What Can a Qualified Income Trust Pay For in Nevada?
Nevada requires the trust to say that the only payments allowed are those federal rules (42 CFR 435.725) permit: patient liability, the personal needs allowance, a spousal or family allowance, and certain unreimbursed medical expenses. Income deposited must be spent by the end of the month after it went in; it may not accumulate. Every item below is cited to DSS's own published rules; where DSS 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.
Income goes into a Nevada Qualified Income Trust each month, and the trustee may pay it out only for the purposes DSS allows. Paying for anything else can put eligibility at risk. Here is the list, with the DSS source for each item.
What DSS's rules allow
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Personal needs allowance
$154 for each month of institutionalization; residents with no community spouse but with dependent family members at home get an additional allowance based on household size.
Source: DSS Medical Assistance Manual F-120.5
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Community spouse allowance
Income allocated to the community spouse for maintenance.
Source: DSS Medical Assistance Manual F-120.5
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Family and dependent allowances
Allowances for a dependent child, parent or sibling, as the manual sets out.
Source: DSS Medical Assistance Manual F-120.5
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Health insurance premiums and costs
Health insurance premiums, deductibles and coinsurance the resident incurs, unless a third party pays them.
Source: DSS Medical Assistance Manual F-120.5
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Necessary medical care not covered by Medicaid
With DHCFP approval, to make sure the care is necessary and the amount reasonable.
Source: DSS Medical Assistance Manual F-120.5
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Patient liability
The remainder is the resident's share of the facility's cost.
Source: DSS Medical Assistance Manual F-120.5
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Home and community-based waiver
The waiver needs allowance equals 300% of SSI, which equals the income limit, so patient liability is zero.
Source: DSS Medical Assistance Manual F-230
The order payments are made in
Nevada's manual subtracts these from total monthly income in order: personal needs allowance, community spouse allowance, family allowance, dependent allowance, health insurance costs, then non-covered medical care; what remains is patient liability (MAM F-120.5).
Trustee and bank fees
Not allowed. Nevada's policy says the trust must not provide for paying guardianship fees, attorney fees or trustee fees, either from the trust or from the patient liability (MAM F-520.6). It says nothing about bank fees.
What the trust can't be used for
The trust must say that the only payments allowed are those 42 CFR 435.725 permits (MAM F-520.6). Withdrawals count in the eligibility determination unless used for the personal needs allowance, a spousal or family allowance, medical expenses not covered by Medicaid, or patient liability (MAM F-530). Income placed in the trust beyond what is paid out for the cost of care is subject to a transfer-of-assets penalty (MAM F-540).
Timing, and money left over
Accumulation is not allowed: income deposited must be spent by the month after the month it was deposited (MAM F-520.6).
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 DSS asks.
Related: who can be the trustee in Nevada, 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.