Interactive Medicaid Guide
QIT Guide
When a Florida Medicaid recipient has a Qualified Income Trust, every dollar that arrives each month has a place it should go: the trust, the VA care money, or the personal checking account. Enter the income and the bills, and this guide shows the minimum and recommended trust deposit, the allowance the person keeps, the estimated patient responsibility, and which account pays each bill. Nothing you enter is saved or sent anywhere.
Start the guideUses the 2026 Florida figures, effective January 1, 2026.
Which account pays for what?
For a Florida Medicaid long-term care recipient. Enter the monthly income and bills, and the guide shows which account each bill should come from, what is left over, and where problems are building.
Start here: which Medicaid program?
The program changes how much income the person keeps and who receives the payment toward care.
Monthly income, before deductions
Use gross amounts. Split VA payments using the VA award letter: the basic pension counts, the aid and attendance or housebound part does not.
Figure the monthly IRA or 401(k) distribution
Use the account value on December 31 of last year and the owner's age at the end of this year. The IRS Uniform Lifetime Table gives the factor.
Health insurance premiums
These reduce what Medicaid requires toward care.
Trust deposit and balances
Is a QIT needed?
Yes. At least $318 must go into the QIT every month. Recommended transfer $1,125; entered $1,125.
What is owed toward care?
Paid every month to the provider the long-term care plan designates. DCF's notice controls the actual amount.
The monthly routine
Do these in the same order every month.
- Every check goes to his or her checking account. Social Security, VA, and pension payments all direct-deposit there, $4,300 a month in total. VA sends pension and aid and attendance as one payment, so it cannot be split at the source.
- On the day the last check of the month arrives, an automatic transfer moves $1,125 to the QIT. Set it up once with the bank. That is the larger of the minimum ($318, counted income of $3,300 minus the $2,982 cap) plus a small cushion, or the patient responsibility. It must post in the same month the income arrives.
- The trustee pays the patient responsibility from the QIT. About $1,115 this month, paid to the provider the long-term care plan designates. Anything left in the trust goes only to providers for his or her care, as the trust allows, or stays in the trust.
- Know what the VA aid and attendance does. $1,000 arrives with the VA check. It does not count toward the cap, but DCF counts it toward the patient responsibility, so it is not extra money. What he or she keeps after the patient responsibility pays his or her living costs and caregivers. To have caregiver costs lower the patient responsibility, DCF must recognize them as uncovered medical expenses.
- Before the month ends, bring personal accounts to $2,000 or less. Pay his or her bills and needs from checking. Projected end-of-month balance: $1,722.On track to stay under the limit.
- Every January, recompute. Social Security, VA, and the Part B premium all change. Update the recurring transfer the same month the new amounts start. The trustee also sends DCF quarterly statements of each month's deposit.
Rules to follow
The short version of what keeps Medicaid in place.
When income comes in
- All income goes by direct deposit into his or her regular checking account. Don't redirect any of it.
- Keep family money and gifts out of his or her accounts. Anything put in becomes his or her asset.
- Count Social Security at its gross amount, before Part B is taken out.
What goes into the QIT
- One automatic transfer from checking to the QIT, ideally at the same bank, on the day the last check of the month arrives.
- The amount is the larger of the minimum plus a small cushion, or the patient responsibility on DCF's notice.
- The transfer must post in the same month, come only from his or her income that month, and never exceed it.
- Only his or her income goes into the QIT. Never savings, refunds, or anyone else's money.
- Recalculate every January, and after any DCF notice, VA change, admission, or discharge.
Rent, food, clothing, personal items
- Paid from checking only, by him or her or his or her agent.
- At home: this is his or her living allowance of up to $2,982.
- Assisted living: room and board plus about $266 for personal needs. Pay room and board to the facility from checking.
- Nursing home: only the $160 personal needs allowance, for personal items. The facility provides room and food.
- Income not spent in the month it arrives counts as an asset the next month. What carries over, plus other countable assets, must stay at $2,000 or less. Check the balance at the end of every month.
Medical costs and caregivers
- Patient responsibility: the QIT pays it every month, directly to the facility, plan provider, or PACE organization.
- Premiums: Part B is usually taken out of Social Security. Medigap or other health premiums may be paid from the QIT directly to the insurer.
- Uncovered medical bills: pay from QIT surplus directly to the provider, and report each one to DCF. Medically necessary uncovered costs can lower future patient responsibility.
- Private caregivers: fair market pay only. A family caregiver needs a written care agreement signed before care begins, time logs, and proper payroll. Without them, payments look like gifts and can cause a penalty.
- Never pay him or her from the QIT, move QIT money back to checking, or pay into a joint account. Money from the trust to him or her counts as his or her income.
VA benefits: common questions
Bring the VA award letter. It breaks the payment into the parts that matter here.
Which VA payments count toward the income cap?
The basic VA pension, VA disability compensation, and DIC count toward the cap. Aid and attendance, the housebound allowance, and the unreimbursed medical expense allowance do not.
Does aid and attendance count toward patient responsibility?
Yes. DCF leaves it out when checking the income cap, but it counts it when setting the monthly patient responsibility. It is not extra money on top of the allowance. If private caregivers are needed, ask us about having DCF recognize their cost as an uncovered medical expense, which can lower the patient responsibility.
What happens to a VA pension in a nursing home?
For a single veteran or surviving spouse with no dependents in a Medicaid nursing home, the VA reduces the improved pension to $90 a month. That $90 is not counted for eligibility or for patient responsibility, and the person still keeps the $160 personal needs allowance. Tell the VA when Medicaid starts.
Can unspent aid and attendance build up?
Not for long. Like any income, what is not spent in the month it arrives counts as an asset the next month. The same is true of a VA back payment: the part left over the next month counts toward the asset limit.
The three pots of money
Each month, money lands in up to three places. Each pot has its own rules.
Income trust (QIT)
- Uncovered doctor, dental, hearing aid, and eyeglass bills
- Prescriptions and medical supplies the plan does not cover
- Health insurance premiums
- Transportation to medical appointments
- Private caregivers, once DCF approves the cost
VA care money
- Private caregivers and adult day care
- Medical costs not covered
- Home safety changes, such as grab bars or a ramp
- Any of his or her other needs, if care is already paid
Personal account
- Rent or mortgage, taxes, insurance, utilities
- Groceries, clothing, toiletries, haircuts
- Home repairs and upkeep
- Caregivers or medical costs the other pots do not cover
- A prepaid funeral plan, after talking to us
Monthly bills and where each one is paid from
Enter a monthly amount for each bill. The guide fills each bill from the right pot, in order.
Care and medical
Why
DCF counts all income, inside the trust and out, then subtracts the allowance, any spouse allowance, and uncovered medical costs including insurance premiums, in that order. What is left is owed each month to the nursing home, the provider the long-term care plan designates, or the PACE organization. It comes first from the trust, because that is what the trust deposit is for. If it goes unpaid, coverage is at risk.
Why
Usually taken out of the Social Security check before it arrives. If it is billed instead, the trust may pay it.
Why
Health insurance premiums are a proper use of trust money. They also lower the patient responsibility, so DCF needs a copy of the premium notice.
Why
A health insurance premium. The trust may pay it, and it lowers the patient responsibility. If Part D is withheld from Social Security, enter it anyway so DCF's budget is right.
Why
Health-related insurance premiums. A long-term care policy pays first for the care it covers, so tell DCF about any benefits it pays.
Why
Premiums for a retiree health plan or other health coverage. The trust may pay them, and they lower the patient responsibility.
Why
Aid and attendance is meant for care, but DCF counts it toward patient responsibility, so caregivers are paid from what he or she keeps after the patient responsibility. The trust can pay caregivers only after DCF recognizes the cost as an uncovered medical expense. That takes a doctor's order, proof the waiver plan does not cover those hours, a written caregiver agreement at a reasonable rate, and timesheets. A family member as caregiver needs a written agreement before any payment.
Why
Treated like private caregivers. Excluded VA money first. The trust only after DCF recognizes the cost.
Why
Uncovered medical costs are a proper use of trust money. The trustee pays the provider directly, never the person. Report recurring costs to DCF, because they can lower the patient responsibility.
Why
Medical expense. Trust money may pay it, sent to the pharmacy.
Why
Incontinence supplies, walkers, and similar items the plan does not provide. A medical expense the trust may pay.
Why
DCF recognizes reasonable transportation to obtain medical care as a medical expense. Keep a log of trips and receipts.
Why
Bills from before Medicaid started may be payable from the trust, depending on its wording, and a few may qualify as an uncovered medical expense deduction. Call us before paying one from the trust.
Home
Why
A living expense, paid from the personal account. Some trust documents allow the trustee to pay the person's own household bills directly to the company. Ask before doing that.
Why
A home expense, paid from the personal account. The trust pays it only if the trust document allows, and then directly to the county. Ask first.
Why
A home expense. Personal account only.
Why
A home expense. Personal account only.
Why
A living expense. Personal account only.
Why
Ordinary upkeep is a living expense, paid from the personal account.
Why
A change needed because of a medical condition may be a medical expense, especially with a doctor's note. Ask us before using trust money.
Daily living
Why
Food is a living expense, paid from the personal account. Trust money is not handed to the person for groceries; any payment from the trust back to him or her counts as his or her income.
Why
Personal account only.
Why
Personal account only.
Why
Personal account only.
Why
Personal account only.
Why
Income in the trust is generally still taxed to the person. Pay taxes from the personal account.
Why
Fees the bank charges on the trust account itself are normally paid by the trust.
Watch out
Why
An irrevocable prepaid funeral can be a good use of extra money, but it must be set up correctly to avoid a Medicaid problem. Never from the trust. Ask us first.
Why
Usually paid from the personal account. Whether the trust may pay any of it depends on the trust document. Ask first.
Why
Giving money away can cause a Medicaid penalty period, and trust money can never be used for anyone else. Do not pay this from any account without talking to us.
Why
DCF can treat payments to family without a written caregiver agreement as gifts. Put a personal care agreement in place first, then the payments move to Private caregivers.
Want the trust deposit confirmed for your family?
DCF's notice and the trust document control what the trustee may pay. Before changing a deposit or paying an unusual bill from the trust, talk with an attorney who handles Florida Medicaid every day.
Schedule a consultation