Ohio Miller Trust: Setup, Funding, and Allowed Spending

A Miller Trust in Ohio, formally a Qualified Income Trust (QIT), is an irrevocable account that holds the portion of your monthly income above Ohio’s Medicaid long-term care income cap so you can still qualify for coverage. In 2026, that cap is $2,982 per month.¹² If your gross income is even a dollar over that number, you need a QIT or your application will be denied, regardless of how much your care costs.

Why Ohio’s Income Cap Makes a Trust Necessary

Ohio uses a hard income ceiling, called the Special Income Level, to decide who qualifies for Medicaid-funded long-term care. The number Ohio counts is your total gross monthly income before taxes, Medicare premiums, or any other deductions. Social Security, pensions, annuities, rental income, and any other recurring payments all count.¹

The math creates a painful gap. Someone receiving $3,100 a month earns too much for Medicaid but falls far short of a nursing facility bill that can run $8,000 or more per month. A Miller Trust closes that gap by redirecting the excess into a compliant account, so the income no longer counts against you for eligibility.

Income is only one piece of the puzzle. Ohio also imposes a resource limit (currently $2,000 for a single applicant) that covers assets like bank accounts and investments. A QIT solves the income problem and does nothing for excess resources.

What the Trust Document Must Say

Ohio Administrative Code 5160:1-6-03.2 spells out every element a valid Qualified Income Trust must contain. Miss any of them and the application can be denied.³

The trust must be irrevocable. Once signed, it cannot be changed or canceled.
Only the individual’s income can be deposited. No savings, real estate proceeds, gifts, or other resources. The one exception is interest the account itself earns.
The Ohio Department of Medicaid must be named as remainder beneficiary. When the primary beneficiary dies, the state receives whatever remains in the trust, up to the total Medicaid benefits paid on that person’s behalf.
The trustee cannot repay other creditors ahead of the state’s claim when the trust terminates.

Depositing anything other than the individual’s income is the single most common mistake, and it will disqualify the whole arrangement. If you sell a car or receive an inheritance, that money cannot touch the QIT account.

Setting Up an Ohio QIT

Drafting the Trust

Before drafting, gather the full legal name and address of the person the trust will benefit (Ohio calls them the “primary beneficiary”), the name and contact information of the trustee who will manage the account, and documentation of every income source. Recent Social Security benefit verification letters, pension statements, and any other proof of monthly income let the trust accurately reflect what will be deposited.

The Ohio Department of Medicaid publishes a standardized QIT template that already contains the required legal language.⁴ Fill in the beneficiary and trustee names, identify the bank that will hold the account, and list the income sources being deposited. An attorney can draft a custom trust, but the state template is free and already approved.

Opening the Bank Account

After the trust is signed and notarized, take it to a bank or credit union to open a dedicated account titled in the name of the Qualified Income Trust. Set it up using the Medicaid recipient’s Social Security number.⁵ Tell the bank representative it is a Medicaid-compliant income trust so the account is coded properly and kept separate from any personal accounts.

Filing With Your Medicaid Application

Submit the executed trust document, proof that the bank account exists, documentation of the required monthly deposit amount, and verification of actual deposits along with the Medicaid application.³ Ohio also uses a standardized verification form (ODM 10193) that your county caseworker may ask you to complete.⁶

Funding the Trust Each Month

Setting up the trust is the hard part. Keeping it running is mostly about discipline. Every month you receive Medicaid benefits, at least the portion of your income above $2,982 must be deposited into the QIT account.⁵ Ohio strongly prefers that income be deposited directly through automatic transfer whenever possible.³

Documentation of monthly deposits must be produced at the annual eligibility renewal or whenever the administering agency requests it. If you cannot provide it, the income that should have been placed in the QIT is treated as available to you, which can push you over the income cap and cost you Medicaid eligibility for that month. Any Medicaid payments made during a period of ineligibility are subject to recovery by the state.³ Skip a deposit or lose track of bank statements and you may owe money back.

What the Trust Can Pay For

Money in a QIT cannot sit in the account indefinitely or be spent on whatever the trustee chooses. Ohio requires distributions to follow a specific priority order, and they must be made by the last day of the calendar month in which the income was deposited.³

A monthly personal needs allowance for the beneficiary’s own spending comes first.
A maintenance allowance for a spouse or dependent family members comes next, if applicable.
Health care costs follow, including long-term care services, health insurance premiums, and other medical expenses not covered by Medicaid.
Trust administration fees of up to $15 per month can cover bank fees, attorney fees, and other running costs. If that is not enough, the trustee can request approval from the Ohio Department of Medicaid for a higher amount.

Distributions outside these authorized categories can be treated as a transfer of assets for less than fair market value, triggering a penalty period during which Medicaid will not pay for long-term care.³ In plain terms: if the trustee pays a cable bill or a credit card balance out of the QIT, that spending can cost the beneficiary months of Medicaid coverage. Letting income pile up in the account instead of distributing it carries the same risk, because excess accumulation can also be treated as an improper transfer.

Mistakes That Cost Eligibility

The rules are not complicated, but they are unforgiving. The errors that most often lead to denied applications or lost coverage:

Depositing non-income funds like a tax refund, gift, or inheritance into the QIT.
Missing a monthly deposit.
Spending trust money on non-medical expenses outside the authorized distribution categories.
Letting money accumulate in the account instead of distributing it each month.

Any one of these can trigger an eligibility review, a penalty period, or an outright denial. If you realize a mistake has been made, contact your county caseworker right away rather than waiting for the annual renewal. Catching an error early is far easier than unwinding months of improper transactions after a formal review.

What Happens When the Beneficiary Dies

The trust terminates at the primary beneficiary’s death. At that point, the Ohio Department of Medicaid has first claim on whatever remains in the account, up to the total amount of Medicaid benefits paid on the person’s behalf over their lifetime.³ The trustee cannot pay other creditors, family members, or funeral expenses from the trust before satisfying that claim.

In practice, QIT balances at death are often modest because the trust is supposed to be distributed monthly rather than accumulated. If the trustee has been depositing income without making proper distributions, a larger balance may remain, and the state will recover what it is owed. Anything left after that passes according to the trust’s terms or Ohio probate rules.

Tax Reporting

A Miller Trust is treated as a grantor trust for federal tax purposes, so the income flowing through it is reported on the beneficiary’s personal tax return. The trust can use the beneficiary’s Social Security number rather than a separate IRS Employer Identification Number, which simplifies the paperwork. Because the income appears on the individual’s Form 1040, a separate trust return (Form 1041) is generally not required. Tax situations vary, and a tax professional familiar with grantor trusts can confirm whether any additional filing applies to you.

1
Ohio Legislative Service Commission. Ohio Administrative Code 5160:1-6-03.1 – Medicaid: Financial Eligibility Using the Special Income Level
2
Social Security Administration. SSI Federal Payment Amounts
3
Ohio Legislative Service Commission. Ohio Administrative Code 5160:1-6-03.2 – Medicaid: Use of Qualified Income Trusts
4
Ohio Department of Medicaid. Qualified Income Trust Template
5
Ohio Department of Medicaid. Qualified Income Trust Information Packet
6
Ohio Department of Medicaid. Qualified Income Trust Verification