Florida Qualified Income Trust (QIT) / Miller Trust Guide – 2026 Florida Medicaid Income Cap

If you or a loved one needs nursing home care, assisted living, or in-home long-term care services in Florida, there is a good chance that monthly income will determine whether Medicaid will help pay the bill. Florida draws a hard line: earn too much each month, and you are locked out-unless you set up a specific legal tool called a qualified income trust, commonly known as a Miller Trust. This guide walks you through exactly how these trusts work, who needs one, and how to avoid the mistakes that cost families their Medicaid coverage.

Florida Medicaid Income Cap for 2026: Do You Actually Need a Miller Trust?

Florida is what Medicaid professionals call an “income cap state.” Unlike states that let applicants spend excess income on medical bills until they reach the eligibility threshold, Florida simply says: if your gross monthly income is above the cap, you do not qualify for long-term care Medicaid. Period.

For 2026, the Florida Medicaid income limit for institutional care and long-term care waivers is $2,982 per month for a single applicant. That figure is calculated as 300 percent of the federal Supplemental Security Income (SSI) benefit rate. For a married couple where both spouses are applying, the combined income cap is $5,964 per month. Some program categories may reference a slightly different threshold-certain sources cite a figure of $2,901 per month for specific Medicaid waiver categories-so it is critical to confirm which program you are applying for.

The income cap is based on gross income, meaning Medicaid counts your actual income before any deductions. Typical income sources that count toward the cap include:

• Social Security retirement or disability benefits

• Pension payments (public systems like FRS, private pensions)

• IRA or 401(k) distributions

• Annuity income

• Veterans Affairs pension income (with limited exceptions for Aid & Attendance)

• Interest, dividends, and rental income

What does not reduce your countable income for the cap test? Medicare Part B premiums, supplemental health insurance premiums, income tax withholdings, and similar outgoings. Florida Medicaid uses those deductions only after you are already found eligible-not to determine whether you clear the income limit in the first place.

A Florida Miller Trust is only needed when the applicant’s gross monthly income exceeds the cap and the applicant is otherwise financially and medically appropriate for long-term care Medicaid. Miller Trusts are essential for individuals whose income exceeds the Medicaid cap due to strict state limits. If your income falls at or below the cap, you do not need a qualified income trust.

The Siegel Law Group, P.A. in Boca Raton helps families across South Florida determine during an initial consultation whether they truly need an income trust or whether another Medicaid planning tool is the right fit.

For a free legal consultation, call 561-955-8515

What Is a Florida Qualified Income Trust (QIT) / Miller Trust?

A Florida Miller Trust is a specific type of irrevocable income trust created solely to solve the income cap problem for Florida Medicaid long-term care. It is not an asset-protection vehicle. It does not shelter savings or investments. Its one job is to act as a legal conduit that helps applicants meet Medicaid’s income requirements by diverting excess income into a trust so that it is not counted toward the Medicaid income limit.

Miller Trusts are also known as Qualified Income Trusts, or QITs-the terms are interchangeable in Florida Medicaid policy. Both refer to the same type of trust authorized under 42 U.S.C. § 1396p(d)(4)(B). The concept traces back to the 1990 federal case Miller v. Ibarra, which established that excess income could be funneled into a qualifying trust so that it would not be counted for Medicaid eligibility in income cap states.

A few important clarifications:

• A QIT cannot be used to shelter assets; it only addresses income limits for Medicaid eligibility.

• It does not avoid estate recovery after the Medicaid recipient’s death.

• It is entirely separate from revocable living trusts, Lady Bird Deeds, or special needs trusts used in broader estate planning.

The Florida Agency for Health Care Administration (AHCA) enforces the income cap rules and reviews income trusts to confirm they meet federal and state requirements. Income deposited in a Miller Trust is not counted towards Medicaid limits-that is the entire point of the structure.

Why Florida Uses an Income Cap Instead of “Spend‑Down” Rules

Many states allow a “spend-down” approach, where Medicaid applicants can pay medical expenses out of pocket until their remaining income drops below the eligibility threshold. Florida does not work this way. Florida is one of the income cap states that sets a fixed ceiling-currently $2,982 per month for 2026 institutional care applicants-and if your gross income exceeds it, you are simply ineligible unless you establish a qualifying income cap trust.

The AHCA does not have authority to waive the income cap or treat medical expense payments as reducing gross income before the eligibility determination. Under federal law, the only fix is using an income trust that meets the “(d)(4)(B)” safe harbor requirements.

This means that without a Miller Trust, even a modest amount of excess income-sometimes just a few hundred dollars-can permanently block access to Florida Medicaid long-term care benefits. A retiree whose Social Security check increased by $100 due to a cost-of-living adjustment could suddenly be over the line. That is why understanding the cap and acting quickly matters so much.

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Who in Florida Typically Needs a Miller Trust?

Not every Florida Medicaid applicant needs a QIT. The requirement applies only to those whose income exceeds the cap and who are seeking long-term care coverage-nursing home Medicaid (Institutional Care Program), the Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) program, or community based waiver services for assisted living or in-home care.

Here are a few concrete examples:

• A single applicant receiving $3,200 per month in Social Security exceeds the income cap by $218 and needs a QIT.

• A retired teacher collecting $2,100 per month from Social Security plus $1,200 from a Florida Retirement System pension has $3,300 in gross income-well over the cap.

• A widowed veteran whose combined Social Security, VA pension, and investment distributions total $3,500 per month is over the limit, regardless of how modest her countable assets may be.

Even if your countable assets are within Florida’s Medicaid asset limits ($2,000 for an individual or $3,000 for a couple), income over the cap will still bar eligibility unless a QIT is in place and funded. Miller Trusts help individuals qualify for Medicaid despite excess income-they are the only workaround in Florida.

Quick rule of thumb-you are likely a candidate for a Florida Miller Trust if:

• Your total gross monthly income from all sources exceeds $2,982

• You need or anticipate needing nursing home, assisted living, or in-home long-term care

• You want Medicaid to help cover nursing home costs or other long-term care costs

• Your income exceeds the cap even by a small amount

In 2026, Florida’s Medicaid income cap is $2,901 per month under certain waiver program calculations, so applicants close to the line should verify which threshold applies to their specific program.

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How a Florida Miller Trust Works Month to Month

Understanding the monthly mechanics is essential because Medicaid eligibility in Florida is determined month by month. Miss a single month and you can lose coverage for that entire period.

The first step is that each month, the portion of the applicant’s income that causes their gross income to exceed the income cap must be deposited into the dedicated trust bank account. Monthly deposits must include all excess income. Many elder law attorneys recommend depositing all of the applicant’s income into the QIT for simplicity, which eliminates the risk of miscalculation.

The second step is the disbursement. Trustees must disburse funds in a strict priority order set by Florida Medicaid rules. The order is:

1. Personal needs allowance – Florida allows $160 per month for nursing home residents. The personal needs allowance varies by state, but in Florida this amount covers incidental personal expenses for the resident.

2. Community spouse allowance – If there is a community spouse, a spousal income allowance may be diverted to ensure the at-home spouse maintains minimum income (more on this below).

3. Health insurance premiums – Medicare Part B premiums, supplemental insurance, and other health insurance premiums are paid from the trust.

4. Approved medical expenses – Funds in a Miller Trust must be used for approved medical expenses not otherwise covered.

5. Patient responsibility – The remaining income goes to the nursing home or managed care provider as the patient’s share of care costs.

Miller Trust funds can pay for long-term care costs following this disbursement sequence. Funds in a Miller Trust can only be used for specific expenses outlined above. As long as the QIT is properly funded and administered for that month, Medicaid will treat the income inside as non-countable for the income cap test.

If monthly funding is skipped, shorted, or late, it can jeopardize Medicaid eligibility for that month and lead to a denial or interruption of Medicaid benefits.

Legal Requirements for a Valid Florida QIT

Qualified income trusts must closely track the federal “(d)(4)(B) trust” requirements, or they will be rejected by Florida Medicaid. The Florida DCF guidelines for reviewing income trusts spell out what the state looks for.

Core legal requirements include:

• Irrevocable – A Miller Trust must be irrevocable to qualify for Medicaid. The Medicaid applicant cannot revoke or change the trust once it is signed. Miller Trusts must be irrevocable to qualify for Medicaid benefits-there is no exception.

• Established for the applicant – The trust must be created for the sole benefit of the Medicaid applicant.

• Funded only with the applicant’s income – No assets, no third-party money, no income from a family member. Only the applicant’s income goes in.

• State as primary remainder beneficiary – The Florida Agency for Health Care Administration is the primary beneficiary, meaning AHCA must be repaid from remaining trust funds to the extent of Medicaid benefits paid on the applicant’s behalf.

• A bank account must be opened in the trust’s name – A separate, dedicated trust bank account is required to hold the income deposited each month.

The trust document must be signed and dated properly. If the applicant lacks capacity, someone with valid authority under a durable power of attorney may sign, but only as Florida law allows. Notarization and witnesses are typically required under Florida trust and elder law practice.

Critically, the trust must be in place and the trust account funded before or during the month for which Medicaid eligibility is sought. Medicaid will not backdate an unfunded QIT. Having the document drafted by an elder law attorney who routinely handles income trusts is the best way to avoid small drafting errors that can invalidate the entire plan.

Setting Up a Florida Miller Trust and Bank Account

The practical setup process moves through several steps, from your first attorney meeting to the first deposit landing in the account.

The attorney drafts the QIT document, ensuring it meets every federal statute and Florida Medicaid requirement. Legal guidance is recommended for setting up a Miller Trust because even minor deviations from the required language can result in a Medicaid denial. The trustee-typically a spouse, adult child, or trusted friend-is named in the document.

Next, the trustee obtains a separate tax identification number (EIN) from the IRS if the bank or attorney advises it. The trustee then opens a dedicated trust bank account titled in the exact name of the qualified income trust. Not all banks are familiar with Florida Miller Trusts, so having the trust document and a letter from counsel ready when you walk in helps avoid delays and bank fees associated with incorrect account setup.

Once the account is open, the trustee must redirect direct deposit arrangements (Social Security, pension payments) or set up monthly transfers so that the required income portion flows into the QIT on time each month. Timing is everything-if the income is not in the trust account during the month Medicaid eligibility is being determined, that month’s coverage is at risk.

The Siegel Law Group can coordinate with local banks in Boca Raton and throughout South Florida to streamline this setup during the Medicaid application process.

Common Mistakes That Can Jeopardize Medicaid Eligibility

Even a well-drafted QIT can fail if it is administered incorrectly. Medicaid redeterminations often uncover errors months after they occur, and by then the damage is done.

The most common operational mistakes include:

• Failing to fund the trust in a particular month – Even one missed month means no Medicaid coverage for that period.

• Depositing too little income – If the applicant’s income exceeds the cap and not enough is placed into the QIT, the income test is not satisfied.

• Commingling funds – Mixing QIT money with non-trust funds, using a joint bank account, or depositing a family member’s income into the trust account can invalidate the structure entirely.

• Paying unapproved expenses – Miller Trusts cannot be used for personal expenses such as gifts to family, vacations, or general household bills. Using QIT funds this way is treated as misapplication.

• Using a spouse’s income incorrectly – Only the institutionalized applicant’s income belongs in their QIT. Directing the community spouse’s income into the same account, or vice versa, is a disqualifying error.

• Closing the account without legal advice – Shutting down the trust account prematurely can trigger repayment obligations and loss of benefits.

Errors in calculating patient responsibility can also cause the facility bill to be underpaid, leading to collection problems and Medicaid compliance issues. If you have received a notice from the state, read more about what to do after a Medicaid denial.

Trustees should keep simple, organized monthly records-bank statements, a summary of each month’s payments, and receipts-and can ask The Siegel Law Group to review their process if they are unsure. For a deeper dive into pitfalls, see our article on the 7 mistakes you’re making with Florida Medicaid planning.

What a Miller Trust Can and Cannot Do

A QIT is only one piece of Medicaid planning. It is laser-focused on the income cap issue and nothing else.

What a Florida Miller Trust can do:

• Allow an over-income applicant to pass the Medicaid income test and begin receiving Medicaid benefits

• Provide a predictable structure for paying the nursing home or long-term care provider each month

• Coordinate with community spouse allowances so the at-home spouse retains adequate income

• Miller Trusts can save thousands on Medicaid expenses monthly by unlocking Medicaid coverage that would otherwise be unavailable

What it cannot do:

• It does not protect countable assets such as savings accounts, non-homestead real estate, or investment portfolios. For asset-related strategies, see our guide on how to protect assets from Medicaid in Florida.

• It does not replace wills, revocable living trusts, or other estate planning tools

• It does not prevent Medicaid estate recovery against the beneficiary’s estate or QIT remainder

• It does not fix transfer-of-assets penalties, five-year look-back issues, or improper gifts made before the Medicaid application

• It provides no limit on South Carolina, limit on Texas, limit on Georgia, limit on Ohio, limit on Missouri, limit on Nevada, limit on Indiana, limit on Tennessee, limit on Mississippi, limit on Idaho, limit on South Dakota, or any other state’s Medicaid cap-it applies exclusively to Florida law

Think of the QIT as one tool in a broader Florida Medicaid planning strategy. It solves the income problem, but asset limits, transfer penalties, and estate recovery all require separate solutions designed with an elder law attorney.

Married Couples, Community Spouse Rules, and Income Trusts

When one spouse enters a nursing home (the “institutionalized spouse”), the other spouse (the “community spouse”) is protected under federal spousal impoverishment rules. These rules exist to prevent the at-home spouse from being impoverished by the cost of care.

A key protection is the minimum monthly maintenance needs allowance, or MMMNA. For Florida in 2026, the MMMNA floor is $2,705 per month and can increase based on excess shelter and utility costs. The spousal income allowance can be up to $4,066.50 per month in 2026, which serves as the ceiling. If the community spouse’s own gross income falls below the MMMNA floor, a portion of the institutionalized spouse’s income can be diverted to make up the difference.

In some situations, the MMMNA diversion alone reduces the institutionalized spouse’s remaining income below the Florida income cap, eliminating the need for a Miller Trust. In other cases, both the MMMNA diversion and a QIT are necessary.

Only the institutionalized spouse’s income should flow through their QIT. The community spouse’s own income is never deposited into the income trust. Getting this wrong is one of the fastest ways to jeopardize Medicaid eligibility.

Community spouse allocations and MMMNA figures change annually and must be re-evaluated each year as part of ongoing Medicaid planning. The Community Spouse Resource Allowance-the maximum countable assets the at-home spouse may retain-is $162,660 for 2026.

Interaction With Other Florida Medicaid Planning Tools

Comprehensive Medicaid planning combines QITs with asset protection and estate planning strategies tailored to Florida law. A Miller Trust handles income; other tools handle everything else.

A Lady Bird Deed (enhanced life estate deed) is often used to protect the homestead from probate and can help with Medicaid estate recovery issues, but it does nothing for the income cap.

Irrevocable asset protection trusts, transfers to a community spouse, and the use of exempt resources (one vehicle, certain prepaid funeral contracts) address the asset limit-currently $2,000 for individuals-not the income limit.

Special needs trusts are different creatures entirely. Typically established under 42 U.S.C. § 1396p(d)(4)(A), these trusts hold assets for disabled beneficiaries without disrupting Medicaid services. They are not substitutes for Miller Trusts.

The Siegel Law Group integrates QIT drafting into full estate planning and elder law packages so that clients’ wills, powers of attorney, and health care directives are all coordinated with their Medicaid goals.

What Happens to the Money in a QIT at Death?

Upon the death of the Medicaid recipient, remaining QIT funds are subject to state payback rules. The trustee must settle and close the QIT according to both the trust terms and Medicaid rules.

The state is the primary remainder beneficiary of the trust. Remaining funds in a Miller Trust go to the state-specifically, funds must reimburse the state for Medicaid benefits paid on behalf of the decedent during their lifetime. The Florida agency (AHCA) must be paid first from any funds remaining in the trust account, up to the total value of Medicaid benefits paid. Trust funds cannot exceed the amount paid by the state, meaning AHCA’s claim is capped at the total benefits paid amount.

Only after AHCA is fully reimbursed do any other remainder beneficiaries named in the trust receive anything. In practice, a well-administered trust typically has no remaining balance because income flows through each month and is disbursed to approved expenses.

The QIT does not take the place of probate or a revocable living trust for handling other estate assets. The overall estate plan must still be in order.

Post-death trustee duties include:

• Obtaining a death certificate

• Notifying AHCA of the Medicaid recipient’s passing

• Paying allowed final expenses if permitted by the trust and Florida law

• Closing the trust account once reimbursement to the Medicaid agency is resolved

Cost, Timing, and Practical Considerations

Families often worry about both the legal cost and the deadline pressures surrounding a Medicaid application. Here is what to expect.

Setting up a Miller Trust costs approximately $400 to $500 at the low end for a straightforward document. However, some legal fees for Miller Trusts can reach $2,500 when the QIT is part of a larger Medicaid planning engagement that includes trust drafting, EIN procurement, bank account coordination, and trustee coaching. Costs for establishing a Miller Trust can vary significantly based on complexity, urgency, and whether additional Medicaid planning tools are needed.

Fees typically cover:

• The trust document itself

• Guidance on obtaining an EIN

• Assistance with bank account setup

• Coaching the trustee on monthly administration and record-keeping

The critical timing rule: the QIT must be signed and funded no later than the first month for which Florida Medicaid eligibility is needed. Families should not wait until the day of a crisis or facility admission. The Siegel Law Group can often prepare and implement a QIT within days in urgent nursing home or hospital discharge situations, but earlier Medicaid planning gives more options and avoids unnecessary stress.

Qualified Income Trusts vs. Other Trust Types in Florida

Florida families often encounter multiple types of trusts and can easily confuse them, sometimes in ways that inadvertently jeopardize Medicaid eligibility. Here is a quick comparison:

Trust Type	Purpose	Irrevocable?	Solves Income Cap?	Countable by Medicaid?
Miller Trust / QIT	Diverts excess income for Medicaid eligibility	Yes	Yes	No (income inside is excluded)
Revocable Living Trust	Probate avoidance, estate management	No	No	Yes (assets are countable)
Special Needs Trust	Protects assets for disabled beneficiaries	Yes	No	No (assets excluded)
Irrevocable Asset Protection Trust	Shields assets from Medicaid countability	Yes	No	Depends on timing/structure

A revocable living trust remains fully countable for Medicaid purposes and does nothing to cure income cap problems. Special needs trusts protect assets for disabled individuals but are unrelated to solving the income cap for long-term care Medicaid. Asset protection trusts and Lady Bird Deeds address property and savings-not monthly income.

In 2026, Florida’s Medicaid income cap is $2,901 per month under some waiver calculations, while the institutional care cap is $2,982. Regardless of which threshold applies, no trust type other than a properly structured QIT solves the income cap problem.

Families should have an elder law attorney review any existing trusts before applying for Florida Medicaid to ensure they do not conflict with income trust planning.

Trustee Responsibilities and Day‑to‑Day Administration

The trustee is the person who keeps the Miller Trust running each month. Eligible trustees include a spouse, adult child, trusted friend, or a professional fiduciary. The nursing home itself cannot serve as trustee.

Monthly trustee tasks in practical terms:

1. Verify income deposits – Confirm that Social Security, pension payments, and other income sources have arrived in the trust account via direct deposit or manual transfer.

2. Pay the personal needs allowance – Disburse the $160 per month PNA to the Medicaid applicant for incidental needs.

3. Pay community spouse allocation – If applicable, send the calculated spousal income allowance to the at-home spouse.

4. Pay insurance premiums – Cover Medicare Part B premiums and any supplemental health insurance premiums from the trust.

5. Pay approved medical expenses – Cover uncovered medical expenses as permitted.

6. Pay patient responsibility – Send the remaining income to the nursing home or care provider.

The trustee must never use QIT funds for non-approved purposes. Gifts to a family member, vacations, or general household spending from the trust account can be treated as a misapplication that threatens Medicaid coverage.

A simple record-keeping system works best: a dedicated folder with monthly bank statements and a one-page summary of payments. The Siegel Law Group often provides written instructions or checklists to new trustees to simplify ongoing compliance.

How Florida Miller Trusts Fit Into Overall Estate and Long‑Term Care Planning

Medicaid planning is just one part of long-term care and estate planning. An income trust must be coordinated with the client’s broader goals-protecting a home, providing for a spouse, and preserving dignity during a difficult chapter.

A Florida QIT can work alongside long-term care insurance, VA Aid & Attendance benefits, and private funds as part of a layered plan for paying for care costs. No single tool does everything.

Durable powers of attorney, health care surrogates, living wills, and pre-need guardian designations are critical so that someone has clear authority to sign the QIT and manage finances if the client becomes incapacitated. Without these documents, establishing a Miller Trust for someone who has already lost capacity can require costly and time-consuming guardianship proceedings.

The Siegel Law Group often reviews or updates clients’ wills and revocable living trusts at the same time as Medicaid and QIT planning to ensure beneficiary designations and titling are consistent. Once the immediate Medicaid eligibility crisis is addressed, families should think about legacy issues-such as special needs planning for disabled beneficiaries or even pet trusts-to round out the picture.

Why Work With The Siegel Law Group, P.A. for a Florida Miller Trust?

The Siegel Law Group, P.A. is a South Florida elder law and estate planning firm built around a simple idea: being your law firm for life and beyond. Among law firms focused on this area, The Siegel Law Group brings a combination of deep Medicaid planning expertise and a commitment to guiding families through every stage of the process.

The firm provides comprehensive Florida Medicaid planning, including income cap analysis, QIT drafting, asset protection strategies, Lady Bird Deeds for homestead protection, and post-eligibility trust administration guidance. Based in Boca Raton, the firm serves clients throughout Palm Beach, Broward, and Miami-Dade counties-including families planning for nursing home, assisted living, and in-home care.

The Siegel Law Group offers free initial consultations to review your income, countable assets, and care needs, and to determine whether a Florida Miller Trust or other Medicaid planning tools are appropriate. Whether you are months away from needing care or facing an urgent hospital discharge, earlier planning always gives you more options.

Do not make irreversible financial decisions-transfers, gifts, account changes-before speaking with an elder law attorney. A single misstep can jeopardize Medicaid eligibility for years.

Ready to find out if you need a Miller Trust? Schedule a free consultation with The Siegel Law Group today, or call the Boca Raton office directly. Your family’s financial security and access to Medicaid coverage may depend on acting now rather than waiting.

Call or text 561-955-8515 or complete a Free Case Evaluation form