Qualified Income Trust Ohio: Miller Trust Rules, Setup, and Medicaid Eligibility

Why a Miller Trust Exists in Ohio

Ohio's Medicaid waiver system has a hard income ceiling. If a person's gross monthly income exceeds the Special Income Limit — set at $2,982 per month in 2026 — they cannot qualify for Home and Community-Based Services waiver Medicaid through normal channels. They don't get to "spend down" the excess because Ohio permanently eliminated its ABD Medicaid spend-down program on August 1, 2016, when the state transitioned to a Section 1634 system.

A Qualified Income Trust, commonly called a Miller Trust, is the only legal mechanism for people whose income exceeds the Special Income Limit to maintain Medicaid waiver eligibility. The trust acts as a pass-through: income above $2,982 flows into the trust's dedicated bank account each month, and the trust distributes it according to strict Medicaid rules.

This is not optional. If a person needs HCBS waiver services — an Individual Options waiver, Level One waiver, or SELF waiver — and their monthly income exceeds $2,982, they must have a functioning Miller Trust. Without one, the waiver enrollment is denied regardless of how severe their disability is.

How the Special Income Limit Works

The Special Income Limit is always set at 300% of the SSI Federal Benefit Rate. In 2026, the FBR is $994 per month, making the SIL exactly $2,982. This figure updates automatically whenever the FBR changes, which happens through annual cost-of-living adjustments each January.

The $2,982 threshold is based on gross monthly income from all sources — SSI, SSDI, DAC benefits, pensions, investment income, and any other regular payments. For many adults with developmental disabilities, income stays well below this limit because their sole income is SSI ($994 maximum). The Miller Trust becomes necessary when an individual receives DAC benefits, an inheritance-funded annuity, or other income streams that push total monthly income above $2,982.

One situation that has become more common since 2025: the Social Security Fairness Act repealed WEP and GPO, causing previously reduced Social Security benefits to increase — which in turn increased DAC benefits for disabled adult children on those records. Some families who were safely under the SIL suddenly found themselves over it.

Setting Up the Trust

A Miller Trust in Ohio must meet specific legal requirements under 42 U.S.C. Section 1396p(d)(4)(B). The trust document must name the State of Ohio as the remainder beneficiary, meaning any funds left in the trust at the beneficiary's death go to Ohio Medicaid as reimbursement for services provided.

The trust must be irrevocable. It can only hold income — not assets like savings, real estate, or investment accounts. And it must be established for the sole benefit of the Medicaid recipient.

Most families hire an elder law or special needs planning attorney to draft the trust document. Typical legal fees for a straightforward Miller Trust in Ohio range from $1,500 to $3,000. Once the trust is drafted, the family opens a dedicated bank account titled in the trust's name and provides the trust documents and account information to the county Department of Job and Family Services.

The Monthly Deposit Obligation

This is where families most frequently make mistakes. Every single month, all of the beneficiary's income that exceeds the Special Income Limit must be deposited into the Miller Trust bank account. Missing a single month's deposit can result in immediate loss of Medicaid waiver eligibility.

Trust funds are used for the individual's patient liability or medical premiums and cannot be accumulated to bypass Medicaid resource limits. The county JFS office should confirm permitted distributions and any personal-needs allowance.

The trust cannot accumulate large balances. It is a monthly pass-through mechanism, not a savings vehicle. Funds that pile up in the trust can create eligibility complications — the county JFS office expects to see the trust functioning as intended, with regular monthly deposits and distributions.

Common Mistakes That Jeopardize Eligibility

The most dangerous mistake is simply forgetting to make the monthly deposit. Life gets complicated, a family member is hospitalized, a billing cycle changes — and suddenly one month's deposit is missed. A missed or incorrect deposit can result in loss of Medicaid waiver eligibility.

The second common mistake is depositing the wrong amount. The deposit must reflect the actual excess above the Special Income Limit for that month. If the beneficiary's income fluctuates (for example, if they work part-time and earnings vary), the deposit amount changes month to month.

Third, some families attempt to use the Miller Trust as a savings account, letting the balance grow over time. This violates the trust's purpose and can trigger a Medicaid eligibility review.

For families navigating the combined complexity of DAC benefits, SSI interactions, and HCBS waiver eligibility, the Ohio SSI at 18 & Adult Disability Benefits Guide includes a Miller Trust setup checklist and monthly tracking worksheet designed specifically for Ohio's waiver system.

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