Miller Trusts in Georgia:How a Qualified Income Trust Works

A Miller trust, which Georgia calls a Qualified Income Trust (QIT), is a special bank account and trust that lets a person whose income is over the Medicaid cap still qualify for long-term care, including home care through EDWP. Each month, some or all of the person's income goes into the trust. Income placed there is not counted toward the income cap.

The trust does not make the money disappear. The trustee can spend it only on set purposes, such as the cost of care. What it does is open the door to Medicaid for people whose income is over the cap.

This guide explains who needs a QIT, who can set one up, how the monthly routine works and the mistakes that can cost a month of coverage. It is not legal advice. For your own trust, talk with an elder-law attorney.

Miller trusts in Georgia at a glance

• Official name: Qualified Income Trust (QIT)
• Who it helps: people whose gross monthly income is at or above Georgia's Medicaid income cap
• Programs: nursing facility care, hospice, and home and community-based services such as EDWP
• What goes in: only the person's income, such as Social Security, pensions or VA benefits
• What cannot go in: savings or other assets
• Who manages it: a trustee, never the person receiving care
• Rules come from: the DFCS Medicaid manual, Section 2407, and DFCS Forms 945 and 946

Who needs a Miller trust in Georgia?

Your loved one may need a QIT if all of these are true:

• They are applying for nursing home care, hospice or a waiver such as EDWP.
• They are applying through DFCS, not through SSI.
• Their gross monthly income is at or above the Medicaid cap for that year.
• They meet the other EDWP rules, including a nursing-home level of care and the asset limit.

The DFCS QIT worksheet (Form 946) says the trust is for people whose gross monthly income is over the state cap. The EDWP section of the DFCS manual is direct about it. If income exceeds the cap, the person must set up a QIT to be found eligible.

"Gross" is the key word. DFCS measures income before anything is taken out. So a parent whose take-home check looks modest can still be over the cap. The cap itself is listed in the DFCS Appendix A1 financial limits. For how DFCS counts income in general, see our guide to Georgia Medicaid income limits for home care.

Where does the Miller trust rule come from?

The rule comes from federal Medicaid law. The DFCS worksheet points to a federal law passed in October 1993. Social Security's program manual describes these trusts as composed "only of pension, Social Security, and other income." You can read its guidance on Medicaid trusts.

Georgia's version sits in Section 2407 of the DFCS Medicaid manual. It sets out the core requirements:

• The trust is for one person only, never a couple.
• It is irrevocable, which means it cannot be cancelled at will.
• It holds only the person's income.
• It must be set up in Georgia.
• When the person dies, what is left goes to the Georgia Department of Community Health (DCH), up to the amount Medicaid spent on their care.
• It cannot be backdated. It starts in the month it is completed and signed.

Who can set up a Miller trust, and who can be the trustee?

Two different roles are involved. One person creates the trust. Another person runs it.

Anyone acting for your parent must show proof of their authority, such as the power of attorney document. This is one reason families sort out powers of attorney early. If your parent can no longer sign and has no agent, a court process may be needed first.

Do you need a lawyer to set up a QIT in Georgia?

The DFCS manual says an attorney is not required to set up or certify a QIT. DFCS gives families a trustee guide, a worksheet, a DCH certification form and a template.

Still, the details matter. A trust that does not match the state template goes to DCH Legal Services for review. Form 947 is used to list each difference from the approved format. DFCS will not approve the case until DCH Legal signs off.

Many families choose an elder-law attorney for this reason. An attorney can draft the trust, coordinate it with a power of attorney, and certify it with their State Bar number.

How does a Miller trust work month to month?

Once the trust is approved, the trustee follows the same routine every month. The DFCS trustee guide (Form 945) and Section 2407 describe it.

1. 1

   Income arrives

   Social Security, pensions and other income land in your parent's own bank account as usual.

2. 2

   Move income into the QIT

   Early in the month, transfer at least the required amount into the QIT account. Many families move all of it.

3. 3

   Pay the cost share

   The trustee pays your parent's monthly cost share or patient liability, if DFCS set one.

4. 4

   Make other allowed payments

   These include a personal needs allowance, money for a spouse or dependent, and certain medical costs.

5. 5

   Keep the records

   Save bank statements, cancelled checks and receipts for the six-month review.

What must be deposited?

The worksheet says the minimum deposit is the amount by which your parent's total income is over the cap, using the formula on the form. DFCS recommends depositing all income instead. It is simpler, and it leaves less room for a costly mistake.

How does the money get into the trust?

Income cannot be sent straight from Social Security or a pension into the QIT. Section 2407 says it must first land somewhere else and then be moved. Form 945 allows a monthly check from your parent's account, or an automatic transfer if both accounts are at the same bank. Anyone can make a deposit. Only the trustee can take money out.

What can the trust pay for?

Required payments come first, and they must be made by the end of the month after the income came in. Form 946 lists the allowed uses:

• The patient liability or EDWP cost share
• A personal needs allowance
• Money diverted to a spouse or dependent family member
• Unreimbursed medical expenses
• Bank fees for the QIT account

Section 2407 gives examples of payments that are not allowed, such as attorney fees, mortgage payments and business costs. A wrong payment can make the trust invalid.

How do you set up the QIT bank account?

Form 945 asks for a checking account titled as a Qualified Income Trust. The trustee should be the only signer, and the checks should carry the same title. The bank may ask for a tax ID number for the trust.

• Use an account just for the QIT. Do not mix in anyone else's money.
• Choose an account with no interest and no fees, if the bank offers one.
• Do not get a debit card or credit card on the account.
• Keep every statement. A successor trustee will need them too.

The guide also says it gives no tax help. The trustee should speak with a tax professional at year end about reporting.

What mistakes can cost a month of coverage?

Most QIT problems are timing problems. The worksheet says eligibility begins only in the first month the trust is properly funded. A missed or late deposit makes your loved one ineligible for that month.

DFCS reviews the trust every six months. The trustee shows proof of monthly deposits, bank statements and cancelled checks. The DFCS QIT checklist (Form 949) shows what caseworkers look for.

What happens to the money in a Miller trust when the person dies?

The trust ends when the person dies. Form 945 says the trustee stops deposits and writes no more checks. The trustee sends the remaining balance to DCH, with a bank statement and a cover letter naming the person.

The state is repaid first, up to the total Medicaid benefits paid. Anything left goes to the remainder beneficiaries named in the trust. A trustee who needs to step down earlier must give written notice and follow the DCH steps for appointing a new trustee.

How A1-GA Healthcare Agency helps

A1-GA Healthcare Agency is a Georgia DCH-approved Medicaid home care provider in Norcross, serving metro Atlanta. We have provided in-home care since 2008 and staffed caregivers since 2004. Once your loved one is approved, they can choose us for EDWP services such as in-home personal support and respite.

We do not set up trusts or give legal advice. We can explain how the QIT step fits into the EDWP process, so you know what to ask DFCS and your attorney. New to the waiver? Read what EDWP is and how it works.

• Phone: 678-446-1832
• Hours: Monday to Friday, 8am to 6pm
• Email: [email protected]
• Office: 4505 Peachtree Industrial Blvd, Suite K, Norcross, GA 30092
• Quick check: fill in our eligibility form or visit our eligibility page