My parent's income is too high for Medicaid. Is there anything we can do?

Being over the limit is not always the end

A lot of families stop here. A pension and a Social Security check together put the person over the Medicaid income limit, someone says ‘you make too much’, and the search ends - even though the income is nowhere near enough to pay for care.

Georgia recognizes a legal arrangement for exactly this situation. It is called a Qualified Income Trust, and almost everyone refers to it as a Miller trust, after the court case that established the idea.

What a Qualified Income Trust actually does

Each month, income above the Medicaid limit is directed into the trust instead of staying in the person’s own hands. Income held that way is treated differently when eligibility is assessed.

The money does not disappear and it does not become family money. It sits under strict rules about how it may be spent, largely toward the person’s own care costs, and there are requirements about what happens to anything left in it after the person dies. If someone describes a Miller trust as a way to keep a parent’s pension in the family, they have misunderstood it.

Used properly, it solves one specific problem: income that is over the limit but not enough to buy care privately. It does nothing about the asset test, and it does nothing about level of care.

The parts that go wrong

Three things sink these arrangements, and all three are avoidable.

Drafting. The trust document has to meet specific requirements. A generic online template is not built for Georgia Medicaid, and a trust that does not qualify simply does not work.

Funding. The right income has to actually flow into the trust, in the right months, in the right way. A trust that exists on paper but is never funded does not help anyone.

Operation. Money coming out has to be spent within the rules, month after month, and records have to be kept. This is an ongoing obligation, not a one-time filing.

This is a point to get advice

This page describes how the arrangement works. It is not legal advice, and no case management agency can give you legal advice about your parent’s finances.

An elder law attorney licensed in Georgia is the right professional here. Ask specifically whether they handle Qualified Income Trusts for Medicaid waiver applicants, ask what they charge, and ask who will be responsible for operating the trust each month once it exists.

Your Area Agency on Aging can also tell you how these trusts are handled locally and can point you toward legal assistance resources for older adults. Ask them the question directly - they hear it constantly.

Do not put the rest of the process on hold

The medical and financial sides of waiver eligibility run separately. The level-of-care assessment does not wait for the income question to be settled, and holding off on the Area Agency on Aging call until the trust is sorted usually just adds months to a timeline that is already two to six months long.

Make the call. Say plainly that income looks like it may be over the limit and that you are getting advice about it. Then keep both tracks moving at once.

Before you assume you are over

Confirm the number. The income limit is tied to a federal benefit rate that is updated every year, and the figure that put your parent out of range in a previous year may not be the figure that applies now. How the limits are structured and who to ask is set out on its own page.