Miller Trusts in Florida: How a Qualified Income Trust Can Protect Your Medicaid Eligibility

Long-term care in Florida is expensive and for many families, Medicaid is the only realistic way to cover nursing home or assisted living costs.

But there’s a common problem: your income may be too high to qualify, even if you cannot actually afford care.

That’s where a Miller Trust, also known as a Qualified Income Trust (QIT), becomes a critical planning tool.

At Cavalier Law Group, we help Florida families structure Medicaid plans correctly, because when it comes to eligibility, precision matters.

What Is a Miller Trust?

A Miller Trust is a special type of irrevocable trust designed to help individuals qualify for Medicaid when their income exceeds Florida’s limit. 

It is authorized under federal law:

• 42 U.S.C. § 1396p(d)(4)(B)

This statute allows certain trusts to exclude income from Medicaid eligibility calculations, provided strict requirements are met. 

Why Miller Trusts Exist in Florida

Florida is known as an “income cap” state.

This means:

• If your income exceeds the Medicaid limit, even slightly, you are automatically disqualified from long-term care benefits. 

The income cap is set at 300% of the Supplemental Security Income (SSI) Federal Benefit Rate, implemented under:

• Florida Administrative Code Rule 65A-1.713 

As of recent figures, this cap is roughly $2,800–$3,000 per month, adjusted annually. 

A Miller Trust provides a lawful workaround:

• Excess income is deposited into the trust
• That income is no longer counted for Medicaid eligibility

How a Miller Trust Works

A Miller Trust is not a traditional asset protection tool, it is strictly an income diversion mechanism.

Here’s how it functions:

1. The Medicaid applicant deposits income (Social Security, pension, etc.) into the trust
2. The income is removed from eligibility calculations
3. The funds are then distributed according to strict Medicaid rules

Once properly structured and funded, the applicant can qualify for Medicaid benefits despite exceeding income limits. 

Legal Requirements for a Valid Miller Trust

A Miller Trust must meet strict federal and Florida requirements. Missing even one requirement can result in denial of benefits.

1. Irrevocable Trust

The trust must be irrevocable, meaning it cannot be changed or revoked after creation. 

2. Income-Only Funding

The trust can only hold income, not assets like savings or real estate. 

3. Sole Benefit Rule

The trust must be established for the sole benefit of the Medicaid applicant. 

4. Medicaid Payback Provision

Upon death, the State of Florida must be reimbursed for Medicaid benefits received:

• Required under 42 U.S.C. § 1396p(d)(4)(B)
• Enforced under Florida law and case precedent 

5. Proper Creation Authority

The trust must be created by:

• The individual
• Their spouse
• A legal representative (e.g., power of attorney or guardian)

As authorized under:

• 42 U.S.C. § 1396p(d)(2)(A) 

How Funds Can Be Used

Once income flows into the trust, it must be distributed in a strict order under:

• Florida Administrative Code Rule 65A-1.7141 

Typical priority includes:

1. Personal needs allowance
2. Spousal support (if applicable)
3. Medical expenses not covered by Medicaid
4. Payment to the care facility (patient responsibility)

Improper distributions can jeopardize Medicaid eligibility.

Important Case Law

Florida courts strictly enforce Miller Trust requirements.

For example:

• Agency for Health Care Administration v. Spence (2024)
• Confirmed that Medicaid must be repaid before any distributions to heirs 
• Maddox v. Florida Department of Children and Families (2020)
• Addressed proper creation and authority issues in trust formation 

These cases highlight a key point: technical mistakes can have serious financial consequences.

Common Mistakes to Avoid

Families often run into problems with Miller Trusts due to:

• Failing to include proper Medicaid payback language
• Depositing assets instead of income
• Not funding the trust consistently each month
• Using funds improperly
• Relying on DIY or non-lawyer services

Why Miller Trusts Require Strategic Planning

A Miller Trust is not just a document, it is part of a broader Medicaid and estate planning strategy.

It must be coordinated with:

• Powers of attorney
• Guardianship planning
• Asset protection strategies
• Estate recovery considerations

When done correctly, it can save families tens of thousands of dollars in long-term care costs.

A Strategic Perspective

Miller Trusts are about more than eligibility, they are about access to care and protecting family resources.

They allow you to:

• Qualify for Medicaid without impoverishment
• Ensure proper care for a loved one
• Navigate complex eligibility rules with confidence

But they must be done right.

Let’s Build It the Right Way

If you or a loved one may need long-term care, early planning is critical.

At Cavalier Law Group, we help Florida families structure Miller Trusts and comprehensive Medicaid plans that protect both eligibility and long-term financial stability.

Schedule a strategy call today:

www.cavalierlawgroup.com

Disclaimer

This content is for informational purposes only and does not constitute legal advice. Medicaid planning and Miller Trusts involve complex federal and state laws and should be evaluated with a qualified attorney based on your specific circumstances.