Georgia Miller Trust (QIT): How to Set Up and Administer a Qualified Income Trust

Georgia is an "income cap" state. If your parent's gross monthly income exceeds $2,982 in 2026 — even by one dollar — they're completely disqualified from Medicaid nursing home coverage and all home-and-community-based waiver services (CCSP and SOURCE). No spend-down option exists.

The only legal workaround is a Qualified Income Trust, commonly called a Miller Trust. Without one, your parent pays private-pay nursing home rates — $7,000 to $12,000 per month in Georgia — until their assets are depleted.

How the Income Cap Works

The $2,982 monthly limit is calculated as 300% of the SSI Federal Benefit Rate ($994/month in 2026). It applies to your parent's gross monthly income — Social Security, pensions, annuities, VA benefits, rental income — before any deductions.

A parent receiving $2,100 in Social Security and $950 in pension income has gross monthly income of $3,050. That's $68 over the cap, and without a Miller Trust, they don't qualify for any Medicaid long-term care benefits.

The income cap applies to both institutional Medicaid (nursing home coverage) and home-and-community-based waivers — including the Community Care Services Program (CCSP) and SOURCE, which fund in-home care and Structured Family Caregiving stipends.

What a Miller Trust Does

The Miller Trust is an irrevocable trust with a dedicated checking account. Each month, the trustee deposits enough of the parent's income into the trust account to reduce their remaining personal income below $2,982. The trust then distributes those funds according to a strict priority order set by Medicaid rules.

The trust doesn't reduce your parent's actual income or hide money from Medicaid. It routes the excess income through a legally recognized channel that satisfies the income cap requirement. Medicaid counts only the income that stays in the parent's personal account.

Setting Up the Trust

Who Can Execute It

The Miller Trust must be signed by one of three people:

1. The Medicaid applicant (your parent), if they have capacity
2. An agent under a durable power of attorney with explicit trust-creation authority (the "hot powers" under O.C.G.A. § 10-6B-56)
3. A court-appointed conservator

If your parent lacks capacity and never signed a POA with the trust-creation hot power initialed, you must first obtain a conservatorship through probate court before you can establish the Miller Trust. This creates a bottleneck that can delay Medicaid eligibility by weeks or months.

Required Trust Provisions

The trust document must include:

• Irrevocability — once signed, the trust cannot be amended or revoked
• An independent trustee — typically an adult child; the Medicaid applicant cannot serve as trustee
• Georgia as residual beneficiary — the trust must name the State of Georgia as the primary beneficiary to receive any remaining funds (up to the total Medicaid benefits paid) after the applicant's death
• Income-only funding — only the applicant's income can be deposited; assets cannot be placed in the trust

The trust cannot be backdated. It takes effect in the month it's signed and funded — not retroactively.

Monthly Administration

This is where most families make mistakes. Every month, the trustee must:

Step 1: The parent's income (Social Security, pensions) deposits into their regular personal checking account.

Step 2: The trustee transfers enough income from the personal account into the Miller Trust checking account to bring the parent's remaining personal income below $2,982.

Step 3: The trustee distributes funds from the Miller Trust account, in this order:

1. Personal Needs Allowance — $70/month for nursing home residents (for personal care items like clothing and toiletries)
2. Community Spouse Monthly Income Allowance (CSMIA) — if the parent's spouse lives at home and earns less than $4,066.50/month, income can be diverted to make up the difference
3. Medicare and Medigap premiums, plus uncovered medical expenses
4. The remaining balance goes to the nursing facility or waiver provider as the patient liability

Step 4: The Miller Trust checking account must show a $0.00 balance at the end of each calendar month, except any minimum balance required by the bank to keep the account open.

What Goes Wrong

Missing a month. If the trustee fails to fund and distribute the Miller Trust in any single month, Medicaid can terminate benefits retroactively and demand repayment for services covered during that period.

Depositing assets instead of income. Only income goes into the Miller Trust. Depositing savings, investment proceeds, or cash gifts violates the trust's terms and can disqualify Medicaid eligibility.

Leaving a balance. Any funds remaining in the trust account at month-end beyond the bank's minimum balance requirement raise red flags during DFCS verification. The trust is designed to be a pass-through account — money in, distributions out, zero balance.

Not having the hot power. If the agent under a POA didn't have the trust-creation power specifically initialed on the statutory form, any Miller Trust they create can be challenged as invalid — potentially unwinding months of Medicaid coverage.

The Cost Question

Attorney fees for drafting a Miller Trust in Georgia typically run $500 to $2,500. Some elder law attorneys include Miller Trust drafting as part of a broader Medicaid planning package.

The Georgia Power of Attorney & Guardianship Kit includes a Miller Trust setup guide with the month-by-month administration checklist and a distribution worksheet that tracks the required payment priority order — so you don't miss a month or make an accounting error that jeopardizes your parent's benefits.

See more Georgia guides →