In Georgia, a single dollar of monthly income over the Medicaid long-term-care limit can disqualify your parent from nursing-home or waiver coverage, and a Georgia Miller Trust is the legal fix. If gross monthly income reaches $2,982 in 2026 and you need Georgia Medicaid to pay for nursing facility care or one of the state's four home- and community-based waivers (the Elderly and Disabled Waiver Program, delivered through the CCSP and SOURCE models, plus ICWP, NOW, and COMP), you almost certainly need one. Georgia is an income-cap state for institutional and waiver Medicaid: the special income limit, set at 300 percent of the Supplemental Security Income (SSI) federal benefit rate, is $2,982 per month in 2026, and for an applicant whose income is at or above that cap a Qualified Income Trust is the route to eligibility.,

Federal and Georgia Authority

The Miller Trust is a creature of federal Medicaid law, operationalized in Georgia by the Georgia Department of Community Health (DCH) and the Georgia Division of Family and Children Services (DFCS).

Federal Authority

  • 42 USC 1396p(d)(4)(B) (the Qualified Income Trust exception, added by the Omnibus Budget Reconciliation Act of 1993; income deposited into a properly structured QIT is not counted toward the Medicaid income limit; the trust is commonly called a Miller Trust after the case law that prompted the provision)
  • 42 USC 1396a(a)(10)(A)(ii)(V) (300 percent SSI special income level option for long-term care)
  • 42 USC 1396a(a)(10)(C) (medically-needy option; Georgia uses a separate Aged, Blind and Disabled Medically Needy class for non-institutional ABD spend-down)
  • 42 USC 1396p(d)(4)(B)(iii) (state-payback requirement)
  • 42 USC 1396r-5 (spousal impoverishment, which interacts with Miller Trust distributions)
  • 42 CFR 435.601 (financial eligibility methodologies)

Georgia Authority

  • O.C.G.A. Title 49 Chapter 4 (Public Assistance, including Medicaid administration)
  • DCH Medicaid Policy Manuals (operational procedures for Miller Trust verification at DFCS)
  • DFCS Caseworker Manuals (specific intake procedures and trust-document review)
  • O.C.G.A. Title 53 Chapter 12 (Georgia Trust Code, governing trust formation)
  • O.C.G.A. 49-4-147.1 (Georgia estate recovery, which reaches Miller Trust residual)

When You Need a Miller Trust in Georgia

A Miller Trust is required when both of these are true:

  1. You are applying for Long-Term Care Medicaid. This means Nursing Facility (NF), the Elderly and Disabled Waiver Program (EDWP) through either of its two service-delivery models, Community Care Services Program (CCSP) or Service Options Using Resources in a Community Environment (SOURCE), the Independent Care Waiver Program (ICWP) for adults who apply between ages 21 and 64, the New Options Waiver (NOW), the Comprehensive Supports Waiver Program (COMP), or the Program of All-Inclusive Care for the Elderly (PACE). CCSP and SOURCE are delivery models inside EDWP rather than separate waivers, so Georgia runs four 1915(c) waivers in total: EDWP, ICWP, NOW, and COMP.
  2. Your gross monthly income is at or above the special income limit, which is $2,982 per month in 2026. Income exactly equal to the cap counts as over it: Georgia treats an applicant whose gross income is equal to or greater than the Medicaid CAP as income ineligible for every long-term-care class of assistance until a Qualified Income Trust is established.,

A Miller Trust is NOT required when:

  • You are applying for Aged, Blind and Disabled (ABD) Medicaid for medical coverage only (no nursing facility or waiver services), in which case the SSI-linked ABD income limit of $994 per month for an individual or $1,491 per month for a couple applies and there is no Miller Trust mechanism.
  • You are applying for MAGI-based Medicaid (children, pregnant women, parents, Pathways to Coverage), where income limits are based on Modified Adjusted Gross Income and Miller Trusts do not apply.
  • Your gross monthly income is below the special income limit of $2,982 per month, in which case you qualify directly without a trust. Note the boundary: below the cap, no trust; at the cap or above it, a trust.
  • You are applying for a Medicare Savings Program (QMB, SLMB, QI, or QDWI), which has separate income thresholds and no Miller Trust mechanism.

How the Special Income Limit Works

Georgia's institutional and waiver income cap, which the state calls the Medicaid Cap, is set at 300 percent of the SSI federal benefit rate and is adjusted annually for Social Security cost-of-living increases. For 2026, the individual special income limit is $2,982 per month, which is three times the 2026 SSI federal benefit rate of $994 per month.

Standard (2026) Individual Couple
SSI federal benefit rate (ABD income limit) $994/month $1,491/month
Special income limit (300% SSI, institutional/waiver) $2,982/month $5,964/month

All of the applicant's countable income, not just the excess, is generally routed through the trust to satisfy DFCS verification procedures.

What Income Goes Through the Trust

Only income belonging to the applicant can be deposited into the Miller Trust. Assets cannot.

Income that CAN be funneled

  • Social Security retirement and disability (RIB, DIB, survivor benefits)
  • Pensions (private employer, federal civil service, state retirement)
  • VA benefits (compensation, pension, Aid and Attendance)
  • Retirement account distributions (IRA, 401(k), 403(b), TSP, with RMDs in pay status)
  • Annuity payments (immediate annuity income; deferred annuities can be problematic)
  • Alimony (court-ordered, paid to applicant)
  • Rental income (from real property owned by applicant)
  • Royalties and trust distributions (from prior trusts naming applicant as beneficiary)

Income that CANNOT be funneled

  • Earned wages (W-2 income from active employment generally cannot be diverted because the employer reports the income to the applicant directly; Miller Trust applicability to wages is complex and rarely successful)
  • Assets (cash savings, bank balances, certificates of deposit; these are resources, not income)
  • Spouse's income (the community spouse's income belongs to the community spouse, not the applicant)
  • One-time gifts or windfalls (these are resources in the month received)
  • Tax refunds (treated as resources)

The Monthly Mechanics

The Miller Trust operates on a strict monthly cycle.

1
Step 1

Deposit gross income

Each month, the applicant's gross income (or as much as is necessary to bring countable income below the special income limit) is deposited into the trust's dedicated bank account. The deposit must occur in the same calendar month the income is received.

2
Step 2

Make the permitted distributions

From the trust account, the trustee pays out, in order: the personal needs allowance (PNA) of $70 per month for Georgia nursing-facility and institutionalized-hospice residents (a separate $90 PNA applies to a VA pensioner or surviving spouse in a nursing home who has no dependents; one who has dependents gets the same $70). The $70 figure is the nursing-facility allowance and does not carry over to waiver participants living at home: all four of Georgia's 1915(c) waivers run post-eligibility treatment of income under 42 CFR 435.726, and the maintenance amount a waiver participant keeps is set by DCH policy and the care plan, so ask your case manager for the figure that applies to you; then; health insurance premiums, including the Medicare Part B premium of $202.90 per month in 2026, plus Medicare Part D, Medigap, dental, and vision; the Community Spouse Monthly Income Allowance (CSMIA), when the community spouse's own income is below the MMMNA, up to the 2026 maximum MMMNA of $4,066.50 per month; a permitted dependents' allowance for minor children or other qualifying dependents at home, calculated under 42 USC 1396r-5(d); the nursing-home patient liability or waiver cost share (the remaining amount, sometimes called the "patient pay amount" or "client cost share"); and reasonable trust administrative expenses such as bank and trustee fees, if the trust document permits them.

3
Step 3

Let the residual accumulate

Any balance remaining in the trust at month-end accumulates. The accumulated balance is part of the residual that, on the beneficiary's death, is paid first to the State of Georgia up to total Medicaid benefits paid.

Worked Examples

Example 1: Single Applicant, NF Care, Over-SIL

Facts: Mr. Jefferson, 78, enters a Georgia nursing facility. His monthly gross income is $3,400 (Social Security $1,800 plus a private pension $1,600). The 2026 special income limit is $2,982 per month, so he is over by $418. Without a Miller Trust, Mr. Jefferson is denied because his $3,400 income exceeds the cap. The figures below use the 2026 Georgia nursing-facility PNA of $70 and the 2026 Medicare Part B premium of $202.90; the Medigap premium shown is illustrative.,

Setup: Mr. Jefferson's adult daughter is appointed trustee. An elder-law attorney drafts a Miller Trust naming the State of Georgia as primary residual beneficiary. A separate bank account is opened in the name "Jefferson Miller Trust." Social Security and the pension provider redirect deposits to the trust account.

Monthly flow:

Item Amount
Gross income deposited $3,400.00
PNA to Mr. Jefferson $70.00
Medicare Part B premium $202.90
Medigap premium $145.00
Patient liability to facility $2,982.10
Total distributed $3,400.00

Mr. Jefferson qualifies. Medicaid pays the facility's rate minus the $2,982.10 patient liability shown above, which is the income left after his $70 personal needs allowance and premiums.

Example 2: Married Couple, Institutionalized Spouse Over-SIL, Community Spouse Below MMMNA

Facts: Mr. King, 82, enters a nursing facility. His income is $4,200 per month (Social Security $2,200 plus a federal pension $2,000). Mrs. King, 79, lives at home; her income is $1,400 per month (Social Security only). The 2026 special income limit is $2,982 per month, and the 2026 MMMNA ranges from $2,705.00 to $4,066.50 per month.,

Spousal impoverishment math: Mrs. King's income gap is $2,705.00 minus $1,400, which leaves $1,305.00 of CSMIA available from Mr. King's income (using the federal MMMNA floor of $2,705.00 in effect July 1, 2026 through June 30, 2027; Georgia may permit up to the $4,066.50 maximum with a fair hearing).

Setup: Mr. King is over the SIL, so a Miller Trust is required for him. The trust is structured to permit CSMIA distributions to Mrs. King.

Monthly flow:

Item Amount
Gross income deposited (Mr. King) $4,200.00
PNA to Mr. King $70.00
Medicare Part B premium $202.90
Medigap premium $145.00
CSMIA to Mrs. King $1,305.00
Patient liability to facility $2,477.10
Total distributed $4,200.00

Mr. King qualifies. Mrs. King's combined income, her own $1,400 plus the $1,305.00 CSMIA, totals $2,705.00, which is exactly the federal minimum MMMNA floor for July 1, 2026 through June 30, 2027.

Example 3: HCBS Waiver Applicant (CCSP), Over-SIL

Facts: Mrs. Lopez, 73, applies for the Community Care Services Program (CCSP) to remain at home. Her monthly income is $3,200 (Social Security $1,400 plus a state teacher pension $1,800). The 2026 special income limit is $2,982 per month, so she is over by $218.

Setup: Same Miller Trust structure as NF, but the distribution mechanics differ. CCSP participants typically retain a larger maintenance allowance for community living expenses (rent, utilities, food). The exact maintenance allowance and waiver cost-share calculation are set by DCH policy and the CCSP care plan.

Monthly flow (illustrative):

Item Amount
Gross income deposited $3,200.00
Maintenance allowance to Mrs. Lopez $2,800.00
Health insurance premiums $330.00
Waiver cost share $70.00
Total distributed $3,200.00

Mrs. Lopez qualifies for CCSP. Medicaid pays for CCSP services minus the waiver cost share.

Spousal Impoverishment and the Miller Trust

When the LTC applicant is married and the community spouse lives at home, federal law under 42 USC 1396r-5 protects the community spouse from impoverishment. The Miller Trust integrates with spousal impoverishment as follows:

  • Income belongs to the spouse whose name is on the check. Mrs. King's $1,400 Social Security is hers; it does not enter Mr. King's Miller Trust.
  • CSMIA flows FROM the institutionalized spouse's Miller Trust TO the community spouse. If the community spouse's own income is below the MMMNA, the institutionalized spouse may direct excess income via the Miller Trust to bring the community spouse up to (but not above) the MMMNA.
  • CSRA (Community Spouse Resource Allowance) is a separate concept. CSRA is an asset-side protection ($32,532 minimum to $162,660 maximum in 2026), not an income-side mechanism. The Miller Trust does not affect CSRA.
  • MMMNA exceptions. If the community spouse has unusually high shelter costs (rent, mortgage, utilities), the MMMNA may be raised through an Excess Shelter Allowance calculation, and the CSMIA from the Miller Trust may be correspondingly larger.

Estate Recovery and the Miller Trust Remainder

Federal law under 42 USC 1396p(b) requires every state to pursue estate recovery from the estate of a recipient who was 55 or older when they received nursing facility services, home- and community-based services, or related hospital and prescription-drug services, and from a recipient of any age who was permanently institutionalized. Recovery may proceed only after the death of a surviving spouse and only when there is no surviving child under 21 or blind or permanently and totally disabled, and every state must maintain an undue-hardship waiver process. The Miller Trust is subject to a separate, federal-statute-level payback requirement:

  • State payback first. Under 42 USC 1396p(d)(4)(B)(iii), on the death of the trust beneficiary, the State of Georgia receives all amounts remaining in the trust up to the total Medicaid benefits paid on behalf of the beneficiary. The trust must name the Georgia Department of Community Health as remainder beneficiary, and this payback is built into every compliant Miller Trust.
  • Georgia is an expanded-estate state, not a probate-only one. Much of the Georgia estate-recovery advice online says the state reaches only probate assets. It does not. Under O.C.G.A. 49-4-147.1 and the DCH rule at Ga. Comp. R. & Regs. Chapter 111-3-8, the recoverable estate is everything in the probate code plus property passing by joint tenancy, right of survivorship, life estate, trust, annuity, Individual Retirement Account, homestead, or any other arrangement. Estates worth $25,000 or less are exempt, and for members dying on or after July 1, 2018 the Commissioner waives any claim against an estate's first $25,000. See our Georgia estate recovery guide for what that reaches asset by asset.
  • Hardship waiver. Federal hardship waiver provisions under 42 USC 1396p(b)(3) and Georgia DCH policy may apply to estate recovery generally, but rarely apply to Miller Trust residual because the trust funds are dedicated to the state by federal statute.

How to Set Up a Miller Trust in Georgia

Option 1: Elder-Law Attorney

The recommended approach.

  • Cost: a flat drafting fee in most cases; ask each attorney for the fee up front, since it varies with the complexity of the income picture. Income-eligible applicants may qualify for free help through Georgia Legal Services Program.
  • Includes: a trust document tailored to Georgia DCH and DFCS verification standards, instructions to the applicant and trustee, and coordination with income sources to redirect deposits
  • Find: Georgia Chapter of the National Academy of Elder Law Attorneys (NAELA), State Bar of Georgia Lawyer Referral (1-800-330-0446), Georgia Legal Services Program (1-833-457-7529) for income-eligible applicants

Option 2: DIY Templates

Higher risk; not recommended without legal review.

  • Pre-printed Miller Trust templates exist online and in self-help books
  • Risk: each county DFCS office may interpret trust language differently; minor drafting defects (missing state-payback clause, ambiguous trustee powers, unclear distribution priorities) can cause denial
  • If you go this route, have the draft reviewed by an attorney before signing; a limited review costs far less than full drafting

Setup Checklist

1
Step 1

Draft the trust document

It must be irrevocable, name the Georgia Department of Community Health as remainder beneficiary up to the amount Medicaid pays, identify a trustee, and list permitted distributions.

2
Step 2

Identify a trustee

Often an adult child, sometimes the elder-law attorney, sometimes a corporate trustee, but never the applicant as sole trustee.

3
Step 3

Apply for an EIN

Get a separate Employer Identification Number (EIN) for the trust through the IRS.

4
Step 4

Open a dedicated bank account

Open the account in the name of the trust, using the EIN.

5
Step 5

Redirect income sources

Point Social Security (file Form SSA-1696 or update direct deposit), the pension provider, the VA, and any retirement-plan administrator to the trust account.

6
Step 6

Submit to DFCS

File the trust document, EIN letter, and bank-account verification with DFCS as part of the Medicaid application.

7
Step 7

Operate the monthly cycle

Run the deposit-and-distribution cycle from month one and document every transaction.

Common Mistakes That Cause Miller Trusts to Fail

  1. Trust is revocable. Georgia treats a revocable QIT as a countable resource, so the trust must be irrevocable.
  2. State of Georgia is not named as remainder beneficiary. Without a clause naming the Georgia Department of Community Health, the trust is not a 42 USC 1396p(d)(4)(B) trust.
  3. Applicant is sole trustee. This creates a conflict; an independent trustee is required.
  4. Single bank account for trust and personal funds. The trust must have its own dedicated account.
  5. Trust funded with assets, not just income. Assets cannot be funneled through a Miller Trust; doing so jeopardizes the trust's qualified status.
  6. Income deposited late or in the wrong month. The monthly cycle must be strict, and the trust must be funded and operational by the eligibility date.
  7. No documentation of monthly transactions. DFCS auditors want bank statements showing deposits and distributions outside the permitted categories.
  8. Believing the Miller Trust shelters assets, or trying to use it for ABD-only coverage. It handles income only and applies only to long-term-care pathways.
  9. Not coordinating with Social Security to redirect deposits. Failure to redirect cleanly causes income to land in the applicant's personal account, defeating the trust.

How to Verify the Numbers

  • Special income limit ($2,982 per month in 2026): Georgia DFCS Medicaid Manual (PAMMS), or call DCH at 1-877-423-4746,
  • SSI federal benefit rate ($994 per month in 2026): Social Security Administration
  • MMMNA range ($2,705.00 to $4,066.50 per month in 2026): CMS State Medicaid Manual, also published annually by the federal Department of Health and Human Services
  • Personal needs allowance ($70 per month, Georgia nursing facility): Georgia DFCS Medicaid Manual (PAMMS) Appendix A1; verify with DFCS at 1-877-423-4746,
  • Estate-recovery scope: O.C.G.A. 49-4-147.1

FAQ

Do I need a Miller Trust if my income is below $2,982?

No. Below the Special Income Limit you qualify for LTC Medicaid directly. Watch the boundary, though: at $2,981 you need no trust; at $2,982 you do, because Georgia's rule applies to income equal to or greater than the Medicaid CAP. If you are unsure, contact DFCS at 1-877-423-4746.

Is a Miller Trust the same as a Qualified Income Trust (QIT)?

Yes. "Miller Trust" is the common name and "Qualified Income Trust" or "QIT" the technical legal one; the terms are interchangeable. The federal statute at 42 USC 1396p(d)(4)(B) uses "qualified income trust."

What happens to the money in the trust when I die?

The accumulated balance is paid first to the State of Georgia up to the total Medicaid benefits Georgia paid on your behalf (42 USC 1396p(d)(4)(B)(iii)). Any balance remaining after the state is paid in full passes to your named beneficiaries.

Can my spouse use a Miller Trust to receive income from me?

The Miller Trust belongs to you, the institutionalized spouse; your community spouse does not need one of their own. If their own income is below the Minimum Monthly Maintenance Needs Allowance, you can direct a Community Spouse Monthly Income Allowance (CSMIA) from your trust to bring their income up to the MMMNA floor.

Can I use a medically-needy spend-down instead of a Miller Trust?

Not for long-term-care eligibility. Georgia does operate an Aged, Blind and Disabled Medically Needy class of assistance, a spend-down pathway for ABD applicants whose income or resources exceed the limits for other ABD categories. That pathway, however, does not lift Georgia's institutional and waiver income cap, so an over-cap applicant who needs nursing-facility or waiver Medicaid still uses a Qualified Income Trust. If your income is over the cap and you need long-term-care coverage, the Miller Trust is the operational path.

What if my Miller Trust application is denied?

If DFCS denies your LTC Medicaid application because of a defect in the Miller Trust, you can request a State Hearing, which the agency transmits to the Office of State Administrative Hearings (OSAH). Georgia policy directs that a hearing on an eligibility decision be requested within 30 days of the notice. Federal law at 42 CFR 431.221(d) caps a state's request window at 90 days from the mailing date, but that 90 days is a ceiling on what a state may allow, not a floor you are guaranteed, and Georgia's window is the shorter one. Do not assume 90 days: the deadline that governs you is the one printed on your own notice of action. Common fixes (revising the trust document, providing additional verification, cleaning up the bank account structure) can often resolve the deficiency through the hearing process or before the hearing through informal review with DFCS. For appeal help, contact Georgia Legal Services Program at 1-833-457-7529 or an elder-law attorney.

Key Phone Numbers and Resources

Georgia Medicaid (DCH) Member Services and DFCS application intake for Medicaid, including long-term care. 1-866-211-0950https://www.gabar.org/about-the-bar/contact-us
DFCS Application Hotline Apply for nursing-facility or waiver Medicaid and ask about Miller Trust verification. 1-877-423-4746https://dhs.georgia.gov/contact
Office of State Administrative Hearings (OSAH) Request a State Hearing if a Miller Trust defect causes a Medicaid denial. 1-404-651-7500
Empowerline (Area Agencies on Aging) Intake for the CCSP and SOURCE home- and community-based waivers. 1-404-463-3333
Georgia Legal Services Program Free help drafting or reviewing a Miller Trust for income-eligible applicants. 1-833-457-7529https://dhs.georgia.gov/contact glsp.org
Atlanta Legal Aid Free legal help with Miller Trusts and Medicaid appeals for income-eligible applicants. 1-404-524-5811 atlantalegalaid.org
Georgia Senior Legal Hotline Free legal advice for Georgians age 60 and older. 1-888-257-9519
State Bar of Georgia Lawyer Referral Referrals to a Georgia elder-law attorney who drafts Qualified Income Trusts. 1-800-330-0446
Social Security Administration Redirect Social Security deposits to the trust account (Form SSA-1696 or direct-deposit change). 1-800-772-1213https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare
GeorgiaCares (SHIP) Free counseling on Medicare Part B, Part D, and Medigap premiums paid from the trust. 1-866-552-4464https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship aging.georgia.gov/georgia-ship
IRS Apply for the trust's Employer Identification Number (EIN). 1-800-829-4933 irs.gov

Learn More

MedicaidGeorgia Medicaid Programs OverviewGeorgia Medicaid 2026: income and asset limits, the EDWP waiver (CCSP and SOURCE), Pathways to Coverage, Miller Trusts, estate recovery, and how to apply. MedicaidGeorgia Medicaid Eligibility & Income LimitsGeorgia Medicaid income limits in 2026: the $994 ABD limit, $2,982 long-term-care cap, $2,000 asset limit, Miller Trust, CSRA, and Pathways to Coverage. MedicaidGeorgia Medicaid Asset Spend-Down StrategiesGeorgia Medicaid asset spend-down strategies for 2026: the $2,000 asset limit, exempt assets, Miller Trusts, and how to qualify without losing everything. MedicaidGeorgia Medicaid Asset Transfer PenaltyHow the Georgia Medicaid transfer penalty and 60-month look-back work in 2026: the penalty divisor, exempt transfers, and how to cure a penalty. MedicaidGeorgia Medicaid Long-Term CareGeorgia Medicaid long-term care in 2026: nursing facility coverage, four HCBS waivers (EDWP with CCSP and SOURCE, ICWP, NOW, COMP), PACE, and how to apply. MedicaidHow to Apply for Georgia MedicaidHow to apply for Georgia Medicaid in 2026: Georgia Gateway, your local DFCS office, Form 700, the documents you need, processing timelines, and how to appeal.
Your next step If your parent's income is at or above $2,982 a month and they need Georgia nursing-facility or waiver Medicaid, call the Georgia Legal Services Program at 1-833-457-7529 or a Georgia elder-law attorney to draft a Qualified Income Trust before you apply.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.