Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: REGINALD E. McELHANNON, INTERIM DIRECTOR
SUBJECT: QUALIFIED INCOME TRUST (QIT) TEMPLATE (MO 886-4657)
FORM ADDITION #37
This memorandum introduces the fillable QIT template, MO 886-4657. (QITs are also referred to as Miller Trusts.) This template is designed to meet the necessary requirements to reduce the countable income for specific MO HealthNet Programs. The template is fillable to allow the participant to type in the necessary information. Instructions for the completion of the QIT template are provided.
QITs may be used to reduce countable income for the following programs:
- Home and Community Based Waiver (HCB)
- Missouri’s Children with Developmental Disabilities (MOCDD)
- Program of All-Inclusive Care for the Elderly (PACE)
The QIT template may not be used to reduce income for any other program administered by the Family Support Division.
Upon receipt of a completed QIT form, staff must review the form to verify all blanks are complete and the form has been notarized. All QIT must be submitted through normal supervisory channels on a Request for Interpretation of Policy (IM-14) to Program and Policy for review.
NOTE: Participants are not required to use the QIT template. A QIT created by an attorney is acceptable, and must be submitted through normal supervisory channels on a Request for Interpretation of Policy (IM-14) to Program and Policy for review.
- Review this memorandum with appropriate staff.
- Review December 1973 Eligibility Requirements Manual Section 015.04.01.02 for additional QIT information.