Miller Trust Ohio: How a Qualified Income Trust Works for Medicaid

Your parent's Social Security and pension add up to $3,200 a month. That's $218 over Ohio's 2026 Medicaid income limit. Without a Miller Trust, your parent is disqualified from long-term care Medicaid — even though their care costs run $7,000+ a month and they have almost no savings left.

What a Miller Trust Is

A Qualified Income Trust — universally called a "Miller Trust" in Ohio — is a special irrevocable trust that exists for one purpose: to route excess income through a separate account so it's no longer counted against Medicaid's income cap.

Ohio's 2026 Special Income Limit (SIL) is $2,982 per month, representing 300% of the federal SSI benefit rate. If your parent's gross monthly income (Social Security, pensions, interest, dividends) exceeds this by even one dollar, they are categorically ineligible for long-term care Medicaid unless a Miller Trust is in place.

How It Works

The mechanics are straightforward once you understand the structure:

1. A separate bank account is opened in the name of the trust
2. Each month, your parent's income that exceeds the SIL is deposited into this trust account
3. The trust distributes the income in a specific order: a personal needs allowance ($75/month), a spousal maintenance allowance (if applicable), medical costs not covered by Medicaid, and the remainder to the care facility or waiver program as the patient liability
4. Upon the beneficiary's death, any remaining trust funds are paid to the Ohio Department of Medicaid up to the amount of benefits they paid on the person's behalf

The trust doesn't hide income or protect assets. It's a technical routing mechanism that satisfies the statutory eligibility formula. The state gets everything back at the end.

Setting One Up

The Miller Trust requires:

• A trust document naming the Medicaid applicant as the beneficiary
• A trustee (usually the adult child or agent under the power of attorney) to manage the account
• A dedicated bank account titled in the name of the trust
• Monthly deposits of income exceeding the SIL
• Annual reporting to the CDJFS caseworker showing deposits and distributions

The trust document must name the Ohio Department of Medicaid as the remainder beneficiary — this is a federal requirement, and banks familiar with Miller Trusts will have the account titling procedures already in place.

The Power of Attorney Connection

Here's where legal authority becomes critical. If your parent has a valid durable financial power of attorney with explicit trust-creation authority (one of the "hot powers" under R.C. 1337.42), you can establish the Miller Trust immediately.

If your parent lacks capacity and has no POA, you're locked out. A guardian must file Form 75.0 (Application to Approve Qualified Income Trust) with the probate court and wait for a judicial order before the trust can be created. During that delay — which can stretch weeks or months — your parent's income exceeds the SIL, Medicaid denies eligibility, and the family pays for care out of pocket.

This is one of the most expensive consequences of not having a power of attorney in place. The care costs that accumulate during the wait for court approval are entirely the family's responsibility.

Common Mistakes

Depositing all income into the trust: Only the amount exceeding the SIL needs to go into the trust account. Routing all income through it creates unnecessary accounting complexity.

Forgetting the monthly transfers: The trust must be funded every month. Skipping a month can jeopardize Medicaid eligibility for that period.

Using a regular bank account instead of a properly titled trust account: The account must be titled in the trust's name. A personal account with informal earmarking won't satisfy the CDJFS caseworker.

Not naming the state as remainder beneficiary: This makes the trust non-compliant, which means it doesn't satisfy the Medicaid eligibility requirement at all.

The Ohio Power of Attorney & Guardianship Kit covers Miller Trust setup alongside the broader Medicaid eligibility process, including how to structure the financial POA with the explicit trust-creation authority required under R.C. 1337.42.

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