The Miller Trust…much like the Rubik’s Cube, it looks fairly simple. But there are so many ways to get it wrong! The purpose of this trust is to hold and distribute income so as to allow a Medicaid Applicant with more than the allowable amount of monthly income to qualify for benefits if he/she is otherwise eligible. We frequently see at least one way that someone has gotten one of these wrong, and it has cost them a month (or more) of Medicaid qualification.

This is the first of a three-part series discussing Miller Trusts and ways to avoid mistakes that result in denied Medicaid applications, costing your loved ones or patients time and money.

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Arkansas is an “income cap” state, which means that if an applicant’s income is in excess of this cap, they are not eligible to receive Medicaid benefits. However, Congress created the Miller Trust as a way around its own restrictive rule. A person who has income in excess of the cap simply assigns all of their monthly income to the Miller Trust. The income can be used only for certain purposes as described below.

Without a Miller Trust, if an applicant’s income exceeds the income cap, which is currently $2,199 (2015 amount) per month, the Department of Human Services (DHS) can deny the application for Medicaid – Long Term Care, which pays for nursing home costs.

The only authorized deposits to a Miller Trust account are the various sources of income of the applicant. No other money can be deposited to the account. Only income. All expenditures must be authorized by your DHS caseworker. Here are some examples:

• An amount of $40.00 per month may be taken from this account as a “Personal Needs Allowance.”
• If the Community Spouse’s income is less than $1,966.25 (2015 amount), they can retain some of their spouse’s income to bring them up to the Minimum Monthly Maintenance Needs Allowance (MMMNA).
• The Settlor’s monthly premium for Medicare Supplement Insurance.
• The Settlor’s prescription drug cost (Medicare Part D premium, co-pay or medications / you must pay the exact amount.)
• The Settlor’s Dental and/or vision plan(s) and hearing aids. (You must first present the unpaid bill to the case worker and obtain prior approval.)
• The Nursing Home must be paid the remainder of all income the Settlor receives each month.

Our next article will cover an income-based “war story” and how the problem could have been avoided.

The information provided on this blog is intended as general information only for a broad audience. It is not intended as legal advice and should not be acted upon as such. If any reader has questions or concerns about any matter mentioned herein, he/she should contact an Elder Law Attorney or other appropriate professional. If any reader has questions or suggestions about a future topic area that he/she would like to see discussed, please contact the author at