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Miller Trust Guide
TX · Guide Last reviewed

How to Set Up a Miller Trust in Texas: Step by Step

To set up a Miller Trust in Texas, you complete the official HHSC Qualified Income Trust template, name a trustee who is not the applicant, open a dedicated trust bank account, and deposit the applicant's income into it in the same calendar month you want coverage to begin. The trust diverts income above Texas's $2,982/month long-term-care Medicaid cap (CMS January 2026 figures) so the applicant qualifies. For the core setup this is a paperwork-and-banking task most families handle themselves; for complex estates, consult a Texas-licensed elder-law attorney. This guide is informational only and is not legal advice — we explain how to use HHSC's own published form; we do not draft it.

Setting up a Miller Trust in Texas is an operational task, not a legal one, as long as you use Texas Health and Human Services Commission's own published template and do not deviate from it. Here is the full sequence, with the HHSC fact behind each step.

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

    A Qualified Income Trust only helps when monthly countable income exceeds Texas's long-term-care Medicaid limit — $2,982/month single, $5,964/month for a couple where both apply (CMS January 2026 figures). If income is under the cap, a Miller Trust usually is not needed.

  2. Download the official HHSC QIT template

    Get the model Qualified Income Trust instrument directly from Texas Health and Human Services Commission on its .gov site. HHSC publishes a Sample QIT PDF linked from Appendix XXXVI of the MEPD Handbook. We never draft or host the trust text — you use the state's own published form.

  3. Fill in the fields the template asks for

    Complete the data fields the HHSC form requests — the applicant's name, date of birth, Social Security number, and each income source (Social Security, pension, and so on) — following the instructions printed on the template.

  4. Name a trustee who is not the applicant

    HHSC Appendix XXXVI states the statutory authority for a QIT is silent on who may serve as the trustee, but HHSC recommends that the beneficiary not be a trustee — the beneficiary may lose Medicaid eligibility if the trust requirements are not met.

  5. Open the dedicated trust bank account

    Open a dedicated bank account titled to the trust. A Texas QIT is set up with the beneficiary's Social Security number — no EIN is required. Branches commonly hesitate, 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. HHSC 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 (personal-needs allowance, any spousal allowance, medical costs and cost-share) and keeps the named income sources flowing into the account. Staying inside HHSC's rules each month is what keeps benefits from being pulled.

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

Get the official HHSC template

Download the model Qualified Income Trust instrument directly from Texas Health and Human Services Commission: HHSC Qualified Income Trust template . HHSC publishes a Sample QIT PDF linked from Appendix XXXVI of the MEPD Handbook. HHSC notes the sample meets the basic MEPD requirements for a QIT when properly completed, but is not the only acceptable QIT form.