№ TAMPFL
Diane Crawford
Crawford Estate & Trust Law
Elder LawTax LawEstate Planning
- City
- Tampa
Estate Planning · Sub-Practice
Medicaid Planning
Nursing home care can cost $100,000 a year or more. Medicaid planning protects your family from financial devastation.
§ Overview
What your case actually involves.
Medicaid is the primary government program paying for long-term care in the United States. Understanding its eligibility rules — and planning around them legally — is one of the most valuable things an elder law attorney can do for a family.
Medicaid is a needs-based program with strict income and asset limits. For single individuals, asset limits are typically $2,000 in many states. For married couples, the community spouse (the spouse not in the nursing home) can keep a "community spouse resource allowance" — often up to $154,140 (2026 federal guideline) — plus the home and one vehicle. Medicaid eligibility requires a "spend down" of excess assets. But certain assets are exempt (home, vehicle, prepaid funeral, certain retirement accounts), and certain planning strategies — Medicaid-compliant annuities, irrevocable trusts, caregiver child exceptions, and others — can legally protect assets while achieving eligibility. Critically, Medicaid has a look-back period: transfers made within 60 months of a Medicaid application are scrutinized, and improper gifts trigger a period of ineligibility. Planning must be done in advance.
§ Key documents in this area
- ▸Medicaid asset protection trust (MAPT) — irrevocable trust that removes assets from Medicaid counting after 5 years
- ▸Medicaid-compliant annuity — converts countable assets into an income stream for the community spouse
- ▸Caretaker child agreement — documents payments to a child providing in-home care as a legitimate transfer
- ▸Personal care agreement — formalizes caregiving by family members as a Medicaid-compliant expense
- ▸Irrevocable prepaid funeral — exempt Medicaid asset; a useful spend-down vehicle
- ▸Community spouse resource allowance documentation — protects the at-home spouse's assets and income
§ How attorneys approach this
- ›Comprehensive financial picture — identifying all countable vs. exempt assets
- ›Crisis planning or advance planning — different strategies apply depending on timeline
- ›Determining the best strategy: spend-down, irrevocable trust, annuity, or combination
- ›Drafting and implementing the chosen structure within Medicaid's rules
- ›Preparing and submitting the Medicaid application with complete documentation
- ›Ongoing compliance — Medicaid rules change; annual redeterminations must be monitored
“The biggest Medicaid planning myth is that giving money to children five years before needing care automatically protects it. The 60-month look-back means that even gifts made just before the 5-year window can create penalties if planning is not done correctly. The second biggest myth is that it is too late once someone is already in a nursing home. Crisis Medicaid planning — done strategically the day someone is admitted — can still legally protect a significant portion of a couple's assets. An elder law attorney who handles Medicaid planning routinely can assess exactly what is possible, even in a crisis scenario.”
§ What to look for in an attorney
- 01Elder law specialization — Medicaid planning is extremely state-specific and constantly changing
- 02Crisis planning experience — if a loved one is already in a nursing home, early planning options are limited
- 03Medicaid application experience — filing the application correctly is critical
- 04Knowledge of state-specific rules — asset limits, income rules, and transfer penalties vary significantly
- 05Coordination with estate planning — Medicaid planning affects wills, trusts, and beneficiary designations
- 06Medicaid estate recovery knowledge — many states recover from the estate after the recipient dies
⚖️
§ Ask these at your consultation
6 questions that matter
- ❓What assets can I legally protect, and which must be spent down for Medicaid eligibility?
- 💰How does the 5-year look-back period work, and what transfers are penalized?
- 🔍How much can my spouse keep if I need nursing home care?
- 📋Should we set up a Medicaid asset protection trust — and how long ago should it have been done?
- 💬Does your state recover Medicaid costs from the estate after death — and how does that affect our plan?
- 💡How do we apply for Medicaid, and what documentation does the state require?
§ Frequently asked questions
Common questions about medicaid planning.
Q 01
Will Medicaid take our house if my spouse enters a nursing home?
Not during the life of the community spouse — the at-home spouse is protected. However, after both spouses have died, many states pursue Medicaid estate recovery against the house. A Medicaid asset protection trust (MAPT), if established more than 5 years before the Medicaid application, removes the home from estate recovery entirely. If the MAPT window has passed, other strategies — like a life estate deed with remainder to children — may reduce recovery depending on state law.
Q 02
My parent was just admitted to a nursing home. Is it too late to protect anything?
No — crisis planning is still available. Even after admission, a Medicaid-compliant annuity can convert countable assets into a protected income stream for the community spouse. Paying off legitimate debts, purchasing exempt assets, pre-paying funeral and burial costs, and completing home repairs are all legitimate spend-down strategies. An elder law attorney can assess the specific financial picture and identify what can legally be protected even now.
Q 03
Can I pay a family member to care for my parent and have that count as a spend-down?
Yes, if done correctly. Payments to a family caregiver must be documented through a formal personal care agreement — a written contract specifying services, hours, and rate of pay. The rate must be consistent with local market rates for similar care. Informal gifts or unstructured payments will be treated as disqualifying transfers under Medicaid's rules. An elder law attorney can draft a compliant agreement and ensure the payments are structured to survive Medicaid scrutiny.
Q 04
What is Medicaid estate recovery — and how much can the state take?
Most states are required to seek reimbursement from the estate of deceased Medicaid recipients for long-term care costs paid. The state can file a claim against the probate estate after the recipient and their community spouse have both died. Assets that pass outside of probate — through a living trust, joint tenancy, or beneficiary designation — are generally not subject to estate recovery in many states. The specifics vary significantly by state, and this is a major reason to involve an elder law attorney in the planning.
§ Featured attorneys
Estate planning attorneys near you.
№ PARKIL
RJ
Attorney
Robert Johnson
Johnson Real Estate Law
Estate PlanningFamily Law
- City
- Chicago
№ KNOXTN
NW
Attorney
Nancy Whitmore
Whitmore Elder Law
Elder LawEstate Planning
- City
- Knoxville
№ SCOTAZ
CP
Attorney
Catherine Perry
Perry Estate & Trust
Elder LawTax LawEstate Planning
- City
- Scottsdale
Premium
№ CHICIL
MS
Attorney
Maria Santos
Santos Business Law
Elder LawEstate Planning
- City
- Evanston
№ ELMHIL
Robert Honig
BankruptcyEstate PlanningReal Estate
- City
- Elmhurst
§ Related practice areas