The complete guide

What Is a Miller Trust?

A Miller Trust — also called a Qualified Income Trust (QIT) or, in a few states, a plain Income Trust — is an irrevocable trust that lets someone qualify for long-term-care Medicaid despite having monthly income over the state's limit. Income deposited into the trust each month is not counted toward that limit. It's required only in "income-cap" states, is unrelated to the 5-year look-back, and is a different tool from a Medicaid Asset Protection Trust — the sections below explain each distinction.

Last reviewed 2026-08-03.

The problem it solves

Long-term-care Medicaid caps how much monthly income an applicant can have and still qualify. For 2026, that cap is $2,982/month for a single applicant in most income-cap states (each state guide on this site has the exact figure). Someone whose Social Security and pension add up to more than that isn't too wealthy to need help paying for a nursing home — they're just over a specific eligibility line. A Miller Trust exists to move the excess income into an irrevocable trust account, so what Medicaid counts drops back under the cap.

Why the name changes state to state

The trust takes its informal name from Miller v. Ibarra, the 1990 federal case that established it, and federal law (42 U.S.C. § 1396p(d)(4)(B)) refers to it as a "qualifying trust." Each state then wrote its own label into policy when it adopted the mechanism — Texas and Ohio still call it a Miller Trust, most states call it a Qualified Income Trust, and Arkansas, Colorado, Mississippi, and South Carolina call it a plain Income Trust. Same legal tool, different label. If you're not sure what your state calls it, that's exactly what each state guide on this site opens with.

Not every state uses one

A Miller Trust only matters in "income-cap" states — states where exceeding the income limit is an automatic disqualification with no other path around it. States that instead use a "medically needy" spend-down (a different mechanism where an applicant reduces countable income by incurring medical expenses) don't need a Miller Trust at all; Louisiana is the clearest example. A few states are hybrids: Missouri's trust exists only to meet the income maximum of its in-home Home and Community-Based waiver — its nursing-facility Medicaid uses a spend-down instead, so a trust isn't part of that path.

Not the same thing: Asset Protection Trusts and the 5-year look-back

These three terms all come up in the same Medicaid-planning conversation, which is exactly why they get confused. They answer three different questions:

• Miller Trust / Qualified Income Trust — answers "my current monthly income is over the limit." It holds ongoing income (Social Security, a pension), not a lump sum, and it's set up at the point someone actually needs care.
• Medicaid Asset Protection Trust — answers "I want to protect savings or property before I ever need care." It's a different, separately-drafted irrevocable trust, set up years in advance, that holds assets (not income) with the goal of keeping them out of Medicaid's reach later.
• The 5-year look-back — isn't a trust at all. It's Medicaid's rule examining the 60 months before an application for gifts and below-market transfers, and penalizing the ones it finds. It governs assets given away in the past; it has no bearing on funding a Miller Trust with current income.

If your situation is "income is too high right now, care is needed soon," a Miller Trust is the tool, and it's what every state guide on this site covers. If it's "I want to plan ahead to protect assets," or a past gift or transfer is in the picture, that's an asset-protection and look-back question — a licensed elder-law attorney is the right next step, not this site.

What it costs

An elder-law attorney typically charges $1,000–$2,500 to handle a Miller Trust from research through drafting. Where a state publishes its own fill-in template, the core setup — completing that template and opening a dedicated bank account — is a task many families handle themselves; where no fill-in template exists, an attorney typically drafts it regardless, and the state guide is written to make that engagement shorter and cheaper. Each state guide below breaks down the exact cost comparison for that state.

Start with your state

Every state does this a little differently — the income cap, the exact form, and the bank-account process all vary. Pick your state to see the specifics:

• Alabama — Qualifying Income Trust guide
• Arizona — Income-Only Trust guide
• Arkansas — Income Trust guide
• Colorado — Income Trust guide
• Florida — Qualified Income Trust guide
• Georgia — Qualified Income Trust guide
• Indiana — Miller Trust guide
• Mississippi — Income Trust guide
• Missouri — Qualified Income Trust guide
• New Jersey — Qualified Income Trust guide
• Ohio — Miller Trust guide
• Oklahoma — Medicaid Income Pension Trust guide
• South Carolina — Income Trust guide
• Texas — Miller Trust guide

Miller Trust Guide is an informational publisher, not a law firm — we do not draft trust instruments or advise on individual situations. For advice on your specific situation, consult a licensed elder-law attorney in your state. See the editorial process and about the author.