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Is your Mother on Community in home Medicaid? If a QTI trust works like a Special Needs trust, there is a Trust paoerwork you can refer to. My nephews SNT has it listed what I can and can't spend it on. No food or housing or utilities. These things he can get help with. I can pay his phone bill and cable but not buy him a phone with the trust. I can buy him stamps.
I would call your Dept of Disabilities and see if they can help with the ramp. Seems you need a certain design. Dr visits, are they really warranted? Do her doctors know how hard it is to get her out of the house? Do they have Nurse Practioners that can come to the house? There comes a time when we just cut out certain doctors. My Mom had a couple of specialists, when she was stable her PCP took over. If she had worsened, back to the specialtist she would have gone. Her PCP had her coming back every two months, found out there was no need for that. She did every six months and that was for refills.
As to Transit I would first check in your city or town; local public transit agencies might even offer mobility counselors who can help to find accessible/affordable w/c options; Uber and Lyft often have programs you can join as a senior or disabled programs for a fraction of normal transit costs. Ask at your senior centers or check with your local council on aging. Many transportation options provide W/C accessible vans.
Wishing you good luck researching in your area. I know what's what in my own city, but cannot speak to yours.
And sorry, but just don't know a thing about QIT. Hoping others here do.
I just came back in to edit and say that Igloo just answered your question regarding QITs. From what I can see this irrevocable trust could not be used to withdraw from any time there was a need for transit or anything else, but do PM igloo if you have a specific question, because for me she's the master of these questions on Forum.