Understanding the Miller Trust

The Qualified Income Trust (QIT), also known as the Miller Trust, gives Medicaid applicants more options to become eligible for coverage based on their monthly income

If you meet all eligibility requirements for Managed Long Term Services and Supports (MLTSS) in New Jersey except for the income limit, you may still have options to receive coverage. MLTSS assists those who need advanced care at home or in a facility like a nursing home or assisted living.

One such option is the Miller Trust, also known as a Qualified Income Trust (QIT), first established in the state on December 1, 2014. The Miller Trust was created so that people who require care – those who are aged or disabled, for example – but who make more than the $2,313 monthly limit can still become eligible for coverage.

It’s important to understand the ins and outs of the benefits and guidelines of the Miller Trust. What follows is a detailed overview of how it works and how you can benefit from going this route.

What is a Miller Trust?

A Miller Trust allows you to hold some of your income in a separate account under a legal trust agreement. You can then disregard a portion of your monthly earnings when determining your eligibility for Medicaid services.

A trustee must be appointed, someone other than you, to manage the funds and ensure that everything goes smoothly with deposits, regulations, and other account details.

This is important because these arrangements are monitored by a Medicaid Eligibility Determining Agency (EDA) and the Division of Medical Assistance and Health Services (DMAHS).

Other conditions that apply to the Miller Trust includes:

• The income deposited must be the individual’s income.
• Income must be deposited the same month it was earned.
• Deposits cannot be resources, like real estate or investment proceeds.
• It must be irrevocable (meaning the applicant cannot make any changes to it unless certain predetermined conditions are met or through court order).
• The state of New Jersey must be the first beneficiary of any remaining funds up to the Medicaid benefits costs paid upon the death of the recipient.
• Deposited income can only be paid according to applicable rules and used to pay cost share. Cost share is the amount of your income required to be paid to the care facility each month to offset the costs that Medicaid covers.
• The month the applicant seeks eligibility is the month the Miller Trust must be funded.

The trustee’s responsibility is then to ensure that these conditions are met and that monthly deposits and payments are made according to the trust agreement terms.

What are the benefits of a QIT, and who is it for?

The benefit of a Miller Trust is that you can disregard the amount deposited when applying for MLTSS care through Medicaid.  

The 2019 Medicaid income limit is $2,313 per month, so anyone who earns more than this, but who would also benefit from MLTSS because of their age or disability, can lower that monthly reported income by transferring some of it into a Miller Trust.

However, the applicant must meet the other guidelines for eligibility for MLTSS in New Jersey. Apart from the income limit, these include:

• Applicant must be 65 or older, be blind, or have a qualifying disability.
• Applicant must not have countable resources over $2,000.
• Applicant must meet the citizenship/residency requirements.
• Applicant must require an institutional level of care.

What happens to any leftover funds in a Miller Trust?

A commission is paid to the established trustee after post-eligibility expenses are paid, including cost share, and only if there is enough of the income left at the end of each month.

Upon the Medicaid recipient’s death, the balance of the Miller Trust is paid to the DMAHS. The trustee will manage the process, which also includes contacting the County Welfare Agency and providing necessary documents.

If you meet eligibility requirements aside from the income limit, consider the Miller Trust for a portion of your income that can be used to pay for cost share or other qualifying expenses.
Because guidelines and requirements in New Jersey can change, it’s important to seek the help you need to apply for Medicaid properly. At Elder Law Department at Goldberg Law Group, our qualified Elder Law Attorneys are committed to assisting clients with estate planning, elder law, and Medicaid services on a personal level. We understand that long-term care can be difficult for families to navigate, so allow our experienced team to help. Contact us today to learn more about our services.