El Paso Senior AdvisorBy El Paso Senior Advisor Care Team · November 10, 2026
In 2026, Texas nursing facility Medicaid requires countable income at or below $2,982 a month. An El Paso resident over that limit can still qualify by depositing whole income sources into an irrevocable Qualified Income Trust each month. The trust does not shelter savings, the $2,000 resource limit still applies, and the resident still pays nearly all income toward care.
What is a Qualified Income Trust for El Paso nursing home Medicaid?
A Qualified Income Trust, often called a Miller trust, is an irrevocable trust that holds only a person's monthly income so that Texas Medicaid does not count that income against its limit for nursing facility care. It lets an El Paso resident whose income is a little too high for Medicaid, but far too low to pay a nursing home privately, qualify.
Texas uses a hard income cap for nursing facility and home and community-based waiver Medicaid. Without a trust, a parent who earns $1 over the cap is ineligible, even though Texas Health and Human Services estimates the average private-pay nursing home stay at $262.37 a day, about $7,870 for a 30-day month. Congress created income diversion trusts in 1993 for exactly this gap.
Income properly deposited into the trust is disregarded when Texas tests eligibility. In El Paso County, 21 of the 22 licensed nursing facilities on HHSC's current list are certified for both Medicare and Medicaid; the exception is Las Ventanas De Socorro, which is Medicare only. See every facility in our El Paso nursing home directory.
Who in El Paso needs a Qualified Income Trust in 2026?
An El Paso resident needs a Qualified Income Trust when their countable monthly income is above $2,982, the 2026 Texas special income limit for nursing facility and waiver Medicaid, and they otherwise qualify. Income at or below $2,982 needs no trust at all.
| 2026 Texas figure | Amount | What it means |
|---|---|---|
| Special income limit (individual) | $2,982 a month | Countable income above this needs a trust |
| Special income limit (couple) | $5,964 a month | When both spouses apply |
| Resource limit (individual) | $2,000 | Not changed by a trust |
| Personal needs allowance | $75 a month | Kept by a nursing facility resident |
| Average private-pay day | $262.37 | HHSC's estimate, also the transfer penalty divisor |
The limit applies to countable income only. Some VA payments, such as Aid and Attendance, are not counted, and a VA pension is reduced automatically for a Medicaid nursing home resident, so check before assuming a trust is needed. Our VA Aid and Attendance guide explains those benefits. Pension income split between spouses by a court order is counted only for the spouse whose name is on the check.
How do you set up a Qualified Income Trust in El Paso?
You set one up by signing a valid trust document, opening a separate bank or credit union account under your parent's Social Security number, and depositing the entire amount of each chosen income source into it every month. Texas recognizes the trust only from the first month all three are done.
The trust must be irrevocable, hold only income, and name the State of Texas as the residuary beneficiary for what Medicaid paid, up to the balance left at your parent's death. HHSC publishes a model trust instrument and recommends that the person receiving care not serve as their own trustee; an adult child often does.
Choose which income sources go in. You may route only a pension and not Social Security, but the whole pension check must be deposited, in the same month it arrives. A bank may ask for a $10 to $20 opening deposit, which Texas allows. Never add savings or other people's money: a deposit of savings turns the account into a countable resource.
The trustee then pays out by the end of the following month: the personal needs allowance, any court-ordered guardianship fees, an allowance for a spouse at home, and the rest toward the cost of care. Once the trust is valid, Texas can disregard the income for up to three months before the application date if your parent met every other rule. If a monthly deposit is missed, that month counts as income-ineligible and Texas can ask for the Medicaid payment back.
What does an El Paso nursing home resident pay each month with a Qualified Income Trust?
With a Qualified Income Trust, the resident still pays almost all of their income to the nursing home each month, keeping a $75 personal needs allowance, and Medicaid pays the rest. The trust changes whether your parent qualifies, not how much of their income goes to care.
Here is an illustration using an El Paso resident with $1,900 a month from Social Security and a $1,500 pension, $3,400 in all. That is $418 over the limit, so the trust takes the entire pension.
| Step | Without a trust | With a trust holding the pension |
|---|---|---|
| Countable income for eligibility | $3,400 | $1,900 |
| Under the $2,982 limit? | No, ineligible | Yes |
| Income used in the monthly co-payment | Not applicable | $3,400, all sources |
| Kept by the resident | Not applicable | $75 allowance |
| Private-pay cost at $262.37 a day | About $7,870 for 30 days | Medicaid pays above the co-payment |
Trust administration costs are not deducted from the co-payment, and other allowed deductions can lower it, so ask the facility's business office to walk through your parent's figures. Read the facility's ratings first in our guide to El Paso nursing home star ratings.
Qualified Income Trust vs. special needs trust: what a Miller trust is not
A Qualified Income Trust is not a special needs trust and does not shelter savings. It holds only income, and the $2,000 resource limit still applies; a special needs trust is a different tool used for people with disabilities under 65 to protect assets.
A Qualified Income Trust also does nothing for citizenship, residency or the medical need for nursing facility care, which Texas tests separately. And it does not help with Community Attendant Services, Medicare Savings Programs or SSI, because diverted income still counts for those programs.
For a married couple, the trust can pay the spouse at home an allowance, and Texas separately protects between $32,532 and $162,660 of a couple's savings in 2026. Our spouse protections page covers how those amounts are set. If assisted living rather than a nursing home is the goal, the same income limit applies to the waiver, explained in our STAR+PLUS guide.
Where can El Paso families get help with a Qualified Income Trust?
El Paso families can start with the Rio Grande Area Agency on Aging at (915) 533-0998 for benefits counseling, then use an elder law attorney or legal aid to draft or review the trust. Texas Health and Human Services staff can review a trust but are not allowed to tell you how to become eligible.
Bring your parent's award letters and recent bank statements to the first conversation. HHSC lists legal aid offices, area agencies on aging, local bar associations and the National Academy of Elder Law Attorneys as places to find counsel. A small trust drafting error can cost a month of coverage, so a legal review is worth it.
If savings are also running out, our money running low guide lays out next steps, and our advisors can tell you which El Paso nursing facilities currently accept new Medicaid residents. Talk to an advisor at no cost.
Related questions: Does a trust change the co-payment? Can a spouse at home keep income? Which El Paso facilities take Medicaid?
Last verified: November 2026.
Frequently asked questions
What is a Qualified Income Trust for El Paso nursing home Medicaid?
A Qualified Income Trust, often called a Miller trust, is an irrevocable trust that holds only a person's monthly income so that Texas Medicaid does not count that income against its limit for nursing facility care. It lets an El Paso resident whose income is a little too high for Medicaid, but far too low to pay a nursing home privately, qualify.
Who in El Paso needs a Qualified Income Trust in 2026?
An El Paso resident needs a Qualified Income Trust when their countable monthly income is above $2,982, the 2026 Texas special income limit for nursing facility and waiver Medicaid, and they otherwise qualify. Income at or below $2,982 needs no trust at all.
How do you set up a Qualified Income Trust in El Paso?
You set one up by signing a valid trust document, opening a separate bank or credit union account under your parent's Social Security number, and depositing the entire amount of each chosen income source into it every month. Texas recognizes the trust only from the first month all three are done.
What does an El Paso nursing home resident pay each month with a Qualified Income Trust?
With a Qualified Income Trust, the resident still pays almost all of their income to the nursing home each month, keeping a $75 personal needs allowance, and Medicaid pays the rest. The trust changes whether your parent qualifies, not how much of their income goes to care.
Qualified Income Trust vs. special needs trust: what a Miller trust is not
A Qualified Income Trust is not a special needs trust and does not shelter savings. It holds only income, and the $2,000 resource limit still applies; a special needs trust is a different tool used for people with disabilities under 65 to protect assets.
