The St. Louis Post-Dispatch recently reported in "Trusts sidestep Missouri income limit for home care" that the Missouri Department of Social Services now recognizes Qualified Income Trusts, also known as Miller Trusts. This type of trust is a workaround for a rule that requires some people to live on $841 a month but allows others to make $1,280 while getting the same in-home help.
This in-home help can some seniors avoid nursing homes. However, it's hard to keep a private home going on $841 a month. The issue involves people who are at least 63 years old and who meet the state's medical standards for receiving in-home help, which is help cleaning, cooking, and other daily functions.
Miller Trusts have been used for many years in other states. However, elder law attorneys in Missouri ran into difficulty getting their state's officials to accept Miller Trusts. Nevertheless, this has recently changed, they claim.
Those who apply for in-home help can only have so much income; those who bring in less than $1,281 a month will qualify. However, if you earn a dollar more than $1,281, you have to pay for your own help until you have only $841 a month left. So it amounts to a $440 monthly penalty for income $1 over the limit!
But a Miller Trust can hold the amount over $1,281 because money in the trust does not count as income. A senior can then satisfy the $1,281 income cutoff and won't have to spend an extra $440 to qualify for home help. He or she can't just keep the money in the trust, however, but must spend it each month for medical needs: a wheelchair, doctor and hospital bills, drugs, and medical supplies.
The Miller Trust solves the basic numbers problem: a senior cannot buy food and clothing and pay utilities, rent or real estate taxes, and medical expenses on $841 a month (in Missouri). That kind of rail-thin budget pushes people toward nursing homes.
Note that a trust is not easy to set up. You need to hire a lawyer and get your bank to accept a small trust account. Typically, small community banks will help, but not the big banks. The senior will not have control of the money in the trust. Instead, it will be in the hands of a trustee, usually a close relative.
Miller Trusts are commonly used in other states that require a spend-down for home help. Somehow, Missouri social services officials had never heard of them.
However, the department spokesperson said, "The Department of Social Services has accepted Miller Trusts for the Home and Community-based services program for a number of years. However, Missourians rarely used it until recently. Due to the sudden increase in demand, it became necessary to establish a better process to handle the higher number of Miller Trusts. Initially, there may have been some confusion, but we have worked through it and apologize for any inconvenience it may have caused."
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Reference: St. Louis Post-Dispatch (May 15, 2016) "Trusts sidestep Missouri income limit for home care"