Qualified Income Trust Requirements and Administration

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If your loved one needs nursing home care in Georgia, you may have already run into a frustrating problem. Their monthly income is too high to qualify for Medicaid, but nowhere near enough to cover the full cost of a nursing home. That gap can feel impossible. A Qualified Income Trust, also known as a Miller Trust or QIT, is a legal tool that bridges exactly that gap. At Slowik Estate Planning in Atlanta, Georgia, we help families understand how these trusts work and how to set them up correctly so Medicaid benefits are protected. This page explains what a QIT is, what Georgia requires, how it is administered, and what happens when things go wrong.

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What Is a Qualified Income Trust and Why Does Georgia Require One?

Qualified Income Trusts can also be referred to as Miller Trusts, Income Trusts, Income Diversion Trusts, Income Cap Trusts, Income Only Trusts, Irrevocable Income Trusts, and d4B trusts. No matter what you call it, the purpose is the same. It is a legal structure that allows a person whose monthly income is over Georgia’s Medicaid limit to still qualify for long-term care Medicaid benefits.

Georgia is an “income cap” state for Medicaid qualification purposes. That means if your income goes over a set monthly limit, you are disqualified from receiving Medicaid, period. There is no middle ground without a QIT. In Income Cap States, the income limit for Nursing Home Medicaid and Home and Community Based Services (HCBS) Medicaid Waivers is generally 300% of the Federal Benefit Rate (FBR), which in 2026 is $2,982 per month for an individual. So if someone receives Social Security, a pension, and VA benefits that together push them over that threshold, they are stuck, unless they use a QIT.

The Qualified Income Trust resulted from the court case Miller v. Ibarra and was later codified by the Omnibus Reconciliation Act of 1992. The federal requirements outlining the structure of the Miller Trust are currently laid out in 42 U.S.C. 1396p(d)(4)(b), with each state implementing its own additional statute on the specific trust requirements, not to be more restrictive than the federal regulations. Georgia has built its own rules on top of those federal requirements, and they are strict.

Think of a QIT as a pass-through account. Each month, the income that is over the Medicaid limit is deposited into this trust account. That money is then used to help pay for medical and care-related expenses. Because the excess income is legally diverted into the trust, it is no longer counted against the applicant, allowing them to become income-eligible. This is a powerful tool, but only when it is set up and managed correctly. Working with an estate planning attorney in Atlanta who understands Georgia Medicaid rules is the best way to get this right from the start.

Georgia’s Department of Community Health (DCH) has specific requirements that every QIT must meet. If any of these requirements are not satisfied, the trust will not be recognized as a valid QIT, and the applicant’s income will still count against them for Medicaid eligibility. These are not suggestions. They are hard rules.

The trust must be established for the benefit of the applicant and must be composed only of income of the applicant, such as pension, RSDI, VA, and accumulated interest. It must be irrevocable. A revocable QIT does not meet the criteria of a QIT and will be treated as a resource. This is a critical point. Many people assume they can retain the right to change or revoke the trust. You cannot. Once you sign it, it is permanent.

The trust must contain no resources. It must also provide that at the applicant’s death, the remainder of the trust will go to the Department of Community Health (DCH), up to the amount that was spent for the applicant’s cost of care by Medicaid. The state gets paid back first. Any remaining funds after Medicaid is reimbursed may pass to named beneficiaries, but that is not guaranteed.

The QIT may not be backdated. It is effective beginning the month in which it is completed and signed by all required parties, not before. Timing matters enormously here. An applicant must establish a QIT in Georgia. A QIT established in another state cannot be used to qualify for Georgia Medicaid. Additionally, the Medicaid recipient can sign the Qualified Income Trust (or their Power of Attorney or court appointed conservator) but the Medicaid recipient may not be the trustee. A trusted family member, friend, or professional can serve as trustee, but the recipient themselves cannot hold that role. Slowik Estate Planning, located in Atlanta, Georgia, can help you identify the right trustee and draft a trust document that meets every one of these requirements.

How to Administer a QIT in Georgia Each Month

Setting up the trust is only the first step. Month-to-month administration is where many families run into trouble. The rules for how money flows in and out of the QIT are detailed, and mistakes can cost someone their Medicaid coverage. Understanding the process before you start is essential.

The income cannot be placed into the QIT by direct deposit from the source of income, such as Social Security. However, the current month’s income may be transferred from another bank account to the QIT account. That means the applicant must first receive their income in a personal account, then manually transfer it to the QIT. This requires active management every single month.

Handled properly, the Qualified Income Trust will always have a zero dollar balance at the end of each month. The only exception to this is if the bank requires a minimum balance to hold the account open. The QIT is not a savings account. Money flows in and flows out within the same month.

The only income removed from the QIT should be for payment of the patient liability to the facility, the Personal Needs Allowance (PNA), diversion to the community spouse or dependent children, medical expenses of the community spouse, or other medical expenses of the applicant not covered by Medicaid. Any other payments made from the QIT may count as income to the applicant. That could trigger a loss of eligibility. The trustee must keep careful records of every deposit and every disbursement. The Department of Community Health requires accounting every six months. The accounting must provide verification of adequate monthly deposits to the QIT and bank statements.

If you are unsure whether you are administering a QIT correctly, contact Slowik Estate Planning. Getting guidance from an Atlanta estate planning lawyer can prevent costly mistakes before they happen. Prior results in any specific case do not guarantee similar outcomes in yours, but proper legal guidance does reduce the risk of errors significantly.

What Happens When a QIT Is Mismanaged

The consequences of mismanaging a QIT in Georgia are serious. This is not a situation where you get a warning and a chance to fix things quietly. Georgia’s Medicaid program takes non-compliance seriously, and the penalties can fall on both the Medicaid recipient and the trustee.

If the trustee fails to properly handle the Qualified Income Trust, this may result in the termination of Medicaid benefits for the resident, as well as an obligation to repay the program for payments made on the resident’s behalf those months that the Qualified Income Trust was improperly managed. That means the family could be on the hook for nursing home costs that Medicaid already paid, which can add up to thousands of dollars very quickly.

Payment for the applicant’s medical care must be paid by the end of the month following the month the income is received. If payments are not made, the applicant is not following the provisions of the trust and is not eligible for Medicaid benefits. Missing even one monthly payment deadline can trigger a case closure. If payment is subsequently made prior to the expiration of the timely notice, Medicaid eligibility may continue without interruption, but that window is narrow and stressful.

Common mistakes include putting non-income assets into the QIT account, allowing the balance to carry over month to month without a valid reason, or making payments from the account for non-approved expenses. None of the trustee’s funds should be placed into the QIT account. Never put any money other than the individual’s countable income into the QIT. The trustee should never pay QIT money to himself or herself for services rendered.

A well-drafted trust document, combined with clear trustee instructions, can prevent most of these errors. Slowik Estate Planning helps trustees understand their responsibilities before they ever make their first deposit. This is also a good time to think about your broader estate plan. Proper Estate Tax Planning in Atlanta Georgia works hand-in-hand with Medicaid planning to protect your family’s financial future.

How a QIT Fits Into Your Broader Estate Plan

A Qualified Income Trust is not a standalone document. It is one piece of a larger estate planning picture. Many families come to us focused only on getting a loved one into a nursing home covered by Medicaid, but there are other important considerations that need attention at the same time.

For married couples, the QIT interacts directly with spousal impoverishment protections. Income may be diverted from the QIT or from retained income to the community spouse and/or to dependent children according to spousal impoverishment and diversion rules. In 2026, the community spouse can retain up to $162,660 of the couple’s countable assets. Understanding how these rules work together can make a significant difference in how much the healthy spouse can keep while their partner receives care.

It is also worth knowing that a QIT does not help protect assets from Medicaid’s estate recovery program. Qualified Income Trusts do not shelter money for the Medicaid recipient or their family. Upon the Medicaid recipient’s death, the state is named as the beneficiary of the Miller Trust. If there are any funds remaining in the trust account, the state will receive it as reimbursement for funds paid for the care of the Medicaid recipient. If asset protection is a goal for your family, that requires separate planning tools and separate legal strategies. Our Asset Protection Lawyer services can help you explore those options.

Georgia’s trust law, found under O.C.G.A. Title 53, Chapter 12, governs how trusts are created, administered, and terminated in this state. The Revised Georgia Trust Code of 2010 covers everything from trustee duties under Article 11 to trust administration under Article 13. These rules apply to QITs just as they do to other trust types. If you have international assets or family members living outside the United States, your QIT planning may also intersect with International Estate Planning considerations that require careful coordination. Slowik Estate Planning can help you see the full picture and make sure every piece of your plan works together. Whether you need help with wills and trusts, Medicaid planning, or a comprehensive estate plan, our Atlanta office is ready to help you take the next step.

FAQs About Qualified Income Trusts in Georgia

Who needs a Qualified Income Trust in Georgia?

You need a QIT if you are applying for Nursing Home Medicaid or an HCBS Medicaid Waiver in Georgia and your gross monthly income is over the Medicaid income cap. In 2026, that cap is $2,982 per month for an individual. If your income from Social Security, a pension, VA benefits, or other sources pushes you over that number, a QIT allows you to legally redirect that excess income so it is not counted against you for eligibility purposes. Without a QIT, Georgia will deny your Medicaid application outright because it is an income cap state.

Can the Medicaid recipient be their own trustee?

No. Georgia’s rules are clear on this point. The Medicaid recipient cannot serve as their own trustee. The trust can be signed by the recipient, their Power of Attorney, or a court-appointed conservator, but the trustee must be a separate person. That trustee is responsible for managing the trust account each month, making required payments on time, and keeping accurate records. Choosing a trustworthy and organized person for this role is one of the most important decisions in the QIT setup process.

What can QIT funds be used for?

The funds in a QIT can only be used for a narrow list of approved purposes. These include payment of the patient liability to the nursing home or care facility, the Personal Needs Allowance for the Medicaid recipient, income diversion to a community spouse or dependent children, and medical expenses not covered by Medicaid. Any payment made outside of these approved categories may be counted as income to the applicant, which could disqualify them from Medicaid. The trustee must be disciplined about following these rules every single month without exception.

What happens to money left in the QIT after the Medicaid recipient dies?

Georgia’s Department of Community Health is named as the first beneficiary of any remaining QIT funds at the time of the Medicaid recipient’s death. The state uses those remaining funds to reimburse itself for the cost of care it provided through Medicaid. Only after the state has been fully reimbursed can any leftover funds pass to other named beneficiaries. In most cases, the QIT balance is very small or zero at the time of death because the trust is designed to be emptied each month. This is why a QIT is not an asset protection tool.

Can a QIT be backdated to cover a prior month?

No. Georgia’s rules explicitly prohibit backdating a QIT. The trust is only effective starting in the month it is fully signed and completed by all required parties. This means timing is critical. If someone is already in a nursing home and their Medicaid application is pending, delays in setting up the QIT can result in gaps in coverage that are difficult or impossible to fix. The moment you realize a QIT may be needed, reaching out to an estate planning attorney right away is the right move. Slowik Estate Planning, based in Atlanta, Georgia, can help you act quickly and correctly.

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