FROM: PATRICK LUEBBERING, DIRECTOR
SUBJECT: QUALIFIED INCOME TRUST CONSIDERATION AS A RESOURCE OR INCOME
MANUAL REVISION #2
42 UCS 1396p(d)(4)(B) created an avenue for individuals receiving or applying for MO HealthNet for the Aged, Blind or Disabled program under the Home and Community Based (HCB) waiver services, Program for All-Inclusive Care for the Elderly (PACE) and MO HealthNet for Children with Developmental Disabilities (MOCDD) to allocate a portion of their own earned or unearned income into a specified and excluded trust. This trust is referred to as a Qualified Income Trust (QIT) or Miller Trust.
The sole purpose of a Miller trust is to reduce the income consideration for an HCB, PACE, or MOCDD participant so that they can be budgetarily eligible for these hard income cap programs. It does not apply to programs that do not have a hard income cap, such as MO HealthNet Non-spend Down or Ticket to Work Health Assurance. If the trust is considered a valid Miller trust, all monies deposited into it are excluded as both income and resource for the participant. This exclusion applies only to the HCB, PACE and MOCDD determinations. It does not apply to any other MO HealthNet or Family Support Division (FSD) programs.
The hallmarks of a valid Miller Trust:
- Uses only the beneficiary’s income to create and maintain the trust
- Income must be deposited regularly
- The beneficiary must be disabled
- Missouri must be named as a beneficiary upon death of the participant
- The beneficiary cannot serve as Trustee
- Disbursements from the trust must be for the participant/beneficiary or the beneficiary’s spouse or disabled child if they reside in the home with the beneficiary
- The beneficiary must be applying for, or receiving HCB, PACE or MOCDD services
Example: Beth Jones receives $1380 gross in Social Security Disability benefits. She has applied for HCB. The current HCB maximum is $1311. She does have her SMI premium taken out of her Social Security, but HCB uses the gross income. Therefore she is $69 over the HCB maximum. She can create a Miller trust, and agree to deposit at least $69 each month into the trust. She decides to deposit $80 a month. Once this trust is set up, the $80 will no longer be counted as income for her HCB determination and she is found to be HCB eligible. Monies in the trust can be used to reimburse her for her SMI premium each month.
Until FAMIS programming is complete, the Poplar Bluff Processing Center, which is tasked with processing these cases with the exception of MOCDD, will employ a work-around to exclude the income from consideration for the appropriate programs without impacting other assistance groups.
The requirement to submit all trust documents to Program and Policy for determination of income and/or resource availability has not changed.
The relevant Income Maintenance Manual sections have been updated to reflect this change.
- Review this memorandum with appropriate staff.
- Send all trusts to MO HealthNet Program and Policy for review.