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Last column I explained that a senior seeking Medicaid assistance for long-term care cannot have a monthly income over a certain amount ($2523 in 2023) to qualify. However, there are different ways in which the applicant’s income can be calculated.

What if the applicant’s income is over the permitted limit, regardless of how that income is calculated? If there is no other realistic option for long-term care assistance, what is that person to do?

If income is the only obstacle, there is a way to qualify for Medicaid assistance. It is called a “Miller” trust, named after the Court case that approved this approach.

Previously, I have explained that a trust functions much like a wagon. If you place your things in a wagon, those things remain yours even if someone else pulls the wagon.

In the case of a Miller trust, a spouse or other trusted relative pulls the wagon (i.e., serves as the trustee). That person opens an account in the name of the trust, and your income is deposited into that account. The money in that account (including the “excess” income) is used to pay for your care. A Miller trust is a way in which the government can ensure your money is used for one purpose . . . to pay for as much of your care as possible. If there is additional cost, Medicaid will provide this.

A Miller trust can be an extremely effective tool. For example, if you have $2500 in monthly income, but a health need that would otherwise cost you $5000 a month for treatment, a “Miller” trust can help ensure you are not left without a way to receive care.

By using a “Miller” trust, excess income will not disqualify you from Medicaid assistance. At the same time, a “Miller” trust ensures your income is used to pay as much of the cost of care as possible, while Medicaid pays the remainder. Next column, I will begin addressing the remaining requirement to qualify for Medicaid assistance; the assets a person may have and still qualify.