Miller Trust Georgia: How to Set Up a Qualified Income Trust for Medicaid in 2026

Why Georgia Requires a Miller Trust

Georgia is an "income cap" state for Long-Term Care Medicaid. If your parent's gross monthly income exceeds $2,982 in 2026 — by even a single dollar — they are categorically ineligible for Medicaid nursing home coverage. There is no spend-down option, no partial qualification. A parent receiving $3,100 per month in Social Security and pension income is treated identically to someone receiving $10,000.

The Miller Trust (formally called a Qualified Income Trust or QIT) exists to solve this problem. It is an irrevocable trust that captures the excess income, routing it through a separate bank account so the applicant's countable income drops below the $2,982 cap. Once the trust is properly established and certified by the Georgia Department of Community Health, the applicant regains Medicaid eligibility.

Who Needs One

Any Georgia Medicaid nursing home applicant whose gross monthly income exceeds $2,982. Common scenarios:

• A parent receiving $2,200 in Social Security plus a $900 pension ($3,100 total — $118 over the cap)
• A retired state employee with a $3,500 monthly pension
• A veteran receiving VA disability payments that push total income past the threshold

The trust may also be relevant to CCSP applicants whose income exceeds the institutional cap. SOURCE uses the approximately $994-per-month SSI-classification threshold, so confirm the applicable program rules with the AAA.

How to Set Up the Trust: Step by Step

Step 1: Draft the trust document. Georgia provides a state-approved template (Form 948) through the Division of Family and Children Services. The trust must name the Georgia Department of Community Health as the primary remainder beneficiary — meaning any funds left in the trust when the applicant dies go to DCH to reimburse Medicaid, up to the total benefits paid. The applicant cannot serve as trustee. An adult child or other trusted person must be appointed.

If you use the state's approved template exactly, submit it with the standard certification form (Form 936). If you deviate from the template — because an elder law attorney adds protective language or modifies distribution terms — you must also submit Form 947 (QIT Approved Format Deviation Form) explaining every change.

Step 2: Get an EIN. The trustee applies to the IRS for an Employer Identification Number for the trust. This takes minutes online through the IRS EIN application (SS-4 equivalent) and is free.

Step 3: Open a dedicated bank account. The trustee opens a non-interest-bearing checking account in the name of the trust using the new EIN. This account must be completely separate from the applicant's personal accounts. Most Georgia banks are familiar with QIT accounts — bring the signed trust document and EIN letter.

Step 4: Submit for certification. Mail the executed trust document, EIN letter, bank account verification, and completed Form 936 (or 936 plus 947 if deviating from the template) to the Georgia Department of Community Health Trust Unit in Tucker, GA.

Monthly Funding and Disbursement

This is where most families make errors. Georgia's PAMMS Section 2407 requires a specific monthly funding sequence:

You cannot direct-deposit income into the QIT. Social Security, pensions, and other income sources must first deposit into the applicant's personal bank account. The trustee then transfers the required amount into the QIT account within the same calendar month.

The trustee must deposit enough to bring the applicant's remaining outside income below $2,982. So if total gross income is $3,400, the trustee transfers at least $419 into the QIT each month.

The trustee then disburses all QIT funds the same month, leaving a zero balance. Permissible disbursements:

• The $70 personal needs allowance (the resident keeps this for personal expenses)
• Health insurance premiums, including Medicare Part B
• The Community Spouse Monthly Income Allowance, if the applicant has a spouse living at home
• The remaining balance to the nursing facility as the resident's patient liability

Missing a month, leaving a balance in the account, or depositing income directly from Social Security instead of transferring from the personal account can trigger a compliance review and jeopardize Medicaid eligibility.

Common Mistakes That Derail the Application

Using a generic trust template from the internet. Georgia's DCH reviews every QIT for compliance with state-specific requirements. Out-of-state templates routinely fail certification because they omit the DCH remainder-beneficiary language or include prohibited provisions.

Naming the applicant as trustee. The applicant cannot manage their own QIT. If no family member can serve, a professional fiduciary or the elder law attorney's office can act as trustee, though this adds monthly fees.

Failing to zero out the account monthly. The QIT is a pass-through mechanism, not a savings account. Any month-end balance signals improper administration.

When to Hire an Elder Law Attorney

The state template works for straightforward cases — single applicant, predictable income, cooperative nursing facility. An elder law attorney earns their fee when:

• The applicant has income from multiple sources with variable amounts (rental income, annuity payments)
• A community spouse needs income diverted from the QIT, requiring MMMNA calculations
• The family has made asset transfers within the 60-month look-back period and needs the trust structured alongside a penalty cure strategy

The Georgia Hospital-to-Home Transition Guide includes a QIT transaction tracker worksheet and the monthly disbursement checklist that walks trustees through every required step, along with the asset inventory template you'll need before meeting with an attorney or filing the Medicaid application.

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