Jacksonville elder law attorney, C. Randolph Coleman, provides answers to Qualified Income Trust FAQs to provide information about qualified income trusts, sometimes called Miller Trusts, to obtain Medicaid funds for long-term care. A qualified income trust is necessary to qualify for Medicaid benefits to pay for nursing home costs when your income is greater than the maximum amount of income allowed to qualify for Medicaid benefits.  For 2023, the Medicaid income limit is $2,742 per month. If you have questions that are not answered through these qualified income trust FAQs, please let us know and we will attempt to find answers to your questions.

Prepare My Florida Qualified Income Trust Right Here, Right Now - Click Here

1. What is a Qualified Income Trust?

If your income is over the allowable limit ($2,742 monthly for 2023) to qualify for Medicaid long-term care services (including nursing home care), a Qualified Income Trust (QIT) (or Miller Trust) allows you to become eligible by placing the amount of your income that is over the limit into an account each month. The QIT is a written agreement, setting up a special account and requiring you to make deposits of income over the allowable limit into the account. You can prepare your irrevocable qualified income trust immediately online, at a fixed cost of $395 by going to our QIT preparation site.

2. Who needs a Qualified Income Trust?

You need a QIT if your gross income, before deductions (such as taxes, Medicare, or health insurance premiums) is over the limit allowed to qualify ($2,742 monthly for 2023) for the Institutional Care Program (ICP). Other programs for which a qualified income trust is necessary if your income is over the limit include, Institutional Hospice, Program of All-Inclusive Care for the Elderly (PACE), or the Home and Community-Based Services (HCBS) waivers. If you have been living in a skilled nursing facility, and you spent down your assets, you will need a Miller Trust to keep your Medicaid benefits, if your gross income exceeds the allowable monthly income limit.

3. How do I establish a Qualified Income Trust agreement?

You can get help from an experienced elder law attorney or Medicaid planning lawyer to set up the QIT agreement. If you want to, you can prepare the Miller Trust yourself. The qualified income trust agreement must meet specific requirements and will need to be approved by the Florida Department of Children and Family Services legal office.

The Florida Supreme Court has ruled that the preparation of a qualified income trust is the “practice of law.” The result of that decision is that you can not legally hire someone other than a Florida lawyer to assist with the planning and preparation of a qualified income trust. The Medicaid laws are very complex, which is why the Florida Supreme Court wants to protect people in Florida from those who may not understand all of the details of Medicaid planning.

The requirements for a qualified income trust are set forth in these qualified income trust FAQs. When completed, you must submit a copy of the QIT agreement to an eligibility specialist who will forward it to the DCF legal office for review. You can prepare your QIT online by clicking here.

4. What items must be included in the Qualified Income Trust agreement?

According to the applicable Florida regulations, the qualified income trust agreement must:

• Be irrevocable (cannot be canceled or changed except under very narrow allowed situations). The qualified income trust must require that the State of Florida will be paid all funds remaining in the qualified income trust at the time of the death of the Medicaid beneficiary (at least up to the amount of Medicaid benefits paid on behalf of the Medicaid beneficiary).
• The Qualified Income Trust Must Consist of your income only. (Do not include or add assets or your gross income for the month).
• Be signed and dated by you, your spouse, or a person who has the legal authority (as the legal guardian or pursuant to a durable power of attorney) to act on your behalf or who is acting at your request or the request of your spouse. If the authority is through a durable power of attorney, the durable power of attorney must specifically provide that your agent, or attorney, in fact, has the authority to establish trusts on your behalf. You should review your durable power of attorney to determine if it has the appropriate provisions. If you need a durable power of attorney that has the legally acceptable language to establish a qualified income trust, you can prepare one by clicking here.

Prepare My Florida Qualified Income Trust Right Here, Right Now - Click Here

5. How does the Qualified Income Trust bank account work?

After setting up the bank account for the qualified income trust, you must make deposits into the qualified income trust bank account every month for as long as you receive Medicaid benefits. The deposits must be an amount that at least includes all of your income in excess of the allowed maximum income. This means you may need to make deposits before a Medicaid application is approved if you need Medicaid coverage immediately.

You should not make deposits for the past or future months. Any income you receive back from the trust will be counted as income to you. If you fail to make a deposit in any given month or to deposit enough income you will be ineligible for Medicaid payment of long-term care services for the month. As long you deposit income into the QIT account in the month it is received, it will not be counted when DCF determines if you are eligible for Medicaid for that month. That means you must contribute at least as much as the amount of income that exceeds the allowable amount for that month. For more information about funding your Miller Trust, see our information on funding your QIT.

6. How much income must I deposit into the Qualified Income Trust account?

You must deposit enough income into the qualified income trust account each month so that your income outside the Miller Trust account is within program limits ($2,742 monthly for 2023). That means you must deposit all of your income over the allowable limit to the qualified income trust account. Alternatively, you can deposit all of your income into the account.

7. It is better to deposit more income than take the chance of depositing too little to qualify for Medicaid?

Call (866) 762-2237 or visit http://www.dcf.state.fl.us/programs/access/docs/ssi_fin_elig_chart.pdf for information about current income standards. If you are uncertain about the income standards after reviewing these qualified income trust FAQs, then our Florida Medicaid lawyer and elder law attorney can assist you with current income standards for Medicaid, as well as assistance with developing a spend-down plan to protect and preserve family assets without creating ineligibility for Medicaid benefits.  If you need more answers than provided by these qualified income trust FAQs, call us to schedule a consultation to see how we can help you preserve assets for the spouse who resides in the home, or other family members, please call us at (904) 448-1969 in Jacksonville, or toll-free at (866) 510-9099, or Contact Us.

8. What happens to the income I deposit in the Qualified Income Trust account?

The income you have deposited to the qualified income trust is used to calculate your “patient responsibility.” The “patient responsibility” is the amount of income the Florida Department of Children and Families determines you must pay the nursing home. If you have a patient responsibility, you are responsible for paying that amount to the skilled nursing home facility where you are living.

DCF may also determine that your spouse who is living at home should receive part of your income to assist your spouse with living expenses. If so, DCF will notify you of the amount that can be diverted to your spouse. It is also possible that DCF will determine that some portion of your income should be diverted to third parties as payment of insurance premiums for medical insurance, or payments to third party health care providers. Those payments should be identified in the determination letter that you receive from DCF. The determination letter will specify the amount of your income that is to be paid to the nursing home, that is to be diverted to your spouse, or that is to be diverted to third parties.

If there is money left in the QIT upon the death of the Medicaid beneficiary, it is paid to the State of Florida, up to an amount equal to the total medical assistance paid on your behalf by the State.

Prepare My Florida Qualified Income Trust Right Here, Right Now - Click Here

9. How do I pay the funds remaining in the QIT to the State?

The QIT trustee or other individual acting on your behalf should contact the long-term care skilled nursing facility to see if any refund for the month of death is due back to the trust. The balance of the Miller Trust at the date of death, plus any refund from the long term care facility should be paid to the State of Florida.

Mail a check payable to the “Agency for Health Care Administration” and mail to:

ACHA Medicaid Recovery Unit
PO Box 12188
Tallahassee, FL 32317-2188

A brief cover letter or note should state that the payment is for a QIT and include the recipient’s name, Social Security number, and/or Medicaid ID number. Enclose a copy of the QIT bank statement covering the date of death to confirm the check is for the balance. Also, include documentation of any refunds received from the long term care facility. Contact ACS at (877) 357-3268 for questions regarding payment of QIT funds to the State of Florida.  We hope these qualified income trust FAQs have been useful and informative for you.