As many of you know, Texas is an income cap state in connection with long-term care (most commonly used for nursing home care) Medicaid eligibility. Presently, if an applicant for nursing home Medicaid has “countable” income (certain income is exempt or excluded) over $2,250 per month, then such applicant is ineligible for nursing home or long-term care Medicaid (which helps pay for long-term care costs). The income cap rises almost every January 1 as a result of the cost of living adjustment (COLA). The income cap for year 2019 will rise to $2,313 per month. An applicant for long-term care Medicaid can achieve eligibility even if his or her income (Texas follows the “name on the check” rule so it does not count the income of the spouse unless the spouse is also applying in which case the cap is doubled) is over the cap by either creating a qualified income trust (commonly known as a “Miller Trust” or a “QIT”) or by getting a court order to shift the income to the community spouse (if the applicant is married and such spouse lives in the “community” – i.e., at home) assuming all other Medicaid eligibility requirements have been met. The qualified income trust or Miller Trust is the most common tool used to overcome the income cap ineligibility issue. The income of only the applicant is placed monthly into this type of trust and some or all of the income may be paid to the community spouse (if applicable) depending on the monthly income of the community spouse (if the community spouse’s income is below the minimum monthly maintenance needs allowance which is presently $3,090.50 per month (and scheduled to rise to $3,160.50 on January 1, 2019). However, if there is a community spouse whose non-countable resource income (i.e., Social Security income, pension income, annuity that qualifies for Medicaid, etc.) combined with the non-countable resource income of the institutionalized spouse is greater than the minimum monthly maintenance needs allowance, then it is often better to get a court order (qualified domestic relations order without a divorce) to shift more income (generally the pension income) to the community spouse. If the applicant is single, then the majority of the income from a qualified income trust will be applied to the nursing home, and the government will subsidize the balance of the cost of care. It should be noted that qualified income trusts do not work to avoid the income cap of $771 (as of 1/1/19) per month for a single person hoping to get  Supplemental Security Income and Medicaid.

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