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Miller Trust Guide
NV · Guide

How to Set Up a Qualified Income Trust in Nevada: Step by Step

Nevada does not publish a fill-in Qualified Income Trust form. To meet its requirements, an attorney (or, where permitted, you) drafts the trust to satisfy DSS's own published policy, names a trustee, opens a dedicated trust bank account, and funds it with the applicant's income in the same calendar month you want coverage to begin. The trust diverts income above Nevada's $2,982/month long-term-care Medicaid cap (income cap effective 2026; personal needs allowance effective August 2025) so the applicant qualifies. For complex estates, consult a Nevada-licensed elder-law attorney. This guide is informational only and is not legal advice — we explain what DSS's policy requires; we do not draft the trust or provide sample trust language.

Nevada does not publish a fill-in Miller Trust form, so the trust is drafted — by an attorney, or by you where permitted — to meet Division of Social Services (DSS), Nevada Department of Human Services -- known until July 2025 as the Division of Welfare and Supportive Services (DWSS)'s own published requirements. Here is the full sequence, with the DSS fact behind each step.

  1. Confirm the applicant's income is over the Nevada cap

    A Qualified Income Trust only helps when monthly countable income exceeds Nevada's long-term-care Medicaid limit — $2,982/month single (income cap effective 2026; personal needs allowance effective August 2025). If income is under the cap, a trust usually is not needed.

  2. Get the required-provisions checklist

    Nevada does not publish a fill-in QIT form. DSS's own published policy (Nevada Medical Assistance Manual (MAM), Chapter F-500 "Treatment of Trusts," Section F-520.6 ("Miller Type or Qualified Income Trusts - QITs"), MTL 03/25, effective March 25, 2025; cross-referenced by F-525 (Resources), F-530 (Income), F-540 (Transfer of Assets), F-545 (Eligibility & Payments Review), F-550 (Undue Hardship); MAM Chapter F-100 "Long Term Care Services" (MTL 08/25), Section F-110.1 (Gross Countable Income Test) and F-120.5 (Patient Liability Budgeting Procedures, incl. the actual ranked deduction order and the Medicare Part B premium sub-rule); federal authority 42 U.S.C. § 1396p(d)(4)(B) and 42 CFR 435.725) instead lists exactly what a compliant trust must contain — the checklist tells you what to bring to an attorney or verify in a draft.

  3. Have the trust drafted

    DSS's MAM F-500 does not state whether a Qualified Income Trust must be attorney-drafted, and no Nevada case or bar opinion specifically addresses QIT kits (see the UPL notes). But because DSS publishes no fill-in instrument, drafting an original trust from the requirements below is, in practice, an attorney task for most families -- self-drafting an original legal instrument carries materially more risk of missing a required clause, including Nevada's distinctive over-funding rule, than filling in an existing state form would. Budget for an attorney; this kit is what keeps that engagement efficient.

  4. Name a trustee

    Nevada's MAM F-500 defines "trustee" generically -- "any individual(s) or entity...

  5. Open the dedicated trust bank account

    Open a dedicated bank account titled to the trust once it is signed. Branches commonly hesitate to open this account type, so know what to say before you go.

  6. Fund the trust in the same calendar month

    Deposit enough of the applicant's income into the trust account to bring remaining countable income below $2,982 — in the same calendar month you want coverage to start. DSS does not back-date, so the month you fund is the earliest month eligibility can begin.

  7. Distribute monthly and keep records

    Each month the trustee pays out only the allowed items and keeps records. Staying inside DSS's rules each month is what keeps benefits from being pulled.

The two steps families get stuck on are opening the bank account in Nevada and funding the trust before the calendar month closes — see how long setting up a Nevada Miller Trust takes for the timing rules.

What your Nevada trust must contain

Nevada does not publish a fill-in Qualified Income Trust form. The Division of Social Services (DSS) does not publish a fill-in Qualified Income Trust form. Its Medical Assistance Manual, Section F-520.6 ("Miller Type or Qualified Income Trusts - QITs"), instead lists in detail what a compliant trust must do -- irrevocable, income-only funding, a federally defined list of allowable payments, a bar on trustee/attorney/guardian fees, a state payback clause, and (distinctively) a prohibition on depositing more than the month's actual cost of care -- but attaches no sample or fill-in instrument for applicants to complete. The checklist below is drawn directly from that section, plus F-530 and F-540, clause by clause, so you or your attorney can draft -- or verify a draft against -- a trust that actually satisfies what DSS requires.

The step that isn't really paperwork

Opening the bank account is where families actually lose time — most branches have never opened this kind of trust account before. Free one-pager: the questions to ask before you drive to a branch, emailed now. Then 4 more short emails over 3 weeks — then we stop. No ongoing newsletter.

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

Common questions

What do you need before you start setting up a Nevada Miller Trust?
Proof of the applicant's gross monthly income (a Social Security award letter, pension statements), and confirmation that income is actually over Nevada's $2,982/month cap — a Miller Trust only matters if both are true. Knowing who will serve as trustee ahead of time also speeds up the rest of the process, since Nevada does not allow the applicant to fill that role.
Is the Nevada Miller Trust process the same as in other states?
The shape is similar everywhere — get the trust document, name a trustee, open a dedicated bank account, fund it, and submit it to Medicaid — but the specifics underneath vary by state: the exact form or requirements, the income cap, whether an EIN is needed, and the agency's own submission process. This guide covers Nevada's specifics.