What Is a Qualified Income Trust (Miller Trust) in Texas?

Last updated: August 11, 2026

If you or a family member is applying for Texas Medicaid long-term care benefits and your income is too high to qualify, a Qualified Income Trust — commonly called a "Miller Trust" — is usually the tool that fixes that specific problem.

The problem it solves

Texas Medicaid long-term care programs have an income cap. If your gross monthly income (Social Security, pensions, annuities, etc.) exceeds that cap, you're technically over the limit even if that income isn't nearly enough to actually cover the cost of care — Medicaid doesn't look at whether the income is enough, just whether it's over the line.

How a QIT fixes it

A QIT is an irrevocable trust that your income (or a portion of it) gets deposited into each month, instead of directly into your personal account. Because that income now legally belongs to the trust rather than to you personally, it's no longer counted against the Medicaid income cap — even though the money still ultimately goes toward your care costs, following strict rules about what the trust funds can be used for.

What actually goes into the trust

Only income — Social Security, pensions, annuity payments, and similar recurring income sources. It does not hold other assets like the home, bank accounts, or investments; Medicaid's separate asset limit rules handle those.

Does a QIT guarantee Medicaid eligibility?

No — and this is the most common misconception. A QIT addresses the income test specifically. You still have to separately meet Medicaid's asset limits, medical necessity requirements, and every other eligibility rule under current Texas HHSC guidelines. The QIT is one piece of a larger eligibility picture, not a standalone solution.

What happens to the trust after death

Texas HHSC is generally entitled to reimbursement from whatever remains in the QIT at death, up to the amount Medicaid paid for care, before any remainder goes to beneficiaries. This is standard for QITs and not something you can plan around — it's part of how the trust structure is allowed to work at all.

This is general information, not legal advice. QIT rules — including exactly which accounts HHSC currently expects and how the trust should be structured — depend on current Texas HHSC administrative rules, which change. Have your specific situation reviewed before relying on this for an actual Medicaid application.