In some states, individuals whose incomes are higher than the eligibility limit for Medicaid nursing home benefits or Home and Community Based Services (HCBS) benefits can qualify for those services by depositing income into a Qualified Income Trust (QIT), which is also called a “Miller Trust.”
Medicare doesn’t cover long-term care services (i.e. custodial care, as opposed to medical care), but Medicaid does. In most states, Medicaid uses a special income limit – which usually amounts to $2,349 a month in 2020 – to determine eligibility for these long-term care benefits. Some states with a special income limit have a Medicaid spend-down, which allows applicants to subtract medical or long-term care expenses from their income that is counted toward the Medicaid eligibility limit.
But in states that don’t have a Medicaid spend-down that covers long-term care, applicants with incomes higher than the limit but less than the cost of nursing home care could have trouble paying for their care. Federal rules require states to allow those applicants to use a Miller Trust to qualify for Medicaid.