Who Can Be the Trustee of a Medicaid Income Trust in South Dakota?
In South Dakota, 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 DSS allows. South Dakota's Medicaid income trust rule, ARSD 67:46:05:33.01, does not name who may or may not serve as trustee -- a genuine, confirmed silence in the state's own regulation, not an oversight in this guide's research. Confirm trustee eligibility directly with DSS or your attorney before naming one. 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 South Dakota-licensed elder-law attorney. This guide is informational only and is not legal advice.
What usually happens
South Dakota doesn't publish a fill-in form, so the trust has to be drafted to DSS's requirements, and an elder-law attorney quotes $1,000–$2,500 to research and draft it. Once it's signed, you take it to the bank, where the branch has never opened one of these and says no.
Meanwhile the month is running out. In South Dakota, coverage can't start before the month the trust is funded, so a month that slips is another month of private-pay nursing care at $9,444–$10,190.
This applies when the person who needs care has gross monthly income over South Dakota's income cap of $2,982, whether you're their child, their spouse, or a professional helping them.
Free: the questions to ask a South Dakota bank before your first visit
7 questions for a five-minute phone call, so you find out whether a branch knows how to open this account before you make the drive. Emailed now, then 4 short follow-ups over the next 10 days — then we stop.
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 DSS allows — the same short list of tasks every month.
What the trustee does each month
- Deposits the applicant's income — Social Security, pension, and any other named sources — into the dedicated trust account.
- Pays out only the amounts DSS permits: typically the applicant's personal-needs allowance of $100/month, any spousal allowance, and the applicant's share of medical and care costs.
- 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 South Dakota setup is the same — see the step-by-step setup and what to say at the bank.
Whoever you name will need this
The trustee is the one who opens the account — and most banks have never seen this type of trust before. Free one-pager: the questions to ask before that first visit, emailed now. Then 4 more short emails over the next 10 days — then we stop.