A Miller trust in Texas lets Dallas seniors with income above the Medicaid cap qualify for nursing home and STAR+PLUS HCBS care.
By Dallas Senior Advisor Care Team · October 16, 2026
A Miller trust in Texas, also called a qualified income trust, is the tool Dallas families reach for when a parent needs Medicaid long-term care but has too much monthly income to qualify. Texas is an income-cap state for nursing facility Medicaid and the STAR+PLUS Home and Community Based Services (HCBS) waiver, which means an applicant whose gross monthly income exceeds the special income limit is denied outright, even if their savings are nearly gone. That limit is 300 percent of the federal SSI benefit rate, roughly $2,982 a month in 2026. It sounds generous until you remember that a retired engineer from Texas Instruments, a former Dallas ISD administrator, or a widow drawing her husband's pension plus Social Security can easily cross it by a few hundred dollars.
The cruel part is that crossing the line does not mean the family can afford care. A parent with $3,300 a month in gross income may still face memory care at $4,800 to $7,000 a month in Dallas County, or a Type B assisted living bill that dwarfs the pension. The Miller trust exists to fix exactly that mismatch. It does not hide money or shelter assets; it redirects the income above the cap into an irrevocable trust account so that the applicant is treated as eligible under Texas Medicaid rules. Families who first hear the term at a Baylor University Medical Center or Parkland discharge planning meeting often assume it is a loophole. It is not. It is a standard, state-recognized eligibility mechanism.
In practice the trust is a dedicated bank account held by a trustee, usually an adult child or other trusted person, and it is irrevocable, meaning it cannot simply be closed and the money taken back. Each month the applicant's income is deposited into that account, and from it the trustee pays only the things Medicaid rules allow. Typically that means the applicant's share of the cost of care, a small personal needs allowance, health insurance premiums, and certain approved expenses. The remainder is not a pot the family can spend on itself. Because the income flows through the trust and is spent for the applicant's benefit, the amount counted against the income cap is brought within the limit.
Setting one up in the Dallas area normally involves an elder law attorney, because the trust document has to satisfy Texas Health and Human Services Commission (HHSC) requirements and must be in place before the case is approved. Many firms in Dallas, Plano, and Fort Worth handle these routinely and can coordinate with the Medicaid eligibility worker handling the file. When the applicant dies, Texas must be reimbursed from what remains in the trust up to the amount of Medicaid paid, which is why families should keep the account clean, avoid mixing it with their own money, and save the bank statements. Sloppy handling is the most common reason a trust that was set up correctly still causes an eligibility problem later.
The trust does not, by itself, pay for anything. It only removes the income barrier. Once the applicant is eligible, the benefit depends on the setting. In a nursing facility licensed under Texas Health and Safety Code Chapter 242, Medicaid covers care after the applicant contributes most of their income, keeping back a small personal needs allowance. In the community, the STAR+PLUS HCBS waiver can pay for personal and attendant care at home or in an assisted living facility, but it does not pay assisted living room and board. That distinction trips up many Collin County families, because a new Frisco or McKinney community may charge a high monthly rent that the waiver never touches.
The waiver also runs through a managed care organization. In the DFW service area the plans are Molina Healthcare, UnitedHealthcare Community Plan, Superior HealthPlan, and Aetna Better Health, and the applicant applies through YourTexasBenefits.com followed by an HHSC medical-necessity assessment. A trust only matters after the financial and level-of-care pieces line up, so families benefit from starting the paperwork early, particularly when there is an interest list for the waiver. Our guide on the STAR+PLUS waiting list explains that timeline, and our income and asset limits guide covers the resource side of the test.
Consider a realistic scenario. A mother is discharged from Texas Health Presbyterian Dallas after a hip fracture and a hospital social worker recommends skilled nursing, then long-term placement. Her son lives in Plano and learns that her combined Social Security and pension is above the cap. The first step is to gather the last several months of income statements, bank records, and the medical documentation, and the second is to call an elder law attorney to draft the trust. The trust account is opened, the income is redirected into it starting the month eligibility is requested, and the Medicaid application goes in with the trust attached. If the application is filed without the trust, the denial can cost weeks.
Dallas County families can also lean on local help. The Dallas Area Agency on Aging, operated by The Senior Source, and the Area Agency on Aging of North Central Texas for Collin, Denton, and Rockwall counties can point families to benefits counseling, while Texas 2-1-1 and the HHSC Aging and Disability Resource Center route callers to the right office. Because DFW spans four counties and families often live a long drive from the parent, a phone-first approach saves real time. If a parent is sliding toward isolation because they have stopped driving, as we describe in our guide on giving up the car in DFW, getting this paperwork moving early can prevent a crisis placement.
The most frequent error is waiting. Families sometimes spend months paying out of pocket, convinced the parent earns too much for Medicaid, without ever asking whether a trust could change the answer. The second is treating the trust account as a family checking account. Paying a grandchild's tuition or the trustee's own bills from it can violate the terms and jeopardize coverage. The third is forgetting that income changes, such as a cost-of-living adjustment, a new pension payment, or a survivor benefit, can alter how much has to flow through the trust.
A fourth mistake is confusing the Miller trust with asset planning. It addresses income only. Countable resources, the five-year look-back for transfers, and the home are separate rules, and Texas Medicaid Estate Recovery can reach certain assets after death, which we discuss in our estate recovery guide. Before moving money anywhere, talk with a licensed Texas elder law attorney. This article is general information, not legal or financial advice, and the Dallas Senior Advisor Care Team recommends verifying current limits with HHSC before relying on any figure.
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