What Happens to a Miller Trust When the Beneficiary Dies in Texas?
When the beneficiary of a Texas Miller Trust dies, money left in the trust does not pass to the family like an ordinary inheritance. Upon the death of the Medicaid beneficiary, funds remaining in the QIT pass to the State of Texas (via Medicaid) up to the total amount of medical assistance paid on the beneficiary's behalf. Any remainder is distributed per the trust's residual beneficiary clause. The trustee should request a final accounting statement from the Medicaid program before disbursing any remaining funds. 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 CMS January 2026 figures 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 HHSC 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.
Common questions
- Who gets the money left in a Texas Miller Trust after the beneficiary dies?
- Upon the death of the Medicaid beneficiary, funds remaining in the QIT pass to the State of Texas (via Medicaid) up to the total amount of medical assistance paid on the beneficiary's behalf. Any remainder is distributed per the trust's residual beneficiary clause. The trustee should request a final accounting statement from the Medicaid program before disbursing any remaining funds.