Qualified Income Trust in Georgia: How It Works and Who Needs One

For many older Georgians, the cost of nursing home care — averaging more than $7,000 per month for a semi-private room — is impossible to sustain from personal funds alone. Medicaid can cover those costs, but qualifying requires meeting both asset and income limits. Georgia is an income-cap state for Medicaid purposes, meaning that applicants whose gross monthly income exceeds the threshold are automatically disqualified — even if their income is only modestly above the limit and they genuinely cannot afford their own care.

A Qualified Income Trust, also known as a Miller Trust or QIT, solves this problem. It allows a Medicaid applicant to remain income-eligible by redirecting excess income through a specially structured trust account each month.

What Is a Qualified Income Trust?

A Qualified Income Trust is an irrevocable trust — specifically authorized under federal law — that allows a Medicaid applicant whose income exceeds Georgia's monthly cap to qualify for long-term care Medicaid by diverting that excess income into a trust each month. Income placed in the QIT is not counted against the Medicaid income limit for eligibility purposes.

It is important to understand what a QIT is not. It is not a savings vehicle. It does not protect assets. It does not accumulate wealth. The QIT simply creates a compliant channel through which excess income flows each month so the applicant can meet Georgia's income eligibility threshold. Money goes in, and money comes back out — all within the same calendar month.

Georgia's Income Cap and When a QIT Is Required

Georgia's Medicaid income limit for long-term care changes annually. When determining eligibility, Medicaid looks at the applicant's gross monthly income — total income before any deductions — not the net amount deposited to a bank account. Social Security, pension income, annuity payments, and other income sources all count toward this gross figure.

If an applicant's gross monthly income falls below the current cap, no QIT is needed — they simply meet the income requirement directly. If gross income exceeds the cap by even one dollar, a QIT must be established before Medicaid will approve the application. The program will not approve benefits until the trust is in place and properly operating.

How the QIT Works Month to Month

The QIT mechanism is straightforward in concept. The Medicaid applicant establishes a QIT by signing a trust document — the Georgia Department of Community Health has a preferred format — that names a trustee and sets out the rules governing the account. The trustee then opens a dedicated checking account in the trust's name at a bank.

Each month, the applicant transfers their gross income — or at minimum the amount that exceeds the Medicaid income cap — from their personal checking account into the QIT checking account. The trustee then uses the funds in the QIT account to pay the applicant's personal liability under Medicaid (the portion they are expected to contribute toward care costs) and any other approved medical expenses. The QIT account must be emptied each month — no funds carry over. The trust account holds nothing at the end of the month.

Because the income passed through the QIT is no longer counted as the applicant's income for eligibility purposes, the applicant's countable income drops below the cap, and Medicaid eligibility is achieved.

Who Serves as Trustee

The trustee of the QIT is the person responsible for managing the monthly income transfers and payments. The Medicaid applicant themselves typically cannot serve as trustee. A family member, close friend, or professional trustee can serve in this role. The trustee must be reliable, organized, and committed to making the required transfers and payments on time every month — because failure to properly administer the QIT can result in termination of Medicaid benefits and an obligation to repay the program for improperly covered months.

The trustee must keep clear and accurate records of every transaction, maintain compliance with Georgia's Medicaid rules governing QIT administration, and be available to respond to any inquiries from the Georgia Division of Family and Children Services.

What Happens to QIT Funds at Death

When the Medicaid recipient dies, any remaining funds in the QIT account must be paid to the state of Georgia as reimbursement for Medicaid expenses paid on the individual's behalf. This payback provision is a federal requirement for all QITs and is written into the trust document. Only after the state's claim is satisfied can any remaining funds pass to other parties.

Setting Up a QIT Correctly

The QIT must be properly drafted, signed, and operational before Medicaid will approve an application. The trust document must comply with Georgia's requirements — the Department of Community Health maintains a preferred template that elder law attorneys familiar with Georgia Medicaid use as the basis for these documents. Once the document is signed by the applicant, their agent under a valid power of attorney, or their court-appointed conservator, the trustee takes it to a bank to open the QIT checking account.

Working with an elder law attorney experienced in Georgia Medicaid planning is essential. An error in drafting, a delay in establishing the account, or mismanagement of the monthly transfers can jeopardize eligibility and expose the family to significant financial consequences.