Qualified Income Trust (Miller Trust) for Nevada Medicaid

If your adult child's countable unearned income exceeds Nevada Medicaid's income limit — $2,982 in 2026 for HCBS waiver programs — a Qualified Income Trust (commonly called a Miller Trust) can preserve their eligibility. Without it, Medicaid treats the full income as countable and disqualifies them, even if the overage is only a few dollars.

How the Income Limit Works

Nevada Medicaid uses different income thresholds depending on the program category:

• Standard SSI-linked Medicaid (MAABD): Income must stay at or below $994/month (the 2026 Federal Benefit Rate) for an individual
• HCBS IDD Waiver: Income can be up to 300% of the FBR — $2,982/month in 2026 — because the state applies institutional (rather than community) deeming rules
• Resource limit: $2,000 in countable assets for all Medicaid disability categories

Most young adults on SSI alone won't hit these limits. The problem arises when a disabled adult child starts receiving DAC benefits (Disabled Adult Child benefits based on a parent's Social Security record), SSDI, or other unearned income that pushes past the threshold. After the Social Security Fairness Act repealed the WEP and GPO, some DAC recipients saw their monthly payments increase enough to trigger this issue for the first time.

What a Miller Trust Does

A Miller Trust is an irrevocable trust that can route qualifying unearned income under Nevada Medicaid rules toward the beneficiary's cost of care. Verify the trust's timing and other requirements with DWSS before relying on it.

Here's how the monthly flow works:

1. Deposit the beneficiary's qualifying unearned income into the Miller Trust
2. Use trust funds only for permitted expenses and allowances under Nevada Medicaid rules
3. Spend deposited income within the time required by Nevada Medicaid rules; accumulation is not allowed
4. At the beneficiary's death, remaining trust funds are subject to Medicaid payback under the trust and applicable law

The trust must be funded with the beneficiary's qualifying unearned income. Family contributions and asset transfers are not substitutes for qualifying income.

Setting Up a Miller Trust in Nevada

Consider using an attorney familiar with Nevada Medicaid trust rules. The trust document must:

• Identify the Medicaid beneficiary and be established from the beneficiary's qualifying unearned income
• Include a Medicaid payback provision (remaining funds are paid to Nevada Medicaid upon death)
• Be irrevocable
• Designate a trustee (typically a parent or family member)
• Specify that no resources may be used to establish or augment the trust and that distributions are limited to those permitted under Nevada Medicaid rules

Costs typically run $1,000–$2,500 for the drafting. Once established, the trust requires a dedicated bank account. The trustee deposits the required qualifying unearned income each month and makes permitted distributions.

Coordination with Other Benefits

A Miller Trust handles income only — it does not shelter assets. If your child also has resources approaching the $2,000 limit, you'll need an ABLE account (which excludes up to $100,000 from SSI/Medicaid counts) or a special needs trust for asset protection.

The Miller Trust does not change SSI's income rules. SSI has its own income rules, and the trust does not determine whether your child qualifies for SSI cash payments. It specifically addresses Medicaid's institutional income cap for waiver programs.

If your child is on the HCBS IDD Waiver waiting list through the ADSD regional centers, keep the regional center and DWSS aligned about Medicaid eligibility before a waiver slot opens. Active Medicaid eligibility must be confirmed before waiver services begin.

When You Don't Need One

Most young adults transitioning at 18 won't need a Miller Trust immediately. SSI payments ($994/month maximum) are well below the $2,982 HCBS income cap. The trust becomes necessary when:

• A parent retires or dies, triggering DAC benefits that combine with SSI to exceed the threshold
• The young adult receives other unearned income that pushes total income past the limit
• The young adult receives SSDI (which can exceed the MAABD limit of $994/month)

The Nevada SSI at 18 & Adult Disability Benefits Guide includes a financial limit worksheet that tracks income against both the SSI and Medicaid thresholds monthly, so you can anticipate when a Miller Trust becomes necessary before it creates an eligibility crisis.

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