*** Updated 2018 ***

The Miller Trust… much like the Rubik’s Cube, looks fairly simple at first glance. But there are so many ways to get it wrong! The purpose of this trust is to hold and distribute income for those over the income limit. It allows 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 people not getting it right. 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. Ignoring this could cost you or your Loved One time and money.

Part 2 – Income Requirements
Part 3 – Restrictions

Income Cap

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. Then they use the income for certain purposes as described below.

Without a Miller Trust, an applicant’s income can not exceed the income cap, which is currently $2,205 (2018 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. There’ll be no depositing of other money to the account. Only income.

All expenditures need authorization from your DHS caseworker. Here are some examples:

• Taking an amount of $40.00 every month from this account as a “Personal Needs Allowance.”
• If the Community Spouse’s income is less than $2,030 (2018 amount). They can retain some of their spouse’s income to bring them up to the Minimum Monthly Maintenance Needs Allowance (MMMNA).
• Monthly premium of the Settlor’s 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 Dental and/or vision plan(s) and hearing aids of the Settlor’s. (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 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.