Qualified Income Trust Ohio: How to Use a Miller Trust When Your Parent Earns Too Much

Ohio Medicaid has a hard income cap of $2,982 per month in 2026. If your parent's gross monthly income — from Social Security, a pension, VA benefits, or anything else — exceeds that figure by a single dollar, Ohio will deny long-term care Medicaid automatically.

The tool that fixes this is called a Qualified Income Trust, also known in Ohio as a Miller Trust. It is not optional if your parent is over the limit. Without it, they cannot qualify for the PASSPORT waiver, the Ohio Home Care Waiver, or Medicaid-funded nursing home care. With it, a parent earning $3,400 a month can still qualify.

What a Qualified Income Trust Actually Does

A Qualified Income Trust does not reduce your parent's income. It creates a legal container for that income so that Ohio Medicaid can treat the over-limit portion as "trust income" rather than countable personal income.

Here is the practical flow every month:

Your parent's income (Social Security check, pension payment, etc.) is deposited into the QIT bank account before being used for anything else. From that account, the trustee distributes the funds in a strict order set by Ohio Administrative Code Rule 5160:1-6-03.2. Whatever remains after those authorized distributions is paid toward the cost of care.

The state then pays the difference between the authorized care cost and what the patient pays. That is how a $3,400-income senior gets Medicaid to cover in-home personal care or nursing home stays.

Ohio's QIT Legal Requirements

The trust must meet several specific conditions or the state will reject it:

Irrevocable: The QIT cannot be undone, amended, or modified after it is signed. Your parent gives up control of the income that flows through it.

Income only: Nothing goes into the QIT account except the applicant's monthly income. You cannot deposit savings, proceeds from selling an asset, or anyone else's money into this account.

Ohio as primary beneficiary: At death, the state of Ohio is named first in line to recover the amount it paid in Medicaid benefits. This is not negotiable.

Dedicated bank account: The QIT must have its own account — you cannot use your parent's regular checking account. Most Ohio banks will open a basic checking account for this purpose when you explain it is a Medicaid trust account.

Monthly funding: Every dollar deposited must be distributed by the last day of the month it is received. You cannot let funds accumulate in the QIT account month over month.

Proper documentation: Form ODM 10193 is the Ohio Department of Medicaid's QIT verification form. This must be submitted with the Medicaid application to prove the trust exists and the account is active.

If any month the QIT is not funded — meaning the income is not transferred in on time — Medicaid eligibility lapses for that month and your parent is responsible for the full private-pay cost of care.

The Monthly Distribution Order

Ohio law specifies the exact sequence in which QIT funds must be distributed:

1. Personal Needs Allowance: For PASSPORT waiver participants, this is $1,938.30 per month (65% of the $2,982 Special Income Level). This is the protected amount your parent keeps for housing, food, and personal expenses.
2. Community Spouse Monthly Income Allowance: If your parent is married and the at-home spouse earns less than $2,705/month, a portion can be redirected to them.
3. Medicare and private health insurance premiums: Including Part B and Part D premiums, and any supplemental (Medigap) premiums.
4. Patient liability: The calculated share of the cost of care that Medicaid requires the participant to pay.
5. Trustee administrative fees: Up to $15/month for bank charges and administration.

What remains after these distributions is the "excess income" that makes the trust work. Medicaid pays the cost of services above the patient liability.

Ohio Medicaid Spend-Down Rules

The QIT solves the income problem. The spend-down process solves the asset problem. Ohio sets a countable asset limit of $2,000 for a single Medicaid applicant (or $3,000 if both spouses are applying).

If your parent has more than $2,000 in countable assets — savings, checking, CDs, stocks, bonds, non-primary-residence real estate — those assets must be reduced before the application can be approved.

What counts as a countable asset:

• Bank accounts (checking, savings, money market)
• Certificates of deposit
• Stocks and investment accounts
• Non-residential real estate
• Life insurance with a cash surrender value above $1,500

What does not count (exempt assets):

• Primary home (if the applicant or spouse lives there, or if there is a written intent-to-return statement)
• One vehicle of any value
• Household goods and personal belongings
• Irrevocable pre-need burial contracts and burial plots of any value
• IRA/401(k) accounts in Required Minimum Distribution payout status

Compliant ways to spend down countable assets:

• Pay off legitimate debts: mortgage balances, car loans, personal debt
• Purchase an irrevocable pre-paid funeral and burial contract
• Fund home modifications that support aging in place: wheelchair ramps, grab bars, walk-in showers
• Buy needed medical equipment, hearing aids, eyeglasses
• Purchase a second vehicle if additional transportation is genuinely needed

What you absolutely cannot do is transfer cash or property to family members during the 60-month lookback window — the five years before the application date. Ohio reviews every financial transaction from that period. Any transfer for less than fair market value triggers a penalty period calculated as:

Penalty months = Transferred amount ÷ $7,787

A $50,000 transfer to an adult child would generate roughly 6.4 months of Medicaid ineligibility. There is no cap on the penalty period.

Setting Up the QIT Without an Attorney

Many Ohio families pay $1,000 to $1,500 in legal fees just to have a QIT drafted. For families with straightforward income situations — where the only issue is that Social Security plus a pension tips the applicant $200 over the $2,982 cap — this is often more than necessary.

A standard Ohio-compliant QIT uses a template trust agreement, names the state as the primary beneficiary, identifies the trustee (usually an adult child acting as agent under the Durable Power of Attorney), and describes the monthly funding obligation.

You open the trust account at a local Ohio bank, obtain the account routing number, and submit Form ODM 10193 with your Medicaid application package.

The key is the monthly discipline: the trust only works if you fund it every month without fail. A missed transfer is a missed month of Medicaid coverage.

The Ohio Aging in Place Guide includes a QIT setup checklist, a monthly transfer worksheet, and a plain-English explanation of the patient liability calculation so you know exactly what your parent will owe each month after Medicaid approves the application.

When You Do Need an Attorney

Some income and asset situations genuinely require an elder law attorney:

• Your parent's monthly income exceeds $2,982 and they have significant non-exempt assets that need to be restructured through an irrevocable trust or real estate transfer
• There are concerns about the 60-month lookback period and past transfers to family members
• You need to draft a Medicaid Asset Protection Trust to shelter assets going forward (though the lookback period means this only protects assets placed in the trust more than five years before a future application)
• Your parent lacks capacity and you need probate guardianship before you can act on their behalf

For these situations, an Ohio elder law attorney typically charges $3,000 to $15,000 for a comprehensive Medicaid planning package. That investment can protect far more in assets than it costs.

If your situation is simpler — income is slightly over the cap, assets are modest — the QIT and spend-down process is something most organized families can handle with the right guide and templates.

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