Your mother’s Social Security and pension add up to $3,100 a month. She needs nursing home care she can’t afford, yet her income may be too high for Texas Medicaid. For many Houston families, a Miller Trust may help. Here’s how it works and what keeps it valid.
Texas sets a limit on nursing home income
Even a modest monthly income can put nursing home Medicaid coverage out of reach. Texas uses a federal formula to determine who earns too much to qualify through the regular income test. The state sets its ceiling at three times the individual Supplemental Security Income (SSI) benefit.
For 2026, that means a single applicant generally cannot earn over $2,982 per month without an alternative eligibility arrangement. The state’s qualified income trust guidance explains one way to address this barrier. The cap typically rises each January when the Social Security Administration (SSA) updates the SSI rate. Some Veterans Affairs (VA) benefits don’t count toward the cap.
A Miller Trust must follow strict rules
Texas allows applicants with excess income to use a special arrangement known as a qualified income trust (QIT), or Miller Trust. Instead of receiving all their income directly, they place designated payments into a trust account. When the arrangement meets state requirements, those deposits no longer count against the income ceiling.
The trust must be irrevocable, which means you can’t cancel it later. It can hold only income, never savings or property. If you choose a source, such as Social Security, the full payment must go in.
The trust must also repay the State of Texas from any funds left at death, up to the total Medicaid benefits paid on your loved one’s behalf. A QIT doesn’t address the $2,000 asset limit, so it usually serves as one part of a broader Medicaid strategy.
Local bank setup requires some preparation
HHSC requires an account that uses the beneficiary’s Social Security number and holds only the income named in the trust. A joint account may work only if the other holder is listed for convenience and doesn’t use it.
If you bank in Harris or Fayette County, ask your branch whether staff have opened these accounts, how they title them and how long a direct deposit change takes.
Trustees must track every monthly deposit
HHSC recommends that the person receiving care not serve as trustee, so an adult child often steps in. Income must reach the account in the same month it arrives. By the end of the next month, the trustee must distribute a personal needs allowance, any allowance owed to a spouse at home and the resident’s share of the nursing home bill. A late distribution can count as a transfer of assets, and a missed full deposit after the first month may invalidate the trust.
Early coordination can reduce admission delays
If a nursing home placement is approaching, compare benefit payment dates with the trust’s deposit schedule. Ask the facility what financial records it needs, and prepare the signed trust and account statements for Medicaid review.
An incomplete account history or a missed transfer can leave a family facing private-pay charges while eligibility remains unresolved. Careful monthly management can reduce paperwork surprises as care begins.