The income-cap rule is where Indiana planning has to start. With the 2026 institutional and waiver income cap set at $2,982 per month, anyone over that line needs a Qualified Income Trust — the Miller Trust — instead of the medically needy spend-down that many other states allow.
A QIT is not a way to shelter assets; it's a mechanism for managing excess income. Indiana's published guidance describes it as an irrevocable trust funded with the applicant's income, naming the State of Indiana as remainder beneficiary up to whatever Medicaid ends up paying, and administered within a required post-eligibility framework. Getting the paperwork right before the relevant coverage month — and keeping up with ongoing deposit and accounting rules — is what makes a QIT actually work.
On top of the income cap, Indiana planning has to account for the five-year transfer look-back and the state's expanded estate-recovery definition, which reaches nonprobate transfers. That combination makes title planning — deciding how a home or other asset is held, not just when it's transferred — just as important as the trust paperwork.