Miller Trust (QIT) Calculator 2026: Qualify for Medicaid When Your Income Is Over the Limit
The image above mirrors what the Miller Trust (QIT) Calculator does below: take monthly income, subtract the Medicaid cap, and route the excess into a qualified income trust before it counts against eligibility.
In about half the states, a single dollar of monthly income over $2,982 makes you ineligible for long-term care Medicaid — no matter how large your nursing home bill is, and no matter how little you have in the bank. The fix is not a spend-down and not a gift. It is a Miller trust (formally, a qualified income trust, or QIT): a special irrevocable trust that holds your income instead of your assets so the state stops counting it against you.
This calculator answers the two questions families actually ask. First: am I over the cap, and by how much? Second: if I set up a QIT, how much has to flow through it every month — and how much of the care cost does Medicaid pick up? Enter your income, your state’s test, and your nursing home cost below; the tool computes the monthly trust deposit and the patient-pay split instantly, using 2026 federal figures.
Miller Trust (QIT) Income Calculator — 2026
Where your income goes each month
| Flow | Amount |
|---|---|
| Income below the cap (retained by you) | $2,982 |
| Deposited into the Miller trust (QIT) | $1,218 |
| Patient pay to the facility | $3,975 |
| Medicaid pays the balance | $8,025 |
| Community spouse diversion | $0 |
| Twelve-month Medicaid cost | $96,300 |
What Is a Miller Trust (Qualified Income Trust)?
A Miller trust — called a qualified income trust (QIT) in the federal statute, 42 U.S.C. §1396p(d)(4)(B) — is an irrevocable trust that exists for one narrow purpose: to receive a Medicaid applicant's excess income so that the applicant's remaining, countable income falls under the state's income limit. The trust holds income only. It is not an asset-protection trust, it cannot hold a house or a brokerage account, and the applicant cannot be the trustee.
The name comes from a 1993 Supreme Court case, Miller v. Ibarra, which struck down Colorado's dollar-for-dollar income cap because it treated the disabled and the elderly differently from other Medicaid applicants. Rather than scrap the cap, CMS let states keep it if they allowed an income trust as the pressure valve. That is why the mechanics below are identical in every state that uses an income cap, while the paperwork and the monthly deposit limits differ from state to state.
The 2026 Medicaid Income Cap: $2,982 per Month
The cap is not a round number invented by the state. It is 300% of the federal SSI benefit rate, which the Social Security Administration set at $994 per month for 2026 (a 2.8% cost-of-living increase over 2025's $967). Three hundred percent of $994 is $2,982, and that is the gross monthly income figure an income-cap state compares your Social Security, pension, annuity, and wage income against.
| 2026 Medicaid figure | Amount | What it controls |
|---|---|---|
| SSI federal benefit rate (FBR) | $994 / month | The base number every cap is derived from |
| Special income limit (300% of FBR) | $2,982 / month | Income cap for nursing home and HCBS waiver Medicaid in income-cap states |
| MMMNA (community spouse allowance) | $2,705 – $4,066.50 / month | How much income may be diverted to a spouse who stays home |
| CSRA (community spouse resource allowance) | $32,532 – $162,660 | Assets the community spouse may keep |
| Home equity limit for eligibility | $752,000 | Maximum home equity before the house counts against you |
| Federal minimum personal needs allowance | $30 / month | Floor for the PNA used in the patient-pay calculation |
Notice what the cap does not consider: your assets, your medical bills, and the cost of your care. A person with $4,200 of monthly income, $40,000 in savings, and a $12,000 nursing home bill is over the cap and therefore ineligible in an income-cap state — even though the state itself would save money by enrolling them. The income cap is a categorical test, and the Miller trust is the only income-side cure for it.
How This Miller Trust Calculator Works
- State test — income-cap states use the hard $2,982 limit; medically-needy states use a spend-down instead, where no trust is needed.
- Gross monthly income — Social Security, pension, annuity, rental income, and wages, before any deductions.
- Nursing home cost — the private-pay monthly rate, which sets the size of the pie being split.
- Personal needs allowance — the small monthly amount the resident keeps; the federal floor is $30 and many states use $60 to $100.
- Allowable medical deductions — Medicare and supplemental premiums, and other medical costs the state lets you subtract.
- Community spouse figures — only for married applicants, where income-first rules divert part of the applicant's income to the spouse at home.
The engine is deliberately transparent. The monthly QIT deposit is simply gross income minus $2,982, floored at zero. The patient pay is gross income minus the personal needs allowance and the allowable medical deductions, capped at the facility's monthly charge. Whatever is left of the facility charge is what Medicaid pays. Every companion table on this page was generated from the same three formulas, so the numbers you see in the table match what the calculator shows at those inputs.
Which States Use the Income Cap? Miller Trust States in 2026
Roughly twenty-five states require or permit a Miller trust to cure excess income for nursing home and home- and community-based services Medicaid. Most set no ceiling on how much income may pass through the trust; a handful cap the monthly deposit. Always confirm the current rule with your state Medicaid agency before you sign anything — a few states also cap the income that can be deposited even when the trust itself is permitted.
| State | Maximum monthly deposit into the QIT |
|---|---|
| Alabama, Alaska, Arkansas, Delaware, Florida, Georgia, Idaho, Indiana, Kentucky, Mississippi, Nevada, New Jersey, New Mexico, Ohio, Oregon, South Carolina, South Dakota, Tennessee, Texas, Wyoming | No limit — all income above the cap flows through the trust |
| Oklahoma | $7,637 (July 2026 – June 2027) |
| Iowa | $12,002.50 (July 2026 – June 2027) |
| Arizona | $8,666.72 (Maricopa, Pima, Pinal counties) and $8,132.22 (all other counties) |
| Colorado | County-region limits from roughly $9,780 to $11,522 |
If your state is not on that list, do not assume you are out of the woods. Some states use the income cap but call the trust by a different name ("income-only trust," "Medicaid income pension trust," "income assignment"), and others allow an income trust voluntarily even where the state also offers a spend-down. The test-type selector in the calculator above lets you model either route.
Income Cap vs. Medically Needy: Two Routes Past the Same Problem
Every state has to answer the same question — what happens when a Medicaid applicant's income is above the eligibility limit — and there are only two answers on the menu. Pick the one your state uses, and note that the choice changes the paperwork entirely, not the underlying math.
| Feature | Income-cap state (QIT route) | Medically-needy state (spend-down route) |
|---|---|---|
| Income limit | Hard $2,982 cap — over the line is disqualifying | Lower medically-needy income level, not a hard cap |
| Fix for excess income | Irrevocable Miller trust / QIT | Monthly spend-down of medical bills |
| Need a lawyer or trustee | Yes — trust document, trustee, separate account | No trust required |
| What you can keep each month | Personal needs allowance plus allowable medical deductions | Personal needs allowance plus allowable medical deductions |
| Paperwork burden | Trust, monthly statements, annual accounting | Monthly medical-bill documentation |
| Cost to set up | Typically several hundred to a few thousand dollars in legal fees | No setup cost |
| Works for married applicants | Yes, with income-first diversion to the spouse | Yes, with the same diversion rules |
What a Qualified Income Trust Can and Cannot Hold
- Can hold: the applicant's monthly income — Social Security, pension, annuity payments, rental income, and wages, deposited every month.
- Can hold: nothing else. Not a checking account balance from before, not savings, not a house, not life insurance cash value.
- Can hold: the amount of income above the cap and enough to fund the patient's own share of the nursing home bill if the state requires it.
- Cannot do: give money to children or grandchildren, pay for a vacation, or hold a remainder for the family.
- Cannot do: be revocable, or name the applicant as trustee. The applicant may not direct distributions.
- Cannot do: survive the applicant. On death, what is left in the trust goes to the state as remainder beneficiary, up to the amount Medicaid paid.
How the Money Flows Each Month (Worked Examples)
The table below uses the calculator's own formulas with a single applicant, a $75 personal needs allowance, $150 of allowable medical deductions, and a $12,000 monthly nursing home charge. Gross income is the only thing that changes from row to row — which is exactly why the income cap matters so much.
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| Gross monthly income | Over the $2,982 cap | Monthly QIT deposit | Patient pay | Medicaid pays |
|---|---|---|---|---|
| $2,500 | Under the cap | $0 | $2,275 | $9,725 |
| $3,500 | $518 | $518 | $3,275 | $8,725 |
| $4,200 | $1,218 | $1,218 | $3,975 | $8,025 |
| $6,000 | $3,018 | $3,018 | $5,775 | $6,225 |
| $8,500 | $5,518 | $5,518 | $8,275 | $3,725 |
Read the last two columns together and the sales pitch disappears: the trust does not reduce what the resident pays toward care. The patient pay is the same with or without a Miller trust, because it is driven by income, the personal needs allowance, and medical deductions. What the trust buys is eligibility — the difference between Medicaid covering $8,025 a month and covering $0, which across twelve months is more than $96,000 of care the family never has to fund privately.
Miller Trust vs. Medicaid Compliant Annuity vs. Spend-Down
If you are married, the same income problem can be attacked from three directions, and they are not interchangeable. A QIT moves income; a Medicaid compliant annuity converts countable assets into an excluded income stream for the spouse at home; a spend-down reduces assets by paying legitimate expenses before the application date.
| Strategy | What it fixes | Best for | Irreversible? |
|---|---|---|---|
| Miller trust (QIT) | Applicant's income above the $2,982 cap | Anyone in an income-cap state who is over the cap | Yes — trust is irrevocable |
| Medicaid compliant annuity | Excess countable assets producing income for the community spouse | Married couples where the spouse at home has an income shortfall | Yes — must be irrevocable, non-assignable |
| Income spend-down | Income in medically-needy states | Applicants in states without a hard cap | No — recurs monthly |
| Asset spend-down | Countable assets above the limit | Single applicants and couples above the CSRA | No — but money is gone |
Mistakes That Get a Miller Trust Rejected
- Funding the trust late. The trust must receive income in the month it is earned, starting from the first month of Medicaid eligibility. Deposits made after the fact are usually treated as countable income again.
- Putting assets in it. A QIT holds income only. Moving savings into it converts an income problem into a transfer-penalty problem.
- Using a revocable trust. Reversible means countable. The trust document must be irrevocable and must name the state as remainder beneficiary.
- Letting the applicant act as trustee. The applicant may not control distributions, and a trust where they do is disregarded.
- Forgetting the monthly accounting. States want statements showing every deposit and every disbursement — the PNA paid to the resident, the medical deduction, and the balance sent to the facility or the state.
- Assuming the trust lowers the nursing home bill. It does not. It lowers the income count. The patient pay figure is unchanged.
- Missing the state's deposit ceiling. Oklahoma, Iowa, Arizona, and Colorado limit how much income can flow through each month; income above their ceiling needs a second strategy.
Steps to Set Up a Qualified Income Trust
- Confirm whether your state uses the income cap at all — the selector in the calculator above models both routes.
- Total your gross monthly income from every source and compare it to $2,982.
- Have an elder-law attorney draft the QIT; most states have a template but the language must match state Medicaid rules.
- Name an acceptable trustee who is not the applicant — a family member, a professional trustee, or a bank trust department.
- Open a dedicated trust checking account and have income deposited there directly, or transferred within the month received.
- Apply for Medicaid and disclose the trust on the application, attaching the document and the account statements.
- Run the monthly cycle: deposit income, pay the personal needs allowance, pay allowable medical premiums, send the rest to the facility as patient pay or to the state as share of cost.
- Keep an annual accounting and refile documentation whenever the state renews eligibility.
Why This Matters for the Rest of the Estate
Eligibility is only the first gate. The money that stays out of the trust remains part of the estate that a state may later pursue — which is why families who complete the QIT paperwork should also model the recovery exposure on the house and other probate assets, and confirm that any life insurance is payable to a named beneficiary rather than to the estate. That single designation is usually the largest single line item between a family and a recovery claim.
Key Takeaways
- The 2026 income cap is $2,982 per month — 300% of the $994 SSI federal benefit rate.
- A Miller trust holds income only and exists solely to bring countable income under that cap.
- The trust does not reduce the patient's nursing home bill; it secures eligibility, which can be worth $90,000+ a year in covered care.
- Roughly half the states use the income cap; the rest use a medically-needy spend-down where no trust is needed.
- On death, whatever remains in the QIT goes to the state as remainder beneficiary, up to what Medicaid paid.
Frequently Asked Questions
What is a Miller trust and why is it called that?
A Miller trust (qualified income trust) is an irrevocable trust that receives a Medicaid applicant's income above the state's income cap so the applicant becomes income-eligible for long-term care Medicaid. The name comes from Miller v. Ibarra, the 1993 Supreme Court case that forced states to allow an income trust as an alternative to a hard income cap.
How much income can go into a Miller trust each month?
In most income-cap states there is no ceiling — every dollar of income above $2,982 moves through the trust. Four states do cap the monthly deposit: Oklahoma ($7,637), Iowa ($12,002.50), Arizona ($8,666.72 in three counties and $8,132.22 elsewhere), and Colorado (county-region limits from about $9,780 to $11,522).
Does a Miller trust work if I am married?
Yes, and married applicants usually gain more, because income-first rules divert part of the applicant's income to the spouse at home up to the MMMNA — between $2,705 and $4,066.50 per month in 2026. The spouse's own income is counted first, and only the shortfall is diverted from the Medicaid applicant.
What happens to the money left in a Miller trust when I die?
It goes to the state as remainder beneficiary, up to the total amount Medicaid paid on the applicant's behalf. The trust cannot pass a remainder to children or grandchildren, which is the main reason a QIT is a compliance tool rather than an estate-planning tool.
Can I put assets instead of income into a qualified income trust?
No. A QIT is limited to income. Placing savings, a house, or an investment account inside it does not shelter those assets and can trigger a transfer-of-assets penalty of months or years of ineligibility.
Do all states allow Miller trusts?
No. About twenty-five states use the income cap and permit a Miller trust; the remaining states use a medically-needy spend-down instead, where no trust is needed because excess income is handled through monthly medical-bill deductions rather than a hard eligibility line.
Can I set up a Miller trust myself without a lawyer?
You can, and some states publish a fill-in-the-blank form, but the document must be irrevocable, must name the state as remainder beneficiary, and must be accepted by the state Medicaid agency as written. A drafting error typically surfaces after a denial, when the family has already spent months out of compliance, which is why most families use an elder-law attorney.
Related Tools and Resources
- Run the Medicaid spend-down calculator to see how medical bills reduce a countable-asset problem.
- Model the other half of the puzzle with the Medicaid compliant annuity calculator for the community spouse's income gap.
- Estimate what a state can take back afterwards with the Medicaid estate recovery calculator.
- Compare final-expense pricing against rising burial costs in the funeral cost inflation calculator.
- See what probate itself costs your heirs with the probate cost calculator.
- CMS spousal impoverishment standards — official 2026 MMMNA and CSRA figures.
- SSA SSI federal payment amounts for 2026 — the $994 base rate behind the $2,982 cap.
- Medicaid long-term services and supports — nursing home and waiver coverage rules.
- AM Best insurer ratings — check financial strength before funding any final-expense or annuity product.
Next Step: Protect the Money That Is Not Going to the State
A Miller trust keeps the state from disqualifying you over income. It does nothing to keep the state from reaching the assets that remain — and most families discover that the largest unprotected asset in the estate is the one nobody thought about: a life insurance policy with no named beneficiary, which falls into probate and straight into the recovery claim. Naming a beneficiary, or funding a funeral on the right policy, is usually the cheapest fix available.
Compare free life insurance quotes from 50+ carriers → and make sure the money your family keeps is money the state never touched.
