What Can a Miller Trust Pay For in Texas?
Each named income source goes into the QIT in full in the month it's received, and the trustee must make distributions by the last day of the following month. HHSC's sample QIT lists the priority: a personal needs allowance, an allowance for a spouse, incurred medical expenses, and then the cost of medical assistance (the co-payment). Trust administration costs may be paid only from funds left after those distributions. Every item below is cited to HHSC's own published rules; where HHSC 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 Texas Miller Trust each month, and the trustee may pay it out only for the purposes HHSC allows. Paying for anything else can put eligibility at risk. Here is the list, with the HHSC source for each item.
What HHSC's rules allow
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Personal needs allowance
$75 a month since January 1, 2024.
Source: HHSC MEPD Handbook H-1500; HHSC sample QIT
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Court-ordered guardianship fees
Appendix XXXVI requires the QIT instrument to provide for court-ordered guardianship fees; HHSC's co-payment rules deduct them second, after the personal needs allowance.
Source: HHSC MEPD Handbook Appendix XXXVI; H-1400
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Allowance for a spouse
Enough to provide, but not exceed, the spouse's minimum monthly maintenance needs allowance.
Source: HHSC sample QIT
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Allowance for family at home
An amount for the maintenance needs of a family at home.
Source: HHSC MEPD Handbook H-1400
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Incurred medical expenses
Incurred medical expenses as Medicaid defines them, including Medicare and other health insurance premiums, deductibles and coinsurance, and care recognized by state law but not covered by Medicaid.
Source: HHSC sample QIT; MEPD Handbook H-2100
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Cost of medical assistance
The cost of medical assistance provided to the beneficiary: the co-payment toward care.
Source: HHSC sample QIT
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Other payments that won't reduce benefits
Payments to or for the beneficiary that won't cause a loss or reduction of Medicaid benefits.
Source: HHSC sample QIT
The order payments are made in
HHSC's sample QIT sets the priority: personal needs allowance, spouse's allowance, incurred medical expenses, cost of medical assistance, then other payments that won't reduce benefits. For figuring the co-payment, HHSC's handbook orders the deductions: personal needs allowance, guardianship fees, spouse, family, then incurred medical expenses (H-1400).
Trustee and bank fees
HHSC sets no dollar cap. Funds left in the QIT after the required distributions may be applied to trust administration, but HHSC doesn't deduct administration costs when figuring how much income goes toward the beneficiary's care (Appendix XXXVI).
What the trust can't be used for
Distributions not made to or for the beneficiary or their community spouse are treated as a transfer of assets; distributions to the spouse and allowable administration payments are not. Only the person's pension, Social Security and other income may go into the QIT, never their resources (Appendix XXXVI).
Timing, and money left over
Income must be deposited the month it's received, and failing to distribute it by the end of the following month is treated as a transfer of assets (Appendix XXXVI).
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 HHSC asks.
Related: who can be the trustee in Texas, 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.