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Coverage for institutionalized individuals and related groups under the special income rule

States may extend Medicaid to certain individuals with incomes too high to qualify for SSI, and who are eligible for nursing facility or other institutional care. Under the special income rule, also referred to as “the 300 percent rule,” such persons must (1) require care provided by a nursing home or other medical institution for no fewer than 30 consecutive days, (2) meet the resource standard determined by the State, and (3) have income that does not exceed a specified level – no greater than 300 percent of the maximum SSI payment applicable to a person living at home. For 2022, this limit is $2,523 per month, three times the monthly SSI payment of $841. States may use a level that is lower than the maximum of 300 percent of SSI.

Since 1993 (OBRA 93), States that use only the special income rule for institutional eligibility, and do not use the medically needy option (described below), must allow applicants to place income in excess of the special income level in a special trust, often called a Miller Trust [Note 19], and receive Medicaid coverage for their care. Following the individual’s death, the State becomes the beneficiary of amounts in the trust.

Note 19: See Miller v. Ybarra, 746 F.Supp. 79 (E. Colo 1990); and see 42 U.S.C. § 1396p(d)(4)(B). These trusts are known as Qualified Income Trusts. The updated income cap information each year is linked to’s Spousal Impoverishment page.

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