spend-down, not an income cap, so a Qualified Income Trust is not the tool for entering a nursing home there. The QIT exists only to meet the absolute income maximum of Missouri's Home and Community-Based (HCB) waiver — in-home and community care for people age 63 and over — and the MOCDD program. If your family member is seeking nursing-home coverage, this kit is not for that; talk to a Missouri elder-law attorney about spend-down.
What does the kit include?
A step-by-step operational guide for the HCB in-home waiver: a plain-English explanation of how a Missouri Qualified Income Trust works, direct links to the official 886-4657 form and FSD's instructions and checklist, guidance on the fields you complete, a monthly funding worksheet built around the excess-only rule, the bank-account walkthrough (including that a third party must be trustee), the month-by-month funding process, and a Missouri-specific list of common denial reasons. Delivered as a single PDF.
Do you provide the trust form itself?
No. We never author or host trust instrument text. The kit links you to FSD's 886-4657 form on Missouri's .gov site, which you download directly from the state, and explains how to complete, fund, and maintain it.
Who needs a Qualified Income Trust in Missouri?
A person applying for Missouri's Home and Community-Based (HCB) in-home waiver (age 63 or older) — or the MOCDD program — whose gross monthly income is above the HCB income maximum ($1,737/month, per FSD's Non-MAGI Eligibility table). Because the HCB income standard is absolute, an over-income applicant cannot spend down to qualify; the QIT is the only path. Nursing-facility applicants do not use a QIT in Missouri.
How much of my income goes into the trust?
Only the portion above the HCB income maximum. If your gross monthly income is $2,000 and the maximum is $1,737, you deposit at least the $263 excess into the trust each month — within the same month you receive it (or within 10 days if fewer than 10 days remain) — and keep the rest of your income in your own name. The trust then spends that money on your own allowable medical and care costs. There is no nursing-facility personal-needs allowance and no payment to a facility, because HCB care is provided in your home.
Can I be my own trustee?
No. Missouri's 886-4657 form does not allow the beneficiary to serve as trustee — a third party must hold and manage the trust account. Most families name the applicant's spouse or an adult child, and the form has you name a successor trustee as a backup. A trustee fee is capped at the lesser of 3% of the income diverted or $10 per month, and a spouse or disabled child who serves takes no fee.
Does a Missouri Qualified Income Trust need an EIN?
Generally no. Missouri's form is silent on a tax ID and has no EIN field; a QIT composed only of the beneficiary's income is usually opened under the beneficiary's own Social Security number. A bank may still ask for an EIN out of habit — if so, keep the account titled in the trust's name using the beneficiary's Social Security number and ask the branch to escalate to its trust department. Confirm the trust's tax treatment with a tax professional if you have questions.
What if my bank refuses to open the trust account?
Bank refusal is common on a first attempt. Although Missouri does not publish a separate bank memo, the 886-4657 form and FSD's instructions are your documentation: it is a single, dedicated account titled to the trust that holds only the applicant's income, opened and managed by the third-party trustee (not the applicant). The kit walks you through handing the branch those documents, the EIN question, who signs, and escalating to the bank's trust department if needed.
What happens to the trust after the person on Medicaid passes away?
The trust terminates. After the trustee pays reasonable wind-up expenses and any taxes, the State of Missouri is reimbursed for the MO HealthNet benefits it paid on the beneficiary's behalf, up to that total. Only the balance remaining after the State is reimbursed passes to the persons named in the form's residuary section.
Do you offer a refund?
Yes — money back if the Missouri Family Support Division rejects the Qualified Income Trust because of something in the kit. Email support@millertrustguide.com within 30 days of purchase with the agency's stated denial reason and we issue a full refund within one business day. If the agency hasn't decided within 30 days, email anyway: the guarantee still applies once you have the denial.
Will you talk to me on the phone about my situation?
No. We do not offer phone support and we do not advise on individual situations. For advice on your specific situation, consult a Missouri-licensed elder-law attorney — you can find one through The Missouri Bar's Find a Lawyer service (MissouriLawyersHelp.org) or Missouri Legal Services.
Will Missouri FSD accept a Qualified Income Trust I fill in myself?
Missouri's Family Support Division says its Qualified Income Trust form (MO 886-4657) 'will be acceptable to the Family Support Division in its current form and before any alterations to the language are made.' In Missouri this trust is used for the in-home HCB waiver, not nursing-facility Medicaid. The form suggests consulting a Missouri-licensed attorney but doesn't require one, and FSD's instructions describe it as a fillable template with notarized signatures for both the grantor and the trustee. Acceptance is the agency's decision, so no outcome can be promised. The kit walks through signing and naming the trustee.
Which banks will open a Qualified Income Trust (QIT) bank account in Missouri?
There's no published list of banks that offer QIT accounts — most retail branches simply haven't opened one before, since it's an uncommon account type, not because anything is wrong with the trust itself. In practice: larger banks (Chase, Wells Fargo, Bank of America) generally have a centralized trust department that can process the request even when a branch teller can't; full-service branches (often a market's main branch) open commercial and trust-style accounts more routinely than limited-service branches; and community banks and credit unions are frequently the most willing, since their account-opening process tends to involve a human review rather than a screen-driven template. Missouri's 886-4657 form and its instructions are silent on a tax ID — there is no EIN field anywhere on the form. As a trust composed only of the beneficiary's income under 42 U.S.C. § 1396p(d)(4)(B), a Missouri QIT is generally opened using the beneficiary's own Social Security number rather than a separate EIN, the way most grantor-type income trusts work. A branch may still ask for an EIN out of habit; if it does, keep the account titled in the trust's name using the beneficiary's Social Security number, and ask the branch to escalate to its trust department rather than forcing an identifier the form does not call for. Confirm the exact identifier with your bank and, if you have questions about the trust's tax treatment, a tax professional. The kit includes the exact script to use at the counter and a printable letter for a branch manager if the first attempt is refused.
When does Missouri HCB waiver coverage begin after the Qualified Income Trust is set up?
Coverage begins the calendar month the QIT is signed, the trust account is opened, and enough of the applicant's income is moved into the trust to bring remaining countable income below the 2026 HCB income maximum of $1,737/month — all in the same calendar month. There is no back-dating, so every month of delay is another month of private-pay in-home or assisted-living care ($5,150–$6,292/month in Missouri). Source: Missouri FSD MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual §0825.030.35 (Income and Budgeting) and §1025.015.04.01.02 (Qualified Income Trusts).
Can you set up a Missouri Miller Trust without a lawyer?
For the core Qualified Income Trust setup, the task is following Missouri FSD's publicly-published template and opening a specific kind of bank account — work many families do themselves. Attorneys typically charge $1,000–$2,500 for it. For complex situations (significant assets, prior gifting, second marriages, multi-state property), consult a Missouri-licensed elder-law attorney. Miller Trust Guide is informational only and is not legal advice; we do not draft the trust or advise on individual situations.
Can an attorney, paralegal, or care manager use this kit for a client?
Yes. It explains Missouri's own published Qualified Income Trust process in plain language, which works whether you're doing this for your own family member or for a client — professionals handling a case outside their usual specialty use it as a working reference this way. It doesn't replace your own judgment on a specific client's facts and isn't personalized advice; it's the same walkthrough of Missouri's official form either way. If you expect to use it across more than a handful of clients or want redistribution rights, email support@millertrustguide.com about licensing options.
Do I need a Miller Trust in Missouri?
It applies when the person who needs long-term-care Medicaid has gross monthly income over Missouri's HCB income maximum of $1,737 (effective July 2026). Count gross income before any deductions: Social Security, pension, annuity and similar income paid in their name. It applies the same way whether you're their child, their spouse, or a professional helping them. If the income is under the maximum, a Miller Trust usually isn't needed. If you're the spouse staying at home, only the applicant's own income counts toward this maximum, not yours; separate federal protections, a resource allowance and, when your own income is low, a monthly income allowance, keep you from being left without enough to live on.
What if Missouri FSD changes the form or the income maximum after I buy?
If Missouri FSD revises its form or policy within 12 months of your purchase, email support@millertrustguide.com and we'll send the updated edition free. This page shows the date it was last verified against Missouri FSD (September 9, 2026). The income maximum is different: it's a routine yearly adjustment, Missouri FSD publishes the new figure, and you use it in place of the old one; the steps stay the same.

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Keep reading

Step-by-step Missouri guides

New to this? What Is a Miller Trust? covers the plain-English basics — what it is, why states use different names for it, and how it differs from a Medicaid Asset Protection Trust. Below are the free operational walkthroughs that go deeper on the questions Missouri families ask most.

Free operational walkthroughs

Primary sources

State agency sources

Last verified against Missouri FSD on September 9, 2026. Email support@millertrustguide.com if anything below conflicts with what Missouri FSD currently publishes — we correct verified discrepancies within five business days.

Every claim here cites a primary Missouri FSD or federal document — see them

Primary state agency sources

  • Official template: Missouri FSD — MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual §0825.030.35 (Income and Budgeting), which states the QIT rule and the absolute HCB/MOCDD income maximum; the detailed FSD rules are in the Qualified Income Trusts section §1025.015.04.01.02; federal authority 42 U.S.C. § 1396p(d)(4)(B) . The Missouri Family Support Division (FSD) — the office within the Department of Social Services that determines MO HealthNet eligibility — publishes an official fill-in Qualified Income Trust instrument: form 886-4657, titled 'Qualified Income Trust' (revised 2-2020; its companion completion instructions were updated 8/2025). Missouri calls it a Qualified Income Trust (QIT), also known as a Miller Trust; the federal authority is 42 U.S.C. § 1396p(d)(4)(B). Missouri is a special case among the states that use an income cap. Nursing-facility (institutional) MO HealthNet uses a medically-needy spend-down, so a QIT is NOT used to enter a nursing home. The QIT exists only to meet the income maximum of the Home and Community-Based (HCB) waiver — Missouri's Medicaid program for in-home and community care for people age 63 and over — and the MO HealthNet for Children with Developmental Disabilities (MOCDD) program. Because the HCB income standard is absolute (an over-income applicant cannot spend down to qualify for the waiver), the QIT is the only way for someone over the limit to become eligible for in-home HCB services. Two Missouri features stand out. First, funding is excess-only: the settlor deposits only the portion of gross monthly income above the HCB income maximum, within the same month it is received (or within 10 days if fewer than 10 days remain in the month), and keeps the rest of their income in their own name. Second, the applicant may not serve as trustee — a third party (a spouse, an adult child, or another person, but never the beneficiary) must hold and manage the trust account. The trust holds only the applicant's income and spends it on the applicant's own allowable medical and care costs; it names the State of Missouri (the MO HealthNet Division) as remainder beneficiary up to the total MO HealthNet paid. The kit explains how the published form works and links you to FSD's own materials; unlike New Jersey and Indiana, Missouri does not publish a separate memo to banks.
  • [1] Policy manual: Missouri FSD policy manual (section MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual §0825.030.35 (Income and Budgeting), which states the QIT rule and the absolute HCB/MOCDD income maximum; the detailed FSD rules are in the Qualified Income Trusts section §1025.015.04.01.02; federal authority 42 U.S.C. § 1396p(d)(4)(B)).
  • Form 886-4657 — Instructions for the Qualified Income Trust: Missouri FSD — Form 886-4657 — Instructions for the Qualified Income Trust . FSD's field-by-field completion guide for the 886-4657 (MO 886-4657 Instructions, revised 8/2025): which name, date, address, trustee, successor trustee, residuary, and signature/notary blanks to complete. Both the grantor's and the trustee's signatures must be notarized.
  • FSD Checklist for Qualified Income "Miller" Trusts: Missouri FSD — FSD Checklist for Qualified Income "Miller" Trusts . The acceptance criteria FSD staff apply when they review a submitted trust: it must be irrevocable, established by the participant (or a parent, grandparent, guardian, or court), composed only of the participant's income, contain a Medicaid-payback provision with multi-state language, and be for the sole benefit of the participant (it must not, for example, allow the purchase of life insurance). This is the source for the kit's denial-avoidance list.
  • IM-4 — Home and Community Based (HCB) Services (who is eligible): Missouri FSD — IM-4 — Home and Community Based (HCB) Services (who is eligible) . FSD's plain-language brochure explaining who qualifies for HCB in-home services (age 63 or older, a Missouri resident with a Social Security number, assessed to need the services) and what help is available — the program the QIT makes an over-income applicant eligible for.
  • MO HealthNet Eligibility for Non-MAGI Programs (Appendix K — income & resource limits): Missouri FSD — MO HealthNet Eligibility for Non-MAGI Programs (Appendix K — income & resource limits) . FSD's current non-MAGI eligibility table (revised July 2026), the authoritative source for both figures used in this kit: the HCB waiver's absolute income limit ($1,737/month, tested individually per applicant) and its resource limit ($6,220.50 for an individual; $12,441.00 for a couple when both are eligible for HCB or Division of Assets).

Federal sources