Medicaid Income Trust PDF Details

As a Medicaid recipient, you may be aware of the Medicaid income trust form. This is a legal document that allows you to protect your assets and still receive Medicaid benefits. However, there are some things you should know about this form before you decide whether or not to use it. In this blog post, we will discuss the pros and cons of using the Medicaid income trust form and provide some tips on how to make the most of it.

In the listing, there's some good information in regards to the medicaid income trust. You might want to look at it just before filling out the gaps.

Form NameMedicaid Income Trust
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesflorida qualified income trust form florida, florida qualified income trust, florida qualified income trust template, sample miller trust florida

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Qualified Income Trust Information Sheet

What is a Qualified Income Trust?

If your income is over the limit to qualify for Medicaid long-term care services (including nursing home care), a Qualified Income Trust (QIT) allows you to become eligible by placing income into an account each month that you need Medicaid. The QIT involves a written agreement, setting up a special account and making deposits into the account.

Who needs a Qualified Income Trust?

You need a QIT if your income before any deductions (such as taxes, Medicare or health insurance premiums) is over the limit to qualify for the Institutional Care Program (ICP), Institutional Hospice, Program of All-Inclusive Care for the Elderly (PACE) or the Home and Community Based Services (HCBS) waivers.

How do I set up a Qualified Income Trust agreement?

You may obtain professional help to set up the QIT agreement, but it is not required. A QIT agreement must meet specific requirements and be approved by Department of Children and Families legal offices. You must submit a copy of the QIT agreement to an eligibility specialist who will forward it to our legal offices for review.

What items must be included in the Qualified Income Trust agreement? The QIT agreement must:

Be irrevocable (cannot be canceled).

Require that the State will receive all funds remaining in the trust at the time of your death (up to the amount of Medicaid benefits paid on your behalf). Consist of your income only. (Do not include or add assets).

Be signed and dated by you, your spouse, or a person who has legal authority to act on your behalf or who is acting at your request or the request of your spouse.

How does the Qualified Income Trust account work?

After setting up the account, you must make deposits into the QIT account every month for as long as you need Medicaid. This means you may need to make deposits before a Medicaid application is approved if you need Medicaid coverage.

You cannot make deposits for a past or future month. Any income you receive back from the trust to you will be counted as income to you.

If you fail to make a deposit in any given month, or to deposit enough income you will be ineligible for Medicaid payment of long- term care services for the month.

As long you deposit income into the QIT account in the month it is received, it will not be counted when we determine if you are eligible for Medicaid for that month.

How much income must I deposit into the Qualified Income Trust account?

You must deposit enough income into the QIT account each month so that your income outside the QIT account is within program standards. It is better to deposit more income than take the chance of depositing too little to qualify for Medicaid. Call (866) 762-2237 or visit for information about current income standards.

What happens to the income I deposit in the Qualified Income Trust account?

The income you have in and out of the QIT is used to calculate your patient responsibility. If you do have a patient responsibility, you are responsible for paying that amount. If there is money left in the QIT upon your death, it is paid to the State, up to an amount equal to the total medical assistance paid on your behalf by the state while the trust was in effect.

How to pay funds remaining in the QIT to the State?

The QIT trustee or other individual acting on your behalf should contact the long term care facility to see if any refund for the month of death is due back to the trust. The balance of the QIT at the date of death, plus any refund from the long term care facility is to be paid to the State.

Mail a check payable to the “Agency for Health Care Administration” to: Xerox State Healthcare, LLC

PO Box 12188 Tallahassee, FL 32317-2188

A brief cover letter or note should state that the payment is for a QIT and include your name, Social Security number, and/or Medicaid ID number. Enclose a copy of the QIT bank statement covering the date of death to confirm the check is for the balance. Also, include documentation of any refunds received from the long term care facility. Contact Xerox State Healthcare, LLC at (877) 357-3268 if you have questions about payment of QIT funds to the State.

Watch Medicaid Income Trust Video Instruction

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