The Texas Miller Trust (Qualified Income Trust), explained

Here is a situation that catches Texas families off guard. A parent needs nursing home care, has almost no savings, and clearly cannot afford the roughly $9,600 a month a nursing home costs. The family applies for Medicaid, feeling certain they qualify. Then the application is denied, for one reason: the parent's monthly income is a few dollars over the limit.

It feels absurd. A pension and a Social Security check that add up to $3,100 a month do not come close to covering care, yet they put the parent over the Medicaid income cap. The good news is that Texas has a clean, legal fix for exactly this problem. It is called a Qualified Income Trust, and almost everyone calls it a Miller Trust.

This guide explains what it does, what it does not do, and how to set one up. It is educational information, not legal advice. Miller Trusts are technical, and a wording or funding error can undo them, so this is a job for a Texas elder law attorney.

Why income can block Medicaid even when a family is broke

Texas Medicaid for long-term care has an income test. In 2026, a single applicant's countable monthly income must be under $2,982. Texas is what is known as an income-cap state, which means that being even one dollar over the limit disqualifies the applicant. There is no partial credit and no spend-down of excess income the way some other states allow.

That creates the trap. Care costs far more than the income limit, but the income limit is well below the cost of care. A parent can be genuinely unable to pay and still be told they earn too much. Without a tool to fix it, the family is stuck paying privately.

What a Miller Trust actually does

A Qualified Income Trust is a special bank account, governed by a short legal document, that holds the income which puts your parent over the limit. Income that goes into a properly built Miller Trust does not count toward the Medicaid income cap. That is the entire trick. The trust does not make the money disappear or protect it for the family. It changes how one specific rule counts it.

Each month, the income is deposited into the trust and then paid out under strict rules: a small personal needs allowance for your parent, a possible allowance for a spouse still at home, any health insurance premiums, and then the rest to the nursing home toward the cost of care. When your parent dies, whatever tiny balance remains goes to the State of Texas, up to the amount Medicaid paid. That state payback requirement is not optional. A trust that leaves it out will be rejected.

So the money still leaves the account every month and still goes toward care. The family does not keep it. What the trust buys is eligibility, which unlocks Medicaid paying the large balance of the bill.

What a Miller Trust does not do

This is where families get the wrong idea, so it is worth being blunt. A Miller Trust:

• Does not shelter or save your parent's income for heirs.
• Does not protect assets or savings. It only deals with income. Assets are handled by separate rules, and the countable asset limit is still $2,000 for a single applicant.
• Does not reduce what your parent owes toward care. Almost all of the income still goes to the nursing home.
• Does not help with the five-year look-back on gifts. That is a different rule entirely.

If someone tells you a Miller Trust will let your family keep the pension, they are describing something else, or they are wrong.

How to set one up, and get it right

1. Confirm it is needed. Add up your parent's gross monthly income. If it is under $2,982, you likely do not need a Miller Trust at all. If it is over, a trust is the standard path.
2. Have it drafted correctly. The document must be irrevocable, hold only income, and name Texas as the remainder beneficiary for Medicaid payback. A Texas elder law attorney does this routinely and inexpensively relative to the cost of care.
3. Open the trust bank account and set up the income to flow into it. The account is usually a plain checking account titled in the name of the trust.
4. Fund it every single month. This is the step families miss. The income has to actually pass through the trust each month, not just on paper. Missing a month can break eligibility for that month, leaving a gap where Medicaid will not pay.
5. Pay out under the rules each month: personal needs allowance, allowable premiums, spousal allowance if any, then the remainder to the facility.

Where it fits in the bigger picture

The Miller Trust solves the income test. It does nothing for the asset test or for protecting the home, which are separate problems with their own tools. If your parent is over the income limit, there is a good chance the family also has questions about savings, the house, and gifts. Handle them together. Our guide on how to pay for a nursing home in Texas covers the income, asset, and look-back tests as one picture, and our Texas Care Funding Playbook walks through the whole process step by step.

What to do this week

1. Total your parent's gross monthly income. Pension, Social Security, annuities, everything. Compare it to the $2,982 limit.
2. If they are over, do not panic and do not start moving money. The fix is the trust, not gifting income away.
3. Call a Texas elder law attorney about a Qualified Income Trust before you file the Medicaid application, so the trust is in place and funded when coverage is supposed to start.
4. Set a monthly reminder to fund the trust once it exists. Consistency is what keeps the eligibility intact.

Being over the income limit is one of the most common reasons a clearly needy family gets a Medicaid denial in Texas, and it is also one of the most fixable. A Miller Trust is a well-worn, legal tool. Set it up correctly, fund it faithfully, and an income problem stops being the thing that stands between your parent and the care they need.