Miller Trust Florida: When Your Income Is “Too High” for Medicaid (But You Still Can’t Afford Care)

“I’m sorry, but your mom makes too much money to qualify for Medicaid.”

That’s the phone call no one wants to receive—especially when you’re staring at nursing home bills that exceed $13,000 a month.

Here’s the frustrating reality: many Floridians find themselves in exactly this situation. Their income is too high to qualify for Medicaid, but nowhere near high enough to actually pay for long-term care.

If this sounds familiar, a Miller Trust (also called a Qualified Income Trust) might be the solution you’ve been looking for.

What is a Miller Trust in Florida?

A Miller Trust is a special type of irrevocable trust designed specifically to help people qualify for Medicaid when their monthly income exceeds Florida’s limit.

Think of it as a legal workaround. Your income doesn’t disappear—it goes into this trust account instead of your personal account. And once it’s in the trust, Florida Medicaid no longer counts it when determining your eligibility.

The trust has strict rules about how the money can be used, but it creates a path to Medicaid coverage that wouldn’t otherwise exist.

In Florida, you’ll also hear Miller Trusts called:

• Qualified Income Trusts (QITs)
• Income Cap Trusts
• Income Diversion Trusts
• d4B Trusts

All these names refer to the same thing.

Florida’s Income Limit: The Problem Miller Trusts Solve

Florida is what’s called an “income cap state.” That means there’s a hard monthly income limit for Medicaid eligibility.

For 2026, that limit is $2,982 per month for an individual seeking nursing home care through Florida’s Institutional Care Program (ICP).

If your gross monthly income—before taxes, before Medicare premiums, before anything—is $2,902, you’re over the limit. Even by a single dollar.

It doesn’t matter that nursing homes in Florida average over $13,000 monthly. It doesn’t matter that you can’t possibly afford private pay. According to Florida’s Department of Children and Families, you make too much money.

That’s where Miller Trusts come in.

How a Miller Trust Works in Florida

Setting up a Miller Trust involves several specific steps:

1. Create the trust document. This legal document must be irrevocable (meaning you can’t change or cancel it later) and include specific language required by Florida Medicaid.

2. Open a trust bank account. This is a separate account used only for income going into the trust. Your Social Security number will be on the account, but you cannot be the trustee.

3. Name a trustee. This person manages the account and makes distributions according to the rules. It can be a family member, friend, or professional—but it cannot be you.

4. Name the State of Florida as beneficiary. When you pass away, any remaining funds go to reimburse Florida Medicaid for the care provided.

5. Deposit your excess income. Starting the month your trust is properly established, your income flows into this account instead of your personal account.

Here’s the critical part: you must deposit the entire payment from each income source. You can’t split your Social Security check between your trust account and your personal account. If Social Security is going into the trust, the whole check must be deposited.

However, you don’t necessarily need to put all your income sources into the trust—just enough to get below the income limit.

What Happens to Money in a Miller Trust?

The trustee distributes money from the Miller Trust each month in a specific order:

First: Personal Needs Allowance You receive $160 per month (Florida’s 2026 amount) for personal expenses like clothing, toiletries, or other items not covered by Medicaid.

Second: Minimum Monthly Maintenance Needs Allowance (if married) If you’re married and your spouse isn’t in a nursing home, they may receive an allowance to cover basic living expenses. In 2026, this can be up to $4,067 monthly.

Third: Your share of nursing home costs All remaining money goes toward paying your portion of the nursing home bill. This is called your “patient responsibility.”

Any leftover funds can go toward Medicare premiums or other medical expenses not covered by Medicaid.

Common Miller Trust Mistakes in Florida

Depositing resources instead of income. Only income can go into a Miller Trust. If you deposit savings or sell property and deposit the proceeds, you’ve violated the trust rules.

Splitting income sources. Remember—you must deposit the full amount from each income source you designate for the trust.

Wrong timing. The trust must be established before you apply for Medicaid. Retroactive trusts don’t work.

Using a generic template. Florida has specific requirements for Miller Trusts. A template from another state or an online form might not meet Florida’s rules.

Making yourself the trustee. You cannot manage your own Miller Trust. Period.

Late distributions. Income deposited in one month must be distributed by the end of the following month, or it’s considered an improper transfer.

What a Miller Trust Costs in Florida

Setting up a Miller Trust typically runs between $400 and $1,000, depending on whether it’s part of a broader Medicaid planning package.

Some elder law attorneys include trust setup as part of their Medicaid application services. Others charge separately.

Compare this one-time cost to what’s at stake: qualifying for Medicaid coverage versus paying $156,000+ annually for private-pay nursing home care.

Who Needs a Miller Trust in Florida?

You likely need a Miller Trust if:

• Your gross monthly income exceeds $2,901
• You need nursing home care or certain Home and Community Based Services
• You meet all other Medicaid requirements (assets, residency, citizenship)
• Your income is less than the private-pay cost of care

You probably don’t need one if:

• Your income is already below $2,901/month
• You’re applying for regular Medicaid (not long-term care)
• You have other planning options that work better for your situation

Why Professional Help Matters

Miller Trusts sound straightforward in theory. In practice, they’re full of technical requirements that must be followed exactly.

One missed detail—the wrong language in the trust document, depositing funds incorrectly, missing a distribution deadline—can invalidate the entire trust. Your loved one remains ineligible for Medicaid while nursing home bills pile up.

Florida Board Certified Elder Law Attorneys work with Miller Trusts regularly. They know exactly what Florida’s Department of Children and Families requires. They can spot problems before they happen.

More importantly, they can determine whether a Miller Trust is actually your best option—or if another strategy might work better for your specific situation.

Getting Started with Medicaid Planning in Northeast Florida

If your family is facing the “too much income for Medicaid, not enough to pay for care” problem, don’t wait.

The sooner you start planning, the more options you have. Miller Trusts need to be established before you apply for Medicaid, and the Medicaid application process takes time.

At Berg Bryant Elder Law Group, our Florida Board Certified Elder Law Attorneys have helped thousands of families in Jacksonville, Orange Park, St. Augustine, and throughout Northeast Florida access the care they need while protecting what they’ve worked a lifetime to build.

We don’t just set up trusts—we create comprehensive plans that address every aspect of your situation.

Contact us today to discuss whether a Miller Trust makes sense for your family. Let’s talk about your options and build a plan that actually works.

This article is for informational purposes only and does not constitute legal advice. Medicaid rules change frequently, and eligibility is determined on a case-by-case basis.