District of Columbia Miller Trust / Qualified Income Trust

QUALIFIED INCOME TRUST (MILLER TRUST)

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

APPLICABILITY IN THE DISTRICT OF COLUMBIA — READ FIRST

The District of Columbia is a "medically needy" spend-down jurisdiction, not an income-cap jurisdiction. A Qualified Income Trust (QIT / "Miller Trust") is generally NOT used and NOT required to establish Medicaid eligibility in the District.

• The District's Medicaid program is administered by the Department of Health Care Finance (DHCF).
• The District has no general income cliff that bars long-term-care eligibility. An applicant whose income exceeds the Medically Needy Income Level (MNIL) — $856.90/month for an individual, effective February 1, 2026 through January 31, 2027 (adjusted annually; confirm current figure with DHCF) — qualifies through the District's Medically Needy Spend-Down: excess income is applied to incurred medical bills over a spend-down period (in the District, up to six (6) months for long-term care; one month for community Medicaid), after which Medicaid pays the remainder.
• Because of this spend-down structure, an applicant is never "too rich" for DC Medicaid long-term care on income grounds; excess income becomes a spend-down obligation rather than a disqualification. This is the mechanism a District applicant uses instead of a QIT.
• The District is also among the jurisdictions that commonly use a § 1396p(d)(4)(C) pooled income trust (administered by a nonprofit) for excess income of disabled individuals as an alternative planning tool.

When this QIT instrument MAY apply in the District. The trust below is a complete and federally valid instrument under 42 U.S.C. § 1396p(d)(4)(B). In the District its use is limited to the narrow circumstance (if any) in which a special income limit equal to 300% of the SSI Federal Benefit Rate — $2,982/month for 2026 (300% × $994 FBR) — is actually imposed on a specific program, such as the Elderly and Persons with Physical Disabilities (EPD) Waiver or institutional Nursing Home Medicaid where the District applies the special income standard. Do not execute or fund this trust for general DC Medicaid eligibility. Confirm with DHCF and a District of Columbia elder law attorney that a QIT (rather than a spend-down or a pooled income trust) is permitted and necessary for the specific program before proceeding.

TRUST IDENTIFICATION

ARTICLE I — RECITALS AND PURPOSE

1.1 Settlor. [SETTLOR FULL LEGAL NAME], an individual residing at [SETTLOR ADDRESS], in the District of Columbia ("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 (here, the District of Columbia) 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 District of Columbia 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 DHCF/Medicaid policy.

1.5 Compliance with Federal and District Law. This Trust shall be construed and administered to comply at all times with: (a) 42 U.S.C. § 1396p(d)(4)(B); (b) the District's Medicaid authority (D.C. Code § 1-307.02); (c) D.C. Mun. Regs. tit. 29, ch. 95 (Medicaid eligibility, including the medically needy spend-down) and ch. 67 (Medicaid liens and estate recovery); and (d) applicable DHCF policy transmittals. 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 bank or trust company authorized to do business in the District, (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 DHCF 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 DHCF 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 (DISTRICT 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 District of Columbia Medicaid State Plan to:

District of Columbia Department of Health Care Finance (DHCF)
Office of Program Integrity / Estate Recovery
441 4th Street NW
Washington, DC 20001

4.2 Notice of Death. Within thirty (30) days after Settlor's death, the Trustee shall provide written notice to DHCF, with a certified copy of the death certificate, and shall request a statement of the amount of medical assistance paid on behalf of Settlor (see D.C. Mun. Regs. tit. 29, ch. 67, §§ 6700 et seq. (Medicaid Program — Liens and Adjustments or Estate Recovery)).

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

4.4 Mandatory District Payback Controls. The DHCF 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 DHCF policy:

(a) Personal Needs Allowance to Settlor in the amount established by DHCF ($[____] per month);
(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 DHCF;
(e) Guardian / Conservator Fees approved by the Superior Court of the District of Columbia, Probate Division, if applicable;
(f) Trustee Fee authorized under Section 2.5;
(g) Bank Fees for the trust account;
(h) Patient Liability / Cost of Care payable to the nursing facility, assisted living, or HCBS provider in the amount determined by DHCF.

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 DHCF 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 DHCF 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 DHCF. Trustee shall provide a fully executed copy of this Trust, with the dedicated trust account information, to the DHCF / Economic Security Administration 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 DHCF have been satisfied.

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 DHCF 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 District of Columbia, including the District of Columbia Uniform Trust Code (D.C. Code § 19-1301.01 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 (District of Columbia Notarization)

DISTRICT OF COLUMBIA, ss:

On this [____] day of [__________], 20[____], before me, the undersigned Notary Public in and for the District of Columbia, 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.

WITNESS my hand and official seal.

_________________________________
Notary Public, District of Columbia
My Commission Expires: [__/__/____]

(SEAL)

EXHIBIT A — TRUST FUNDING WORKSHEET

DRAFTING / FILING CHECKLIST

☐ FIRST confirm with DHCF / District elder law attorney whether a QIT is actually permitted or required — the District generally uses the medically needy spend-down (or a pooled income trust), NOT a QIT
☐ Verify the applicable income standard (MNIL vs. 300% FBR special limit) for the specific program
☐ Confirm Settlor is otherwise eligible for DC Medicaid (level of care, applicable asset limit, citizenship, DC 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 DHCF / ESA eligibility worker
☐ Confirm Trustee is not the Settlor
☐ DHCF named as primary remainder beneficiary up to total medical assistance paid
☐ Notarize before a District of Columbia Notary Public
☐ 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
• 42 U.S.C. § 1396p(d)(4)(C) — pooled income trust (alternative tool commonly used in DC)
• D.C. Code § 1-307.02 — District of Columbia medical assistance program (Title XIX state plan authority)
• D.C. Mun. Regs. tit. 29, ch. 95, §§ 9515-9516 — Medically Needy eligibility group; Spend Down for Medically Needy Coverage
• D.C. Mun. Regs. tit. 29, ch. 67, §§ 6700 et seq. — Medicaid Program: Liens and Adjustments or Estate Recovery
• D.C. Code § 19-1301.01 et seq. — District of Columbia Uniform Trust Code
• D.C. Code §§ 19-1305.02, 19-1305.03 — spendthrift provision and exceptions (enforceable against a claim of the District or the United States)
• DC Department of Health Care Finance — Medically Needy Spend-Down: https://dhcf.dc.gov/service/medically-needy-spend-down
• DC Department of Health Care Finance — Medicaid Estate Recovery Policy: https://dcps.dc.gov/sites/default/files/dc/sites/dhcf/release_content/attachments/Info%20on%20Estate%20Recovery%20for%20DHCF%20gov_final.pdf
• Social Security Administration — SSI Federal Payment Amounts for 2026 (FBR $994/individual): https://www.ssa.gov/oact/cola/SSI.html

Template last updated: 2026-07-06; last verified against code.dccouncil.gov, dhcf.dc.gov, and ssa.gov on 2026-07-06. The District of Columbia is a medically needy spend-down jurisdiction; verify whether a QIT (rather than a spend-down or pooled income trust) is permitted for the specific program before execution. Confirm current MNIL, spend-down period, and 300% FBR figure with DHCF before relying on this document.