What Happens to a Miller Trust When the Beneficiary Dies in Nevada?
When the beneficiary of a Nevada Miller Trust dies, money left in the trust does not pass to the family like an ordinary inheritance. On the individual's death, the trust must pay Nevada Medicaid Estate Recovery (MER) all amounts remaining in the trust, up to the total medical assistance paid on the individual's behalf (MAM F-520.6.a.6). MER's own FAQ explicitly lists Qualified Income Trusts among the assets it recovers under NRS 422.054 and NRS 422.29302, and states that funeral expenses may not be paid from a QIT. Standard exemptions apply if the individual is survived by a spouse, a child under 21, or a child of any age who is blind or disabled. Send correspondence to Nevada Health Authority, Medicaid Estate Recovery, 9850 Double R Blvd, Suite 200, Reno, NV 89521 (email mer@nvha.nv.gov, please allow 72 hours for a response); once MER issues a claim amount, mail payment to Nevada Medicaid Estate Recovery, P.O. Box 848473, Los Angeles, CA 90084-8473. Every applicant receives a Medicaid Estate Recovery Notification of Program Operation (Form 6160) at the time of application -- keep it with the trust file, along with proof of the final payment, once the trust terminates. Because most of the applicant's income flows through the trust each month to pay for care, the balance remaining at death is usually small. 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 income cap effective 2026 (300% of the SSI Federal Benefit Rate); Personal Needs Allowance effective August 2025 (MAM F-120.5, MTL 08/25) -- Nevada's own published income chart is dated September 2024 and had not been refreshed to 2026 rates as of this kit's research cap of $2,982/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 DSS allows. That is what lets the diverted income go uncounted for eligibility.
What's usually left
In practice the balance at death is often small. Most of the applicant's income flows into the trust and back out again each month to pay the personal-needs allowance and the applicant's share of care — so the trust is a pass-through, not a place where money piles up.
What about the house?
The trust payback above is a separate legal channel from Medicaid's broader estate-recovery program, which is what could otherwise reach the applicant's home. Federal law (42 U.S.C. § 1396p(b)(2)) bars a state from pursuing that broader estate recovery — against the home or anything else in the estate — for as long as the applicant has a surviving spouse. That protection is automatic; the surviving spouse does not have to apply for it, and it applies the same way in every state. It also applies while the applicant has a surviving child who is under 21, or blind or disabled at any age.
This is a deferral, not a permanent exemption: once the surviving spouse (and any protected child) has also died, the state may then pursue recovery from what remains of the estate, which can include the home. Couples who want to plan specifically for the home beyond that point should raise it with an elder-law attorney — that's a separate question from the Miller Trust this kit covers. See our full Medicaid estate recovery guide for how the broader program works, the federal protections, and the legitimate ways an attorney can help plan around it.
The Nevada denial traps that cost families a month of coverage
Most denials are paperwork, not eligibility. This free one-pager lists every DSS denial trap with the citation behind it — emailed now. We'll also send 4 short follow-ups over the next 3 weeks (the bank step, the trustee role, when to call an attorney) — then we stop. No ongoing newsletter.
Common questions
- Who gets the money left in a Nevada Miller Trust after the beneficiary dies?
- On the individual's death, the trust must pay Nevada Medicaid Estate Recovery (MER) all amounts remaining in the trust, up to the total medical assistance paid on the individual's behalf (MAM F-520.6.a.6). MER's own FAQ explicitly lists Qualified Income Trusts among the assets it recovers under NRS 422.054 and NRS 422.29302, and states that funeral expenses may not be paid from a QIT. Standard exemptions apply if the individual is survived by a spouse, a child under 21, or a child of any age who is blind or disabled. Send correspondence to Nevada Health Authority, Medicaid Estate Recovery, 9850 Double R Blvd, Suite 200, Reno, NV 89521 (email mer@nvha.nv.gov, please allow 72 hours for a response); once MER issues a claim amount, mail payment to Nevada Medicaid Estate Recovery, P.O. Box 848473, Los Angeles, CA 90084-8473. Every applicant receives a Medicaid Estate Recovery Notification of Program Operation (Form 6160) at the time of application -- keep it with the trust file, along with proof of the final payment, once the trust terminates.