Do I Need a Miller Trust?

If you're applying for Medicaid in Texas to help pay for long-term care—like a nursing home stay—you may have heard the term Miller Trust or Qualified Income Trust (QIT). For many families, this trust is the key to unlocking Medicaid eligibility when income is too high. What is a Miller Trust exactly, and do you really need one?

The Medicaid Income Limit Problem

To qualify for long-term care Medicaid in Texas, you must meet strict income and asset limits. In 2025, the income cap for an individual applicant is $2,901 per month. If your gross monthly income is even one dollar over this amount, you are not eligible for Medicaid—unless you have a Miller Trust.

What Is a Miller Trust?

A Miller Trust, also called a Qualified Income Trust (QIT), is a special legal tool that helps people with too much income become financially eligible for Medicaid. The trust is irrevocable and must be properly drafted and executed. The applicant’s income is deposited into the trust each month. The catch is that when the applicant dies, money left in the trust must be repaid to the State of Texas. For this reason, it is very important to operate your QIT very carefully to reduce the amount of money held in it at any given time.

What a Miller Trust Does NOT Do

A Miller Trust is a tool to address income only—it does not protect assets. If you have excess savings, investments, or property, you will still need additional Medicaid planning strategies to qualify. It also doesn’t shield income from being used for your care. Medicaid still requires you to contribute most of your income toward your monthly care expenses, even when you use a Miller Trust.

Do I Need a Miller Trust?

You need a Miller Trust only if you are applying for long-term care Medicaid in Texas (e.g., for nursing home care or certain waiver programs), and your gross monthly income exceeds the income cap (currently $2,901/month in 2025). If your income is below the limit, you don’t need one. If your assets are the issue—not your income—a Miller Trust won’t help, and you may need other forms of Medicaid planning.

How Do You Set One Up?

Because Miller Trusts are technical and must comply with very specific rules, they should be drafted by an experienced elder law attorney. We prepare the trust, help you set up the necessary bank account, guide you on how to operate the trust in compliance with the Medicaid rules and reduce your payback liability, and coordinate with the Medicaid application to ensure everything is timed and executed correctly.

A Miller Trust is a powerful—but narrow—solution to a very specific problem: excess income. If you're over the Medicaid income limit but otherwise eligible, this trust could be the bridge you need to qualify. At The Toups Law Firm, we’ll help you determine whether a Miller Trust is right for you, and we’ll build a complete Medicaid plan that protects what matters most.