In Florida, which is an “income cap” state, eligibility for Medicaid benefits is barred if the nursing home resident’s gross income from all sources exceeds $2,094 a month (for 2012). However, if the excess income above this amount is paid into a “(d)(4)(a)” qualified income trust” (“QIT”), or “Miller” trust, any person in Florida, regardless of income level, can qualify for Medicaid benefits to pay for nursing home costs.

A QIT is a trust that is designed to allow the individual whose income is above the “income cap” to deposit all of the income in excess of the allowable limit into the trust on a monthly basis. Each month the income is then paid from the trust to the nursing home up to the nursing home’s standard rates.

If, at the death of the person who has received benefits from Medicaid, there are any funds remaining in the QIT, those funds are paid over to the State of Florida, up to the total amount of the benefits paid by Medicaid on behalf of the deceased person (“Medicaid Recovery”). If any funds remain in the QIT after the State has been reimbursed, those funds may be distributed as directed by the Medicaid recipient in the trust document.

The QIT should be established the month before the application for Medicaid benefits is filed with the Florida Department of Children and Families. All of the income for the month in which eligibility for Medicaid benefits is sought should be transferred into the QIT. For more information about qualified income trusts please click here.

How Much Income Can I Make and Still Qualify for Medicaid?

All Income Must Be Paid to the Nursing Home Except Allowable Deductions

The basic Medicaid rule for nursing home residents is that they must pay all of their income, minus certain deductions, to the nursing home. The deductions include a $35-a-month personal needs allowance, a deduction for any uncovered medical costs (including medical insurance premiums), and, in the case of a married applicant, an allowance for the spouse who continues to live at home if he or she needs income support. The income of the Medicaid benefits recipient that can be diverted to the community spouse is called the Minimum Monthly Maintenance Needs Allowance (MMMNA). For 2012, the MMMNA is $1,838 per month, up to $2,381 per month. A deduction may also be allowed for a dependent child living at home.

For Medicaid applicants who are married, the income of the community spouse (the one who is not in the skilled nursing home) is not counted in determining the Medicaid applicant’s eligibility. Only income in the applicant’s name is counted in determining his or her eligibility. Thus, even if the community spouse is still working and earning $5,000 a month, she will not have to contribute to the cost of caring for her spouse in a nursing home if he is covered by Medicaid.

In addition to meeting the requirements of the income test as set forth above, to qualify for Medicaid benefits to pay for nursing home costs, it is also necessary to meet the requirements of the“asset test,” or resources test.

If you need the assistance of an experienced elder law attorney to prepare a qualified income trust, or to help you or your family members meet the asset test to qualify someone for Medicaid benefits to pay for nursing home costs, please contact us at 904-448-1969, or by email at

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