Qualified Income Trust in Florida: How Miller Trusts Work for Medicaid

Your parent's Social Security and pension total $3,400 per month. Florida Medicaid's income limit is $2,982. Without a Qualified Income Trust, they're disqualified from long-term care benefits — even if they have almost no savings. This is the problem the QIT solves, and thousands of Florida families establish one every year.

What a Qualified Income Trust Actually Does

A QIT (also called a Miller Trust, after the court case that created them) is an irrevocable trust that captures income exceeding Medicaid's limit. It's not a loophole — it's a mechanism Florida specifically authorizes so that middle-income seniors aren't locked out of long-term care funding.

The trust is established with a separate bank account. Each month, the applicant's full income flows into the QIT account. The trustee then distributes funds in a strict, state-mandated order:

1. Personal needs allowance: $160/month to the applicant
2. Community spouse income allowance: Up to $4,067/month if the non-applicant spouse's own income falls below that threshold
3. Incurred medical expenses: Co-pays, premiums, or medical costs not covered by Medicaid
4. Patient responsibility: The remainder goes to the care facility or the state Medicaid program

The QIT must be funded every month — skipping a deposit can jeopardize ongoing Medicaid eligibility.

Who Needs a QIT

Any Florida Medicaid long-term care applicant whose gross monthly income exceeds $2,982 in 2026. Common income sources that push families over the limit:

• Social Security retirement benefits
• Federal or state pension payments
• Annuity distributions
• Required minimum distributions from IRAs or 401(k)s in payout status

If combined income from all sources exceeds the cap by even $1, a QIT is required before submitting the Medicaid application.

How to Set Up a Miller Trust in Florida

Step 1: Draft the trust document. The QIT must be irrevocable and name the state of Florida as the remainder beneficiary — meaning any funds left in the trust at the applicant's death go to repay Medicaid for benefits received. Elder law attorneys typically charge $500 to $1,500 for drafting.

Step 2: Open a dedicated bank account. The QIT needs its own checking account at a Florida bank, titled in the name of the trust (e.g., "Qualified Income Trust for [Parent's Name]"). The applicant's Social Security and pension direct deposits are redirected to this account.

Step 3: Appoint a trustee. Usually an adult child or family member. The trustee is responsible for making the monthly distributions in the correct order and keeping records.

Step 4: Submit with the Medicaid application. Include a copy of the executed trust document and the new bank account information when filing through the DCF MyACCESS Portal.

Common Mistakes That Derail QITs

Depositing only the "excess" income. Florida requires the applicant's full income to flow through the QIT, not just the amount over $2,982. Partial deposits violate the trust terms.

Mixing QIT funds with personal accounts. The trust account must remain completely separate. Co-mingling funds — even temporarily — can invalidate the trust and trigger a Medicaid denial.

Forgetting the trust after approval. The QIT isn't a one-time filing. Monthly deposits and distributions must continue for as long as the applicant receives Medicaid benefits. Missing a month can result in loss of eligibility.

Not naming Florida as remainder beneficiary. If the trust document doesn't include the state as beneficiary for remaining funds at death, it won't qualify.

QIT vs. Medicaid Planning Attorney: Do You Need Both?

A Medicaid planning attorney handles the broader eligibility strategy — asset protection, spend-down plans, spousal impoverishment protections, and the look-back period analysis. The QIT is one specific tool within that strategy.

For straightforward cases where income is the only barrier (assets are already under $2,000), some families establish a QIT without an attorney using template documents. For complex situations involving excess assets, a home, or spousal protections, working with an elder law attorney on the full picture is worth the $3,000 to $15,000 investment.

The Florida Care Decision Guide includes a QIT setup checklist, a monthly distribution tracking worksheet, and a complete Medicaid asset inventory that separates countable from exempt assets — giving you the preparation work before the attorney's meter starts running.

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