What are valid expenses that reduce income to avoid exceeding the Medicaid income limit?

Medicaid eligibility rules with respect to income vary by state...what state are you in?

Many states permit the income to be spent down on medical expenses--even on the nursing home--in order to reduce it below the technical maximum income amount permitted under Medicaid rules.

Other states allow the applicant to set up a Qualified Income Trust (also known as a Miller Trust) to hold the income. The income is paid into the trust and the trustee pays it over to the nursing home, and Medicaid pays the difference between the income and the nursing home cost.

In short, it is virtually impossible to have too much income regardless of the state you are in, unless the income is so high that it exceeds the actual cost of the nursing home.

Gary is it the situation that her monthly income from SS, disability monthly income, retirement income or other monthly income have been over time increasing so that now she is close to or will be over the ceiling allowed by your state for monthly income for Medicaid??

If so that's a bit different of a problem than having extra funds as assets.

For those who have guaranteed monthly income (like SS, federal retirements, most civil service type retirements) and it runs above the allowed $ amount by Meducaid, they can do a Miller trust. Miller is totally legit and done all the time. The facility usually won't mention Miller nor wil SSA as this is giving legal advice. Miller is not a DIY project IMHO a good attorney or FA can get it structured for your wife do that it works for your states laws & is flexible for future changes in income.

For example, when I applied for Medicaid for my mom in TX the monthly income limit was $ 2,064 a month. So if mom had $ 3,064 in income, she would be 1K over the maximum allowed so disqualified for Medicaid. But by doing a Miller, it gets the overage income so VOILA!! mom is within medicaid limits. Miller is structured differently in each state, some states have it do it is more like a traditional trust and builds each month and when they die miller reverts to the state. While other states have it so that all monthly income gets paid out from miller to the facility so no building of a miller kitty. The state is the beneficiary of the Miller trust in all situations.

There was a poster on this site who did one for her mom in FL, ran about $1500 in legal and it is the full pay out each month type direct to the facility - daughter lives out of state so management wise this works well. Now the income must be guaranteed source of income to work so make sure it is. Good luck.

My familiarity with miller is due to having within our family, railroad retirement folks. RR pays really really well & high retirement $amounts. 3-5k a month for RR is pretty normal. But not enough for NH costs but over Medicaid limits. Miller is the solution to get them Medicaid eligible.

We do own our home - 6 years ago we "spent down" to qualify for Medicaid and among other things paid off our mortgage.
Presently we are credited with expenses for monthly Medicare and my retirement (I don't qualify for Medicare) insurance which I cover my wife as well. So - answer to cberryman is yes.
Kathy - I'm in the process of establishing a "Special Needs trust".
The real issue here is the Dept of Health Services wont provide advise - they claim they don't want to be held responsible if we make a bad decision based on their input.... a result being, I have no idea what the correct approach is to address this problem.

My mom has Medicaid and pre-paid her funeral expenses to spend down the extra income after selling her car. You need to use a funeral home that deal with the Medicaid "Choices" program.

If you own the home where you reside (not a vacation home) you could put in a new furnace roof, other needed repairs. Not anything outlandish, but repairs that anyone would expect.to be needed as in when you go to buy a house, a certified home inspector would give a list of problems (like a bad roof, old inefficient furnace, rotten windows, cracked & dangerous sidewalk). Actually, you could start by having your home inspected by 2 or 3 certified inspectors and I don't know how Medicaid could quibble if you made truly necessary repairs. Don't forget to check for radon levels, and operational well & septic system. Good luck.

For the State Of Wisconsin which has both Family Care in some Counties and
Community Options/Partnership in other Counties( also called Home and community based Waivers) there are three income groups.
A* Income eligible for other Full Benefit MA program
B* Gross Income under $2199 - may have cost share
C* Gross income Above $2199= will have to pay towards the cost of care, called a Cost Share in certain circomstances the spend down is all but $591 a month ( Residential Care Apartment or living independently in the Community.)
Cost of Care must be Greater than gross income*
In addition to these programs Wisconsin has Institutional Medicaid, FOr a person who meets Level of Care and has assets below $2000. ( Nursing Home) If the Cost of Care is above the person's income. All income except $45 Personal Needs Allowance goes toward the Nursing Home bills, Medicaid pays the balance.
I know that the rules of eligibility are complex. For the most accurate information see your Cou nty Aging and Disability Resource Center, Economic Support Office, a Medicaid Planning Attorney, or consult :
https://www.dhs.wisconsin.gov/health-care-coverage/health-care-coverage/medicaid/badgercare-plus/medicaid-elderly-blind-and

For the Record Wisconsin does not have "Miller " trust we have Special Needs Trust for Disabled people , WISPAC Trust.
Medical Expenses are not counted when calculating Gross Income
Example:Medicare Part B Premium, Medical, Dental, Vision Insurance Premiums.

Gary - ok, that makes a huge difference in how to approach the situation. Having excess assets (money in the bank, CD's) are pretty simple, you just spend all the money to get to 2K. But increasing months income is whole different sticky.

Hmmm - the farm trust may be an issue for doing a Miller. Miller requires the monthly income be from a guaranteed or "qualified" source. The farm may not meet that criteria. But what might be able to be done is have the other sources of income (which are probably "qualified" or guaranteed) go into the Miller and then the farm trust $ stays outside of Miller. Really you need experienced legal to set this up - I'd look for a NAELA certified atty and also if it's such that she could do a SNT maybe get that done. There will be a way around the problem you just need someone experienced to do this that works for legal in your state.

On another note, if she was diagnosed when younger, she may qualify for the new this year ABLE program - it's a specific type of trust for those who have a disability before age 25 or 28? I am a trustee for my cousin who had 1950's polio, he is totally competent but physically it is not good as he is having secondary polio issues. He has a SNT set up by his parents (now dead), we are looking into moving $ from the SNT to an ABLE to get his trust defunded somewhat sooner than what is presently planned. ABLE allows for up to 14K placed each year that is totally outside of any Medicaid $ limits - so over 5 years you could have a 70K that doesn't count against them. I think Able allows up to 100K. Google ABLE to see if she could qualify to have been diagnosed within the age limit. ABLE does not work for elderly / aging dementia issues. ABLE is like spanking new for 2014 and just being set up in states - it seems to be so that only certain banks are able to ABLE (like what SBA does in having SBA preferred lenders). Good luck.

Thanks all for the input. Presently her income is within the program limits, so this issue is hypothetical - hopefully I wont have to pursue this, but I want to know my options.
Igloo - my wife was diagnosed with MS when she was 45.
And, I've been "googling" for Miller Trust - but not getting anything for Wisconsin. With all the unique Medicaid provisions from state-to-state, I wonder if a Qualified Income Trust (Miller Trust) is recognized in Wisconsin?