What Is a Qualified Income Trust (Miller Trust) in Florida?
Many Florida families are surprised to learn that earning too much monthly income can disqualify a loved one from Medicaid long term care coverage. A Qualified Income Trust offers a legal path around this obstacle for families who need help paying for nursing home or assisted living costs.
Overview
Florida is what is known as an income cap state for Medicaid long term care purposes. This means there is a hard monthly income limit rather than a sliding scale. In 2026, that limit is 2,982 dollars per month for a single applicant, equal to three times the federal Supplemental Security Income benefit rate. If an applicant's gross monthly income from Social Security, pensions, annuities, or other sources exceeds this amount, even by one dollar, they cannot qualify for long term care Medicaid without additional planning. A Qualified Income Trust, commonly called a Miller Trust, is the legal tool Florida allows to address this problem under federal authority found at 42 U.S.C. Section 1396p(d)(4)(B).
How a Qualified Income Trust Works
A Qualified Income Trust is an irrevocable trust, meaning it cannot be changed or canceled once it is properly created and funded. Each month, the Medicaid applicant's excess income, the amount above the 2,982 dollar cap, is deposited into a dedicated bank account held in the name of the trust. Because that income sits inside the trust rather than in the applicant's own account, it is not counted when Medicaid determines financial eligibility. The trustee, who cannot be the Medicaid applicant if that person lacks legal capacity, is responsible for making accurate and timely deposits and disbursements every month.
Who Can Create the Trust and How Funds Are Spent
The trust can be created by the applicant if they have capacity, by their spouse, or by an agent acting under a properly drafted durable power of attorney. Florida Statute 709.2202 requires that the specific authority to create a trust be separately initialed on the power of attorney document, so a general grant of authority is not enough. Once the trust is funded, disbursements follow a strict priority order set by Florida Medicaid policy. Funds first cover a personal needs allowance for the recipient, then a monthly allowance for a community spouse if one exists, then health insurance premiums, and finally the recipient's patient pay amount owed to the care facility.
What Happens to Trust Funds After Death
A Qualified Income Trust does not allow a family to pass leftover funds directly to heirs. Under Florida's Medicaid estate recovery law, codified at Florida Statute 409.9101, any money remaining in the trust account when the Medicaid recipient dies must first be paid to the state to reimburse benefits provided during their lifetime. Only funds remaining after that reimbursement, if any, can be distributed further. This payback requirement is a defining feature of how these trusts operate and is not something families can negotiate around.
Ready to Get Started?
A Qualified Income Trust can be the difference between a Florida family qualifying for essential long term care coverage and facing a denied Medicaid application. Because the drafting and monthly administration requirements are strict and unforgiving of errors, this is not a document families should attempt without professional guidance. For related reading, see the Karia Law Elder Law and Medicaid Planning page.
Frequently Asked Questions
No. Only applicants whose gross monthly income exceeds Florida's income cap, which is 2,982 dollars per month in 2026, need this type of trust. Applicants under the cap can apply for Medicaid long term care directly without one.
No. A Qualified Income Trust only addresses income that exceeds the monthly Medicaid cap. It does not shelter countable assets, which remain subject to Florida's separate asset limits and five year lookback rules.
Errors in monthly deposits or disbursements can jeopardize the Medicaid recipient's ongoing eligibility. Because the margin for error is narrow, accurate and consistent trust administration each month is essential to maintaining benefits.
Disclaimer: This article is for general informational purposes only and does not constitute legal advice. It does not create an attorney-client relationship. Laws vary and individual circumstances differ. Consult a licensed Florida estate planning attorney for advice specific to your situation. Tejus Karia, Esq. is a member of The Florida Bar.
- Does everyone applying for Florida Medicaid long term care need a Qualified Income Trust?
- Can a Qualified Income Trust be used to protect assets as well as income?
- What happens if the trust is not funded correctly every month?