nursing homes – Holland Elder Law

Miller Trusts Texas. What they are. How they work.

Michael L. Holland — Tue, 04 Feb 2025 16:50:35 +0000

In some states (Texas being one of them), when the income of an applicant for Medicaid exceeds the monthly limit, a special type of document is necessary to meet income eligibility rules. Known as “income cap” states, they cap monthly income to $2,901 (for 2025). In these states, if your income is more than the monthly amount Medicaid permits, special rules allow you to redirect your income to a Qualified Income Trust. Most folks know it as a “Miller Trust” (so named for the family that brought the court action that now makes the solution possible) and as a “QIT.” In Texas, this arrangement is commonly referred to as a Miller Trust Texas solution, helping applicants qualify for Medicaid despite exceeding income limits.

Why Miller Trust Texas Solutions are Needed

A Qualifying Income Trust is set up for one reason and one reason only. In it’s most basic form a person gains income eligibility by depositing specific income received into a checking account titled in the trust name.

It’s used to process the Medicaid applicant’s income so that it fits Medicaid’s income rules. The trust must follow special rules for managing the monthly income of the person seeking Medicaid’s help. The instructions contained within the document are what make up the trust. Only income may be deposited into these types of trusts. The trust bank account is prohibited from accepting anything other than income. That is why they are generically referred to as income trusts.

Regulations require depositing income into a Miller Trust checking account authorized by the trust. Rather than using an existing account, I recommend fresh bank accounts with a zero balance. You can use a current account, but it’s too risky. In my practice, I always help clients set up a new account, which is easier and safer.

Medicaid policy limits the monthly income people can receive and still get nursing home benefits. The Federal government adjusts this upper limit for inflation each year. If the applicant’s income exceeds the limit, special rules allow them to be put into a Miller Trust.

When deciding eligibility, the Medicaid agency ignores the income deposited into the Miller Trust bank account. Using this approach reduces countable income. The apparent income reduction helps the person in need of long term care meet the strict income rules.

How Income Flows Through the Trust

A qualified income trust in Texas helps people qualify for Medicaid but it doesn’t shelter income. Money deposited into trust bank account typically flows out of the trust to pay the nursing home. It’s designed to cover part of the care costs. The balance of the nursing home payment comes from Medicaid. If any money remains in the trust after death, the state keeps it to help defray their costs.

Here’s an example of how a QIT works in Texas

Let’s say your dad needs nursing home care. He gets a monthly Social Security payment of $2,950. His income exceeds the Medicaid eligibility limit of $2,901 but is not enough to pay for the care he needs. The rules say he won’t qualify for Medicaid, but the QIT provides a way.

The first step is to hire an attorney to create a Medicaid qualified income trust. You then deposit the Social Security check into the account. This drops the amount of income the state counts against his eligibility. His Social Security income will pay part of his care. Medicaid makes up the difference.

Expenses Allowed Using The Miller Trust Texas Solution.

The Medicaid agency figures out how much of the long-term care costs an individual must pay. They add up the amount of income received each month. From that, they allow payments for health insurance premiums. Examples include premiums for

Medicare Part B,
Prescription Drug plans (Medicare Part D),
Group retirement health insurance
Medicare Supplements
Vision insurance and
dental coverage.

Payment of medical expenses not otherwise covered by Medicare and Medicaid is also allowed through the trust. The trustee (the person managing the trust) cannot use trust funds for any other purpose than what Medicaid allows.

Your dad also gets to keep a $75 out of the $2,950 for his personal needs.

If an applicant has a spouse, the trust may be able to distribute part of the income to the spouse. This allotment is called the Minimum Monthly Maintenance Needs Allowance. The Spousal Income Protection rules determine the size of this monthly allowance. For 2025, the largest allocation in Texas is $3,948 per month.

Payback Provision

The trust will typically distribute all deposited funds each month to cover the items detailed above. There is little chance the balance will grow in the qualified income trust.

Typically, money flows into the trust and right back out each month. If a person dies with a balance in the Miller Trust bank account, the state can recover what it spent on the applicant’s care. After the state is repaid, the trustee can distribute the rest to beneficiaries named in the document.

Setting up and managing a Miller Trust is not a “do-it-yourself” project. The rules are too complicated.

If you set it up the wrong way, you face a real risk of losing thousands of dollars’ worth of benefits. Remember that once you lose those benefits, they are lost to you forever. If you have income that’s too high to qualify for Medicaid, a Qualifying Income Trust makes sense. But, you must execute each step the right way.

Find an experienced Miller Trust attorney to guide you. A skilled attorney will prepare the specific instructions needed for the trust. You’ll get advice on how the trust should be set up and how to fund it. It’s the best way to avoid the pitfalls and get all the benefits from qualified income trusts in Texas.

Make Sure You Get Medicaid—Call Me Today!

A Miller Trust can help you qualify for Medicaid in Texas, but setting it up the wrong way could cost you thousands in lost benefits. Don’t take that risk!

📞 Call me now at (713) 970-1300. Get your questions answered. The call is FREE!

As an elder law attorney, I will walk you through the process step by step, making sure everything is done right. Get the care you need—call today!

Texas Medicaid Nursing Home Benefits: Do You Need an Elder Care Attorney?

Michael L. Holland — Tue, 04 Feb 2025 16:50:35 +0000

Applying for Texas Medicaid nursing home benefits is complicated. Even small mistakes can lead to costly delays. Understanding income and asset limits, Medicaid rules, and how to protect your home requires careful planning.

This article explores whether you should hire an elder care attorney, how they can speed up the process, and why their guidance can help protect your assets and secure Medicaid approval faster.

Whether or not it’s advisable to hire a Houston Elder Law attorney to prepare and submit your application for Texas Medicaid nursing home benefits turns on several questions:

How complicated is the applicant’s financial picture?
How well-organized are you?
How much time do you have available?
How comfortable are you dealing with a government bureaucracy?
Can you afford to lose a month or more of eligibility if you are denied eligibility because of an error?

Medicaid offers a variety of financial support programs. The application process for non-nursing home programs is relatively simple. Most people can apply without help. Nursing home benefits are a different matter.

Nursing home Medicaid is a form of insurance for long-term care costs. Because the cost of nursing home care is so high (over $6,500 monthly in Texas), most middle-class families need this program to help cover the monthly fees. The long-term nursing home coverage application process is complex and confusing to the inexperienced. Relying on the skills of an experienced Elder Law attorney is a near necessity.

Successfully applying for Medicaid requires meeting strict guidelines on income and assets. It also requires you to understand the terminology and definitions unique to the program. Like all government agencies, the Texas Department of Health and Human Services (which runs Medicaid in Texas) has its own definitions for the terms used in its regulations.

How they define “income,” for example, differs from the definition used by the Internal Revenue Service or the Veteran’s Administration. The agency counts some forms of income when determining income eligibility. It ignores other.

For example, the “aid and attendance” income portion of a Veteran’s enhanced pension is not “countable income.” Social security, pensions, interest, dividends and IRA distributions count.

If the applicant’s countable monthly income exceeds the limit, an Elder Care attorney can draft a special document called a Qualified Income Trust. But, drafting the document is only half the battle.

You’ll also need to attach a bank account to the trust. The bank account receives the income, but not necessarily all of it. The State also has rules regarding how and when money must be deposited into the trust and how it’s paid out.

Handled improperly, Medicaid can disqualify the trust, costing a family thousands of important Medicaid dollars.

Texas also limits the amount of assets a person can keep and still qualify for benefits. As with income, certain assets are not counted. Examples include the personal residence, prearranged funeral plans and one automobile.

Yet, to exclude these items Medicaid requires other rules to be met. The Medicaid caseworker is legally required to count these otherwise excludable resources when they fail to meet all the requirements for exclusion.

How Medicaid treats a personal residence is another complicating factor. Just because the house is not counted when determining eligibility doesn’t mean it’s protected. Medicaid considers the money provided by the agency like an advance.

It’s not a gift from the government.

That means the State has a legal right to recover the amounts they’ve spent once the person passes on. Since the home is typically the largest asset a person owns when they die, you face the very real possibility of the state forcing the sale of your home get repaid for the funds used to pay for your care.

A good Elder Care attorney plays a valuable role. Hiring a Houston Elder Care attorney has several advantages:

* Expert guidance on the best way to qualify for Texas nursing home Medicaid
* How to get benefits sooner
* How to keep your share of costs as low as possible
* Experience dealing with complications as they arise
* Serving as your advocate through a challenging application process
* Protecting the family home

A drawback to hiring an attorney is the fee you’ll incur. Given the high monthly cost of Texas Nursing home care, if an attorney can speed up eligibility by as little as a month or two, you’ll generally cover the fee and then some.

For some families the peace of mind that comes from knowing the application is in capable hands is enough to justify hiring an attorney. Also keep in mind the funds used to pay the attorney would have likely been paid to the nursing home anyway.

5 Reasons to Hire a Houston Elder Law Attorney for Medicaid Planning

Michael L. Holland — Thu, 26 Oct 2023 10:50:34 +0000

There are many reasons you might be looking for an elder law attorney for medicaid planning in Houston, Texas. However, one of the most common reasons is that you or a loved one is facing the need for specialized long-term nursing home care.

Unfortunately, many families unnecessarily lose tens of thousands of dollars by opting to privately cover the cost of long-term care. Usually, they’ve been told that they’re ineligible for Medicaid, or they’re just generally misinformed about their options.

Did you know that the average cost of nursing home care in the US is $8,000 per month?

For example, if your loved one has been sent directly from a hospital to an nursing home for thereapy, there’s a good chance nobody told you that Medicare only lasts 100 days. You might be facing an $8,000 nursing home bill with less than 30-day’s notice! Many families assume they’re on their own at this point, even though Medicaid is designed to help pay nursing home costs in situations like these.

No matter what specific circumstances are causing you or your loved one to seek long-term nursing home care, here are five really good reasons to see a competent elder law attorney

Reason 1 – Nursing Homes are NOT Non-Profit Organizations

You’d be surprised how many families automatically assume that nursing homes are either non-profit or government-funded organizations. Neither is true – nursing homes are a business like any other. Their goal is to sell their service (elder care) and make a profit. They’re not in business to provide accurate legal advice or to help your family understand their options. And they’re certainly not there to save you money!

Nursing homes often make more money from their privately-funded residents than their Medicaid-funded ones. This is because nursing homes can charge you or I much more per month than they can charge the government. Strictly from a business perspective, nursing homes actually want you to pay for their services on your own.

Of course, this isn’t to say that nursing homes and their staff are trying to steal your money. Some of the kindest and most true-hearted people I’ve ever met work in nursing homes. But, their job is to provide a safe environment with good care. It isn’t to save you money.

Reason 2 – Peace of Mind

Your peace of mind is the most important benefit of hiring an elderly law attorney. A competent attorney will answer all your questions accurately and provide a clear course of action for you and your family to take. He or she will tell you exactly what to expect throughout the process of Medicaid planning and qualification, which medical expenses you should plan to cover and for how long.

Reason 3 – Save Every Possible Penny

An elder law attorney’s chief goal is to help you preserve a financial legacy for your family. You don’t have to use everything in your bank account to help pay for nursing home costs. An elder law attorney will help you understand what’s protected and what’s not. This is the key to making the most of you and your loved one’s current income and assets.

Reason 4 – You’re Ineligible for Medicaid Coverage

Or so you might think…

If you need Medicaid to help pay for nursing home costs, but you looked at the income and asset guidelines and believe you’re ineligible, think again. The Texas Medicaid program is complex. Chances are that you can qualify for financial help sooner than you think. For example, a Miller Trust can help you protect certain types of income that would otherwise go directly to the nursing home.

Whatever income and assets you have available, an elder law attorney can help you make the most of your financial resources.

Reason 5. You Need Medicaid Coverage — Fast!

The faster you need financial assistance, the more important it is that you seek the services of an experienced elder law attorney for Medicaid planning. Most of my clients approach me needing immediate help with a Medicaid-related problem. Even if you have a family member in a nursing home now, it’s not too late to get help. When it comes to Medicaid – the sooner you act the better.

Lawyers focused in elderly care law are the people who can reliably protect the maximum amount of income and assets in the shortest time possible. These are just five reasons to consider talking to an elder law attorney. This article is too short to cover all the specific circumstances that warrant contacting an elder care law firm.

📞 Call Me Now for a Free Strategy Session – Let’s Protect Your Savings!

I know how overwhelming nursing home costs and Medicaid planning can be. If you’re worried about losing your savings or being denied benefits, I can help.

📞 Call me today at (713) 970-1300 for a FREE strategy session!

Together, we’ll find the best way to qualify for Medicaid, protect your assets, and secure the care you need. Don’t wait—call now and let’s get started!

Whether your spouse, your sibling or your parent is the one in need of long-term care, you CAN get help paying nursing home costs.

Medicaid Income Cap States in 2025

Michael L. Holland — Thu, 26 Oct 2023 10:50:31 +0000

Certain states impose strict Medicaid income limits, known as “Medicaid Income Cap States.” This article explains which states have these restrictions, how Medicaid eligibility is determined, and how a Miller Trust can help applicants qualify. Learn how an elder law attorney can guide you in navigating Medicaid rules to protect your assets and secure nursing home benefits.

A number of states apply Medicaid income limits. These states are referred to as “Income Cap States. The legislature in each strictly limit the amount of income an applicant for Medicaid nursing home benefits can have and still qualify for benefits.

Medicaid Income Cap States In 2025

Alabama
Alaska
Arizona
Arkansas
Colorado
Delaware
Florida
Georgia
Idaho
Iowa
Kentucky
Louisiana
Mississippi
Nevada
New Jersey
New Mexico
Oklahoma
Oregon
South Carolina
South Dakota
Tennessee
Texas
Wyoming

Important note:

Income qualification is still possible- even if the applicant has “excess income” – by using the services of an elder law attorney. When income exceeds the annual limit in Texas, you have a simple solution. It’s a special attorney-drafted agreement known as a Miller Trust. Without a Miller Trust, state law requires the caseworker to deny the application.

Medicaid Income Limits

In most states for 2025, the income limit for a single person seeking nursing home assistance is $2,901 of “countable income”. Some states set the limit higher. In Texas, the legislature sets that limit to $2,901.

Texas Medicaid considers income as payments bestowing a benefit to a household. Medicaid rules count some income when deciding how much a person must pay for care. Policy can also exclude certain income from that calculation. Factors specific to an income source determine if it’s countable.

Is Medicaid Eligibility Based on Income or Assets?

Medicaid uses both income and the value of a Medicaid applicants’ assets to decide eligibility. You will hear attorneys, nursing home personnel and caseworker also call them “resources”, “countable assets” and “countable resources.”

Medicaid rules offer a number of exceptions to what might be considered a “countable” resource subject to spending down. In Texas, the applicant’s personal residence, an automobile, personal jewelry, clothing and furniture and fully paid funeral arrangements are not counted toward financial eligibility.

When a senior’s resources exceed the Medicaid eligibility limit, the applicant (and spouse, if married) must use part of those excess assets to pay for their expenses until their assets are reduced to the limit.

As long as one spouse is not seeking Medicaid help (called the “community spouse”), federal and state law allows married individuals to keep more assets than a single person. For 2025, federal law guarantees a minimum protection level of $31,584.

Medicaid has rules that protect assets. Sadly, most people are unaware that state Medicaid policies allow them to protect more of their life savings—the uninformed end up spending more than the law requires.

Don’t let that happen to you.

Proper planning can save you and your family substantially more than the minimum spousal protection level. A person with resources that are greater than Medicaid’s limits may still be able to qualify for financial assistance.

Don’t overspend assets. Here’s a solution…

Find an elder law attorney experienced with Medicaid matters. The advice can prevent over spending for nursing home care. By using the laws, you can qualify faster and protect more assets and get eligibility.