If a parent's monthly income is a few hundred dollars over Florida's Medicaid long-term care cap, a Qualified Income Trust can still make them eligible — here's exactly how it works in Central Florida.
By Orlando Senior Advisor Care Team · October 23, 2026
Florida's Medicaid long-term care programs use a hard income ceiling. For 2026 it is $2,982 a month in gross income for a single applicant — three times the federal SSI benefit rate of $994. That one number decides eligibility for both Institutional Care Program coverage in a nursing home and the Statewide Medicaid Managed Care Long-Term Care waiver, which is the program that pays for personal care in an assisted living community or at home.
The word that trips families up is gross. Medicaid counts the Social Security benefit before the Medicare Part B premium is withheld, plus pensions, annuity payments, required minimum distributions, VA pensions in some cases, and rental income. A retired teacher in Winter Park with $1,900 in Social Security and a $1,250 pension is at $3,150 — $168 over the line. She cannot pay for a $4,900-a-month memory care suite out of that income, but on paper she is too wealthy for Medicaid.
This is a bright-line test, not a sliding scale. Being $10 over is the same denial as being $1,000 over. It is also the single most common reason we see Central Florida families walk away from Medicaid believing they don't qualify when they actually do.
Florida law provides the fix: a Qualified Income Trust, also called a QIT or a Miller Trust. It is an irrevocable trust paired with its own dedicated bank account, and the Florida Agency for Health Care Administration must be named as the remainder beneficiary so the state can be reimbursed for benefits it paid.
The mechanics are simple but unforgiving. Each month, income is deposited into the trust account before the calendar month ends. Income that passes through a properly drafted QIT is no longer counted against the $2,982 cap, so the applicant becomes income-eligible. Money then flows back out in a set order: a $160 personal needs allowance for a nursing home resident, an income allowance for a spouse still living at home, health insurance premiums including Medicare and any supplement, and finally the patient responsibility paid to the facility.
Two details matter more than families expect. First, a QIT is not a savings account — it is meant to be emptied each month, and a balance that accumulates can create problems at review. Second, how much income to route through it is a judgment call: some attorneys deposit only the overage, while many Central Florida elder law attorneys direct an entire income stream, such as the whole pension check, to avoid a month where a cost-of-living bump quietly pushes the applicant back over. That decision belongs to an attorney who knows current Department of Children and Families policy, not to a template downloaded online.
A Qualified Income Trust solves income and nothing else. The asset test is separate and still applies: $2,000 in countable assets for a single applicant, $3,000 when both spouses apply. The homestead, one vehicle, and prepaid funeral arrangements are generally excluded, but bank accounts, a second property, and non-qualified brokerage holdings are not.
The five-year lookback is also untouched by a QIT. Gifts and below-market transfers inside that window create a penalty period calculated with Florida's 2026 transfer divisor of $10,645, and the home equity limit for 2026 is $752,000. Married couples get meaningful protection on the asset side instead: the community spouse may keep up to $162,660 in 2026 under the Community Spouse Resource Allowance, and a minimum monthly maintenance needs allowance between $2,705 and $4,066.50 can divert income from the applicant to the spouse at home.
The sequence matters. Apply through the DCF ACCESS system, complete the CARES assessment conducted by the Department of Elder Affairs, and have the QIT drafted, signed, and funded in the month you want coverage to begin — the ability to correct this retroactively is limited, and a trust funded on the first of next month does not repair this month's denial. Orange, Osceola, Seminole, and Brevard counties sit in SMMC Region 7, so once eligibility is approved your parent selects a long-term care plan serving that region.
If you are not sure whether your parent is over the cap at all, start by adding up gross monthly income from every source and comparing it to $2,982. The Elder Helpline at the Senior Resource Alliance (1-800-963-5337) can point you toward Central Florida legal aid and elder law resources, and our advisors can tell you which Orlando-area assisted living and memory care communities actually accept the SMMC Long-Term Care waiver — a shorter list than most families assume. This article is general information, not legal advice; confirm your own situation with a Florida elder law attorney.
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