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Miller Trust Guide
MO · Guide Last reviewed

What Happens to a Miller Trust When the Beneficiary Dies in Missouri?

When the beneficiary of a Missouri Qualified Income Trust dies, money left in the trust does not pass to the family like an ordinary inheritance. On the beneficiary's death the Qualified Income 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, in an amount up to that total. The payment goes to the MO HealthNet Division, Attention: Cost Recovery Unit, PO Box 6500, Jefferson City, MO 65102. Only the balance remaining after the State is reimbursed passes to the persons named in the form's residuary section. Missouri does not publish a separate residuary remittance form; the trustee coordinates the exact payoff amount with the MO HealthNet Division's Cost Recovery Unit, resolves the State's claim before distributing any balance, and keeps proof of payment in the permanent trust file. Because only the income above the HCB maximum flows through the trust — and the trust may hold accumulated income spent on the applicant's care over time — the balance at death varies. 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 HCB income maximum of $1,737/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 Missouri FSD allows. That is what lets the diverted income go uncounted for eligibility.

What's usually left

In an HCB waiver trust, only the income above the HCB maximum flows through the trust, and Missouri lets the trust hold accumulated income to spend on the applicant's care over time — so the balance at death varies rather than always sitting near zero. Whatever remains is applied first to the State's Medicaid payback.

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Common questions

Who gets the money left in a Missouri Miller Trust after the beneficiary dies?
On the beneficiary's death the Qualified Income 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, in an amount up to that total. The payment goes to the MO HealthNet Division, Attention: Cost Recovery Unit, PO Box 6500, Jefferson City, MO 65102. Only the balance remaining after the State is reimbursed passes to the persons named in the form's residuary section. Missouri does not publish a separate residuary remittance form; the trustee coordinates the exact payoff amount with the MO HealthNet Division's Cost Recovery Unit, resolves the State's claim before distributing any balance, and keeps proof of payment in the permanent trust file.