Miller Trusts Can Help You Qualify for Medicaid

Erich M Niederlehner Pensacola Elder Law and Estate Planning Attorney • March 13, 2023

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Many seniors find themselves in need of Medicaid to pay for their long-term care but are surprised to learn that their modest monthly income may disqualify them. The reason for this is that Medicaid is a “means-tested” benefit. In other words, you must not have income exceeding certain thresholds in order to qualify and receive Medicaid benefits. For example, in New Jersey, the monthly income limit for nursing home or community-based services is $2,742 for an individual.


Medicaid expects all of an applicant’s monthly income, besides a monthly personal needs allowance and Medicare premiums, to go toward nursing home costs. The personal needs allowance in Florida is $130 a month. So, what if you have more income and other expenses? A Miller Trust may help you resolve this dilemma.


A Miller Trust is a Medicaid planning tool that can assist you in meeting the income limits and qualifying for Medicaid. Unlike other planning tools, Miller Trusts do not have specific disability or age requirements.


How Does a Miller Trust Work?

If your income exceeds Medicaid’s income limit, you can deposit the amount of your excess income into a Miller Trust – also referred to as a “qualified income” trust. Once it is deposited into this trust, it is not counted as income by Medicaid. However, to qualify, a trust must be irrevocable, which means you cannot cancel or change it. Once you put money into the trust, you cannot get it back directly. However, the trust can pay certain expenses on your behalf.


A Miller Trust is a good option for any Medicaid applicant needing long-term care services, whether at home, in their community, or in a skilled nursing care facility. This trust is created by the applicant, a guardian, or a person with a properly drafted power of attorney. A trustee is chosen to manage the trust and the income deposited. Anyone other than the Medicaid applicant can serve as a trustee.


Once the trust is set up, the trustee establishes a bank account to receive excess income from the Medicaid applicant. The income can only be used for certain expenses. For example, it may be used to pay the personal needs allowance of an individual in a nursing home, Medicare premiums, bills not covered by Medicaid, or supplement costs of a nursing home.


Another requirement of a Miller Trust is that the applicant’s state Medicaid agency will be the beneficiary of any remaining funds in the trust upon the death of the Medicaid applicant. The amount the state receives is limited to the total value the state paid in long-term care on behalf of the applicant. Any amount remaining after this payment may go to a person the applicant chooses.


Medicaid Income Cap

You should be aware that not every state allows Miller Trusts as a method to qualify for Medicaid. Currently, only about 25 states, known as “income cap” states, permit it. Other states do not impose an income limit for nursing home care, and so there is no need for a Miller Trust in these locations. For example, in Massachusetts, you would pay all your income, minus certain deductions, to the facility, and Medicaid would pay the remaining cost.



Before creating a trust, it is important to speak with an elder law attorney to ensure this option is right for you. If you live in a state where this is not allowed, there may be other options, such as pooled income trusts, which serve a similar purpose.


For guidance in Medicaid planning, consult an experienced Elder Law attorney, please contact elder law and asset protection attorney Erich M. Niederlehner, owner of Trusted Elder Law & Asset Protection located in Pensacola, Florida and serving all in Florida or Alabama. Visit our website at www.TrustedElderLaw.com or call us at 855-ELDER-FIRM. If you need help with Medicaid planning to qualify for long-term nursing home care, estate planning for all generations and ages, probate, placement assistance with a nursing home or assisted living facility or bankruptcy asset protection services please learn how Trusted Elder Law & Asset Protection can help you and your loved ones.

What Is Memory Care, and What Are Its Benefits?

By Erich M Niederlehner Pensacola Elder Law & Estate Planning Attorney • March 13, 2023
Memory care is specialized care for patients living with Alzheimer’s disease, dementia, or other conditions that cause memory loss. Hospitals and nursing homes may have memory care units or a separate entity dedicated to this service. Memory care provides seniors with meals, opportunities to socialize, mentally stimulating activities, and support for their caregivers. Benefits of Memory Care People living with memory dysfunction need specialized care. Although there is often an expense involved with getting care, the benefits make it worthwhile. Some of the many benefits of memory care may include the following: Round-the-clock supervision Assistance with medication compliance Transportation to and from doctor’s appointments A secure environment that allows seniors to remain independent while reducing the risk of wandering Access to expert and individualized medical care Living Options for Seniors Living With Alzheimer’s or Dementia If your loved one suffers from Alzheimer’s disease or dementia, you may be seriously considering what the best next step is for securing their long-term care. Several living arrangement options exist for seniors living with memory loss concerns. Your loved one’s condition may make one of the following potential housing arrangements a better option than another. Here are some of the choices you may want to explore for memory care: Low-Income Housing Low-income housing may be the most economical option for long-term housing. This option is great for someone with a fixed income. Low-income housing helps seniors whose condition is mild and has not diminished to the point where they cannot live unsupervised. Here, they may continue living in their community with their spouse if they do not also need specialized care. Nursing Home Nursing home care is probably the most well-known living arrangement option for seniors who can no longer live independently. Some offer a specific unit or space dedicated to memory care. Nursing home employees can also give residents medication, place an IV, provide wound care, and so on. Other facilities generally do not provide this high level of medical care. This may be a suitable option for seniors who have dementia as well as another chronic medical condition. Memory Care Community Memory care facilities specialize in caring for seniors in the more advanced stages of dementia. In addition to 24-hour care and staff who are specifically trained to treat residents with memory loss issues, these communities also may be secure, locked facilities to help your loved one avoid wandering. Memory care communities also assist with activities of daily living and are often designed to mimic the look and feel of a private home. Independent Living Community Independent living communities are a good idea for seniors whose condition is mild to moderate. These communities may include memory care services. This option works best for seniors who can still bathe, dress, and perform other regular maintenance on their own. These facilities provide seniors with a private living space and social and recreational activities to help keep their minds active, which promotes healthy brain function. This service is private-pay, so Medicaid will not cover the expense. Assisted Living Facility An assisted living facility allows seniors who need memory care to continue living independently. Employees can help residents with medical emergencies, but if they need individualized, 24/7 care, this may not be the best option. An assisted living facility can be a good option for seniors who require help with cooking, bathing, dressing, running errands, and getting to and from doctor’s appointments. Medicaid typically covers some costs of assisted living facilities, such as personal care services or on-site therapy. Note, however, that assisted living facility offerings vary by state; not every facility will provide memory care services. Continuing Care Retirement Community Continuing care retirement communities help seniors whose conditions may decline over time. Patients can enter a continuing care facility when they are still high-functioning. As their condition worsens, they already have support and a care team to meet their changing needs. Medicaid does not cover the cost of living in a continuing care retirement community in most cases, so be sure to budget accordingly if your loved one needs this service in the future. Senior Day Care This option does not involve lodging. However, it can be a great way to ensure your loved one has someone to look after them when you need to work, go to school, or have other tasks to complete outside of the home. Adult day cares let seniors socialize and take part in mentally stimulating activities that may help slow the progression of their disease. These programs may include specialized services for those with dementia. Medicaid coverage for these services varies by state. Financial assistance may also be available, such as grants or loans. Contact an Elder Law Attorney Knowing what to do for your family can be challenging. Connecting with an experienced elder law attorney can help point you in the right direction as you decide how to care for your loved one. If you need an experienced Elder Law attorney, please contact elder law and asset protection attorney Erich M. Niederlehner, owner of Trusted Elder Law & Asset Protection located in Pensacola, Florida and serving all in Florida or Alabama. Visit our website at www.TrustedElderLaw.com or call us at 855-ELDER-FIRM. If you need help with Medicaid planning to qualify for long-term nursing home care, estate planning for all generations and ages, probate, placement assistance with a nursing home or assisted living facility or bankruptcy asset protection services please learn how Trusted Elder Law & Asset Protection can help you and your loved ones.
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