Connecticut Miller Trust / Qualified Income Trust (HUSKY C)

QUALIFIED INCOME TRUST (MILLER TRUST)

(Irrevocable Income-Only Trust under 42 U.S.C. § 1396p(d)(4)(B))

APPLICABILITY IN CONNECTICUT — READ FIRST

Connecticut is a "medically needy" spend-down state (one of the section 209(b) states), not an income-cap state. A Qualified Income Trust (QIT / "Miller Trust") is generally NOT used and NOT required to establish Medicaid eligibility in Connecticut.

• Connecticut's Medicaid program is HUSKY Health; long-term-care Medicaid for the aged, blind, and disabled is HUSKY C, administered by the Connecticut Department of Social Services (DSS).
• Connecticut has no special income limit / 300% SSI "income cap" that bars long-term-care eligibility. An applicant whose income exceeds the Medically Needy Income Limit (MNIL) qualifies through a spend-down: the excess income is applied to incurred medical and care costs (including the nursing-home bill itself), after which Medicaid pays the remainder.
• Because there is no income cliff, an applicant is never "too rich" for HUSKY C long-term care on income grounds; high income means a larger spend-down, not disqualification. This spend-down is what a Connecticut applicant uses instead of a QIT.
• A nursing-facility resident retains a Personal Needs Allowance ($75/month in Connecticut) and may divert income to a community spouse under federal spousal-impoverishment rules (the MMMNA).

When this QIT instrument MAY apply in Connecticut. The trust below is a complete and federally valid instrument under 42 U.S.C. § 1396p(d)(4)(B). DSS's own public eligibility page lists a "Long-Term Care Medicaid (Institutionalized Individuals)" income limit of $2,982/month for 2026 (300% × the $994 SSI Federal Benefit Rate) — separate from the $851/month ordinary HUSKY C community income limit — which tracks the optional federal "special income level" for institutionalized individuals under 42 C.F.R. § 435.236. The weight of authority (including Connecticut elder law practitioners and the 209(b)/medically-needy classification confirmed by the Connecticut General Assembly's own research office) indicates Connecticut relies on the medically needy spend-down — not a Miller Trust — even for applicants over that figure, and that this trust form is rarely, if ever, used or recognized in Connecticut practice. Because DSS has not published a Uniform Policy Manual chapter describing QIT procedures (unlike states such as Georgia, Texas, or Ohio that plainly require one), do not execute or fund this trust for any Connecticut Medicaid program without first confirming in writing with the DSS eligibility worker and a Connecticut elder law attorney that (a) a special income limit applies to the specific program and (b) DSS will accept a QIT to satisfy it. Where DSS will not, use the medically needy spend-down instead.

TRUST IDENTIFICATION

ARTICLE I — RECITALS AND PURPOSE

1.1 Settlor. [SETTLOR FULL LEGAL NAME], an individual residing at [SETTLOR ADDRESS], in [____________] County/Town, Connecticut ("Settlor"), is the Settlor and primary lifetime beneficiary of this Trust.

1.2 Statutory Authority. This Trust is established pursuant to 42 U.S.C. § 1396p(d)(4)(B), which authorizes a "Qualified Income Trust" composed only of pension, Social Security, and other income of the individual, the corpus of which is paid to the State upon the individual's death up to the amount of medical assistance paid on the individual's behalf.

1.3 Purpose. The sole purpose of this Trust is to permit Settlor to satisfy the income requirements of any Connecticut Medicaid program that imposes a special income limit (300% of the SSI Federal Benefit Rate) by directing Settlor's monthly income (or such portion as is necessary) into an irrevocable trust so that the income deposited is not counted under that special income limit.

1.4 Irrevocability. This Trust is, and shall remain at all times, IRREVOCABLE. Settlor expressly waives and disclaims any power to alter, amend, revoke, or terminate this Trust except to the extent expressly required to maintain compliance with 42 U.S.C. § 1396p(d)(4)(B) and applicable DSS/Medicaid policy.

1.5 Compliance with Federal and State Law. This Trust shall be construed and administered to comply at all times with: (a) 42 U.S.C. § 1396p(d)(4)(B); (b) Conn. Gen. Stat. § 17b-261 et seq.; (c) Conn. Agencies Regs. § 17-134d-1 et seq. (DSS financial-eligibility regulations, also cited as R.C.S.A. § 17-134d-33 et seq.); and (d) the DSS Uniform Policy Manual. Any provision that conflicts with those authorities shall be deemed amended to the minimum extent necessary to achieve compliance.

ARTICLE II — TRUSTEE

2.1 Initial Trustee. [TRUSTEE FULL LEGAL NAME], whose address is [TRUSTEE ADDRESS], is appointed Initial Trustee. The Trustee may be (a) a Connecticut-chartered bank or trust company, (b) a competent adult family member or other adult, or (c) a professional fiduciary.

2.2 Successor Trustee. If the Initial Trustee resigns, dies, becomes incapacitated, or is otherwise unable or unwilling to serve, [SUCCESSOR TRUSTEE FULL LEGAL NAME], of [SUCCESSOR TRUSTEE ADDRESS], shall serve as Successor Trustee.

2.3 Settlor Shall Not Serve as Trustee. Consistent with DSS policy and to avoid challenges to the Settlor's lack of control over trust assets, Settlor shall not serve as Trustee of this Trust.

2.4 Trustee Bond. ☐ A bond is waived. ☐ Trustee shall post bond in the amount of $[________________].

2.5 Trustee Compensation. Trustee shall serve ☐ without compensation or ☐ for reasonable compensation not to exceed $[____] per month, provided such compensation is a permitted distribution under DSS policy and ARTICLE V.

ARTICLE III — FUNDING OF TRUST

3.1 Initial Corpus. This Trust shall be funded with a zero ($0.00) balance and shall be deemed established upon (a) execution of this instrument and (b) opening of a dedicated trust bank account titled exactly as follows:

"[TRUSTEE NAME], Trustee of the [SETTLOR NAME] Qualified Income Trust dated [__/__/____]"

3.2 Permitted Trust Property. The Trust shall receive ONLY the following categories of Settlor's income:

☐ Social Security retirement, disability, or survivor benefits
☐ Veterans Administration benefits
☐ Pension and retirement annuity payments
☐ Railroad Retirement benefits
☐ Civil Service Retirement payments
☐ Required Minimum Distributions from IRAs / 401(k)s / 403(b)s
☐ Other income of Settlor: [____________________________]

3.3 Prohibited Property. The Trust SHALL NOT receive:

(a) Any income, asset, or resource belonging to any person other than Settlor;
(b) Any of Settlor's countable resources, savings, or non-income assets;
(c) Gifts, inheritances, lump-sum settlements not classified as income, or other one-time payments unless those payments are characterized as income under SSI/Medicaid rules;
(d) Any property that would convert the Trust into a self-settled asset trust outside the scope of 42 U.S.C. § 1396p(d)(4)(B).

3.4 Timing of Deposits. Income directed into the Trust shall be deposited in the calendar month in which it is normally received by Settlor. Income not deposited timely may be counted as available income and may jeopardize eligibility.

3.5 Income Diversion. ☐ All of Settlor's income shall be deposited into the Trust each month. ☐ Only the portion of Settlor's monthly income that exceeds the applicable special income limit (300% of the SSI Federal Benefit Rate, $2,982/month for 2026, as adjusted annually) shall be deposited.

ARTICLE IV — REMAINDER BENEFICIARY (STATE PAYBACK)

4.1 Primary Remainder Beneficiary. Upon the death of Settlor, the Trustee shall pay from the remaining trust property all amounts up to the total amount of medical assistance paid on behalf of Settlor under the Connecticut State Plan to:

State of Connecticut Department of Social Services
Estate Recovery / Administrative Recoveries Unit
55 Farmington Avenue
Hartford, Connecticut 06105

4.2 Notice of Death. Within thirty (30) days after Settlor's death, the Trustee shall provide written notice to DSS, with a certified copy of the death certificate, and shall request a statement of the amount of medical assistance paid on behalf of Settlor (Conn. Gen. Stat. § 17b-93, § 17b-95).

4.3 Secondary Remainder Beneficiaries. If, and only if, DSS receives full reimbursement of all medical assistance paid on behalf of Settlor, any remaining trust corpus shall be distributed as follows:

4.4 Mandatory State Payback Controls. The DSS payback right under this Article supersedes any conflicting direction of Settlor and is binding on all secondary beneficiaries. This clause is required by 42 U.S.C. § 1396p(d)(4)(B) and may not be waived.

ARTICLE V — PERMITTED DISTRIBUTIONS DURING SETTLOR'S LIFETIME

5.1 Order of Monthly Distributions. Each month, the Trustee shall make distributions ONLY in the following order and ONLY to the extent permitted by current DSS policy:

(a) Personal Needs Allowance to Settlor in the amount established by DSS ($[____] per month; currently $75.00);
(b) Health Insurance Premiums including Medicare Part B, Part D, and supplemental (Medigap) premiums paid on behalf of Settlor;
(c) Community Spouse Monthly Income Allowance to Settlor's community spouse, if any, under federal spousal-impoverishment rules (the MMMNA);
(d) Family Allowance to dependent family members as authorized by DSS;
(e) Guardian / Conservator Fees approved by the Connecticut Probate Court, if applicable;
(f) Trustee Fee authorized under Section 2.5;
(g) Bank Fees for the trust account;
(h) Applied Income / Patient Liability payable to the nursing facility, assisted living, or HCBS provider in the amount determined by DSS.

5.2 Prohibited Distributions. The Trustee SHALL NOT:

(a) Distribute trust property to or for the benefit of any person other than Settlor or as authorized in Section 5.1;
(b) Make gifts of trust property;
(c) Pay any expense inconsistent with DSS policy or that would jeopardize Settlor's eligibility;
(d) Lend trust funds to any person;
(e) Accumulate trust income beyond what is necessary for ordinary administration of the Trust.

5.3 Zero Balance Goal. Trustee shall manage distributions so that the trust account is, to the extent practicable, reduced to or near zero at the end of each calendar month.

ARTICLE VI — ADMINISTRATIVE PROVISIONS

6.1 Accountings. Trustee shall maintain detailed monthly records of all deposits and disbursements and shall provide an accounting to DSS upon request and to Settlor (or Settlor's guardian/conservator/agent) at least annually.

6.2 Tax Matters. This Trust is a grantor trust for federal income tax purposes under 26 U.S.C. §§ 671–679. All trust income shall be reported on Settlor's individual income tax return (Form 1040). Trustee shall obtain a separate Employer Identification Number only if required by the financial institution.

6.3 Notice to DSS. Trustee shall provide a fully executed copy of this Trust, with the dedicated trust account information, to the DSS eligibility worker processing Settlor's application.

6.4 Termination. This Trust shall terminate upon (a) the death of Settlor and full distribution of remaining trust property under Article IV, or (b) Settlor's ineligibility for the relevant Medicaid program for any reason other than excess income, after all payback obligations to DSS have been satisfied. Reference is made to Conn. Gen. Stat. § 45a-486 regarding termination of inter vivos trusts where the settlor is a medical-assistance applicant or recipient.

6.5 Spendthrift Provision. No interest of any beneficiary shall be subject to voluntary or involuntary transfer, assignment, attachment, garnishment, or claim of creditors, except as required by 42 U.S.C. § 1396p(d)(4)(B) and DSS estate-recovery rights.

6.6 Severability. If any provision of this Trust is held invalid, the remaining provisions shall continue in full force and effect.

6.7 Governing Law. This Trust shall be governed by and construed under the laws of the State of Connecticut, including the Connecticut Uniform Trust Code (Conn. Gen. Stat. § 45a-499a et seq.), to the extent not preempted by federal Medicaid law.

ARTICLE VII — EXECUTION

IN WITNESS WHEREOF, the undersigned Settlor and Trustee have executed this Qualified Income Trust on the date first written above.

ACKNOWLEDGMENT (Connecticut Notarization — Conn. Gen. Stat. § 1-29 et seq.)

STATE OF CONNECTICUT
COUNTY OF [____________]

On this [____] day of [__________], 20[____], before me, the undersigned officer, personally appeared [SETTLOR FULL LEGAL NAME] and [TRUSTEE FULL LEGAL NAME], known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained.

In witness whereof I hereunto set my hand and official seal.

_________________________________
Notary Public / Commissioner of the Superior Court
My Commission Expires: [__/__/____]

(SEAL)

EXHIBIT A — TRUST FUNDING WORKSHEET

DRAFTING / FILING CHECKLIST

☐ FIRST confirm with DSS / Connecticut elder law attorney whether a QIT is actually permitted or required — Connecticut generally uses the medically needy spend-down, NOT a QIT
☐ Verify the applicable income standard (MNIL vs. 300% FBR special limit) for the specific program
☐ Confirm Settlor is otherwise eligible for HUSKY C (level of care, $1,600 single asset limit, citizenship, CT residency)
☐ Open dedicated trust bank account with $0 initial balance (only if a QIT is required)
☐ Re-direct income deposits to QIT account in month of receipt
☐ Provide signed Trust and account information to the DSS eligibility worker
☐ Confirm Trustee is not the Settlor
☐ DSS named as primary remainder beneficiary up to total medical assistance paid
☐ Notarize before a Connecticut Notary Public / Commissioner of the Superior Court
☐ Provide certified copy to community spouse, if applicable
☐ Calendar annual income-standard update

SOURCES AND REFERENCES

• 42 U.S.C. § 1396p(d)(4)(B) — federal Qualified Income Trust authority
• Conn. Gen. Stat. § 17b-261 et seq. — Connecticut Medical Assistance Program
• Conn. Agencies Regs. § 17-134d-1 et seq. (R.C.S.A. § 17-134d-33 et seq.) — DSS financial-eligibility regulations
• Conn. Gen. Stat. § 17b-93, § 17b-95 — state claim / recovery from estates
• Conn. Gen. Stat. § 45a-486 — termination of inter vivos trust (settlor or spouse is a medical-assistance applicant/recipient)
• Conn. Gen. Stat. § 45a-499a et seq. — Connecticut Uniform Trust Code
• Connecticut DSS "How to Qualify" (HUSKY C income/asset limits, incl. $2,982 institutionalized-individual figure): https://portal.ct.gov/HUSKY/How-to-Qualify
• Connecticut DSS HUSKY C / Long-Term Care: https://portal.ct.gov/dss
• medicaidplanningassistance.org, 209(b) state list (Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Virginia): https://www.medicaidplanningassistance.org/other-eligibility-pathways/

Template last updated: 2026-06-14. Connecticut is a medically needy (section 209(b)) spend-down state; verify whether a QIT is permitted for the specific program before execution. Confirm current MNIL, Personal Needs Allowance ($75), and 300% FBR figure with DSS before relying on this document.