Medicaid has two hurdles: Asset limits (e.g., $2,000 for individuals in Ohio) and Income limits (e.g., $2,829/month in 2026 for Ohio). Assets in a proper MAPT aren't countable after the lookback, but high income (from pensions, Social Security, or trust distributions) could still disqualify you in "income-cap" states like Ohio (about half the U.S.).
There is an inexpensive (less than $1000.00) solution in that case. Enter the Qualified Income Trust (QIT), aka Miller Trust: It's a simple, irrevocable "bucket" where you deposit excess monthly income. Here is how it works:
- Income Segregation: The deposited amount isn't "counted" toward your Medicaid income limit; it's like setting it aside. Your "official" income drops below the cap, qualifying you.
- Allowed Uses: QIT funds can pay for your care (e.g., nursing home co-pays), medical bills, or other needs. It's not "hidden"; it's used for you, but structured to comply.
- Payback Rule: After your death, remaining funds reimburse the state for Medicaid costs (like a lien).
- Example: The income limit is $2,829/month; you get $3,829. Deposit $1,001 or more into QIT. Your "countable income" is now $2,828, so you qualify. The trustee of the QIT pays some bills such as your Personal Needs Allowance (PNA) (a small monthly amount to pay personal expenses), health insurance premiums (e.g., Medicare Part B or supplemental insurance), a spousal allowance if a spouse is living at home), and your share of the nursing home or care costs; Medicaid covers the rest. At death, the Trustee pays any funds toward your burial expenses, and the surplus, if any, is paid to the state.
Even "significant" income (e.g., $10,000/month) won't disqualify an applicant if funneled through a QIT; it's a federal requirement in income-cap states. In non-cap states (e.g., New York), excess income just means higher co-pays, no QIT needed.
Important Reminder About Your General Durable Power of Attorney (GDPOA)
Don't overlook this: If you become incapacitated, your agent (under your GDPOA) must handle Medicaid planning. A generic "power to settle trusts" isn't enough—it could be too vague for courts or banks. Explicitly include:
- Specific Authority to create/fund a QIT for income management.
- Power to establish an irrevocable trust (like a MAPT) specifically for Medicaid/asset protection.
