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Aged, Blind and Disabled Manual Section: Financial Eligibility Requirements Policy Manual Number: 110.055 Chapter: ABD Trusts

May 1, 2026 Division of TennCare 7 maintenance or medical needs, the value of the trust is an unavailable asset, but the trust itself is a third party medical resource and must be reported to the TennCare Third Party Liability Unit. h. Qualified Income Trust (QIT) or Miller Trust A QIT is a trust that is created specifically for the purpose of becoming eligible for TennCare Long-Term Services and Supports (LTSS). For individuals seeking LTSS whose gross income is over the income limit, the state allows the individual to create a QIT into which he or she directs income. This may enable an individual to qualify financially for TennCare Medicaid. i. QIT Defined A QIT is a trust consisting of the individual’s income. Any type of income may be directed into the QIT, although Social Security income and pension income are among the more common types. A QIT is created for the purpose of establishing income eligibility for TennCare Medicaid in order to receive Medicaid coverage when an individual is or soon will be confined to a nursing facility or Home and Community Based Services (HCBS) Waiver program. ii. QIT Policy Individuals applying for or receiving TennCare Medicaid LTSS, whose income is over the income limit, may still qualify for Medicaid coverage if some or all of his or her income is placed in a valid QIT. This applies to both individuals who are or who will be confined to a nursing facility or enrolled in an HCBS waiver. Individuals who are eligible to create a QIT must also meet all other TennCare Medicaid and CHOICES eligibility requirements. Income placed in a valid QIT will be treated as unavailable in accordance with federal standards. For the QIT to be considered valid, the individual’s gross monthly income must be above the income limit. Income that is not placed in the QIT must be at or below the income limit. If income not placed in the QIT is over the income limit, the individual is not financially eligible regardless of the income placed in the QIT. An individual whose income is placed in a QIT and who is subsequently found to be eligible for Medicaid will be considered eligible on the first day of the month in which eligibility is established, or the date of admission to the nursing home or HCBS program, whichever is later. iii. Income Test The amount of income placed in a QIT cannot be limited nor can it be counted when testing income against the income limit. However, it is used in determining patient liability during post-eligibility treatment of income. Income that is not placed in the QIT is tested against the income limit. If the individual’s income that is not placed in a QIT is over the income limit, the individual is not income-eligible for TennCare Medicaid.