One man, $68 problem

A Florida widower collects $3,050 monthly from Social Security and pension but faces a $10,000 nursing home bill. Medicaid denies him because he's $68 over the income limit.

“His combined $3,050 in monthly income won't cover a third of the bill, yet Medicaid still denies his nursing home application.”

The income cap system

About two dozen states set Medicaid nursing home limits at 300 percent of the federal SSI rate, which equals $2,982 monthly in 2026. One dollar over means denial.

“One dollar over the threshold is a denial. Sixty eight dollars over is also a denial.”

Which states have income caps

Income cap states include Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Nevada, New Mexico, New Jersey, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, and Wyoming.

Enter the Miller Trust

A Miller Trust is an irrevocable account that holds only the applicant's income and names the state as remainder beneficiary. Medicaid ignores money flowing through it, making applicants eligible.

“The trust moved the widower's $3,050 through the one channel Medicaid was permitted to disregard.”

How the money flows

Once approved, the applicant keeps a small personal needs allowance and approved deductions like Medicare premiums. Everything else, including trust money, becomes the patient's contribution to the nursing home bill.

Common mistakes families make

Families often use regular checking accounts instead of proper trusts, miss monthly deposit deadlines, or copy another state's form. Each error can invalidate eligibility for that month.

“Families open an ordinary checking account and label it a Miller Trust.”

Three steps to get it right

First, confirm your state uses an income cap. Second, have a state-specific trust prepared before you need it. Third, set up automatic monthly deposits with records for the Medicaid office.