Who Can Be the Trustee of a Miller Trust in Missouri?
In Missouri, 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 Missouri FSD allows. Missouri requires a third-party trustee: under the 886-4657 form, the beneficiary may not serve as their own trustee — a distinct departure from states like Arkansas that allow self-trusteeship. Most families name the applicant's spouse or an adult child. The trust may be established by the individual, their spouse, parent, grandparent, guardian, conservator, or a court, and the form has you name a successor trustee in case the first cannot continue. The trustee opens and manages a single trust bank account that holds only the applicant's income, deposits the over-the-cap portion each month, spends the trust only on the applicant's allowable medical and care costs, keeps full monthly accounting records, and provides FSD a full annual report at each eligibility review (within 10 days of any request; failure to cooperate can end the case). A trustee fee is capped at the lesser of 3% of the income diverted into the trust or ten dollars per month; a spouse or a disabled child living with the beneficiary who serves as trustee may take no fee, while a genuine commercial trustee may charge a commercially reasonable fee. Unless the trustee is the beneficiary's spouse or disabled child, the Department of Social Services may require the trustee to post bond. Confirm any complex situation with a Missouri elder-law attorney. 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 Missouri-licensed elder-law attorney. This guide is informational only and is not legal advice.
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 Missouri FSD allows — the same short list of tasks every month.
What the trustee does each month
- Moves only the applicant's over-the-limit income — the amount above the HCB maximum — into the dedicated trust account each month, keeping the rest in the applicant's own name.
- Spends the trust only on the applicant's own allowable medical and care costs (and any allowable fee). There is no nursing-facility personal-needs allowance and no payment to a facility, because HCB care is provided at home.
- 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 Missouri setup is the same — see the step-by-step setup and what to say at the bank.
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Common questions
- Does the trustee of a Missouri Miller Trust have to be a lawyer?
- No. Managing a Qualified Income Trust is an administrative task — opening the dedicated account, depositing the applicant's income each month, and paying out only the amounts Missouri FSD allows. Missouri requires a third-party trustee: under the 886-4657 form, the beneficiary may not serve as their own trustee — a distinct departure from states like Arkansas that allow self-trusteeship. For advice on your specific situation, consult a Missouri-licensed elder-law attorney.