Medicaid is a state and federally funded program that provides health coverage to individuals with limited income and resources. It covers a range of medical services, including hospital stays, doctor visits, prescriptions, and nursing home care.

For seniors and individuals with disabilities, Medicaid is often the only way to afford long-term care, whether in a nursing home, assisted living facility, or at home. Medicare, by contrast, only covers short-term rehabilitation stays in a nursing home and does not pay for ongoing long-term care.

Since the cost of long-term care can range from $5,000 to $12,000 per month, Medicaid plays a critical role in ensuring people get the care they need without exhausting their life savings.

To qualify for long-term care Medicaid, an applicant must meet three main requirements:

1. Medical Necessity – The applicant must require nursing home-level care, meaning they need help with daily activities such as bathing, dressing, eating, and mobility. A doctor’s evaluation is usually required.

2. Income Limits – Medicaid sets a maximum monthly income threshold, which varies by state but is typically around $2,500 per month for an individual.

3. Asset Limits – Most states require applicants to have less than $2,000 in countable assets, though some assets (like a primary home and a car) may be exempt.

If you exceed the income or asset limits, you may still qualify through Medicaid planning strategies, which we can help you navigate.

Yes! Many people assume they must spend down all their money before applying, but that’s not always the case. There are legal and ethical strategies to help protect assets while qualifying for Medicaid, including:

• Medicaid Spend-Down: Using excess income to pay for medical expenses until you reach eligibility.

• Income Trusts (Miller Trusts/QITs): In some states, excess income can be placed into a special trust to qualify.

• Exempt Asset Planning: Some assets, like a primary residence, prepaid funeral plans, and certain annuities, can be structured to avoid Medicaid disqualification.

Each case is unique, and Medicaid rules are state-specific, so working with a Medicaid expert can help you legally qualify while preserving as much of your assets as possible.

Not necessarily. In many states, your primary residence is exempt from Medicaid eligibility calculations as long as:

• The applicant or their spouse still lives there.

• The home’s equity value is below a state-specific limit (typically $700,000 to $1,000,000).

However, after the Medicaid recipient passes away, the Medicaid Estate Recovery Program (MERP) may attempt to recover costs from the home’s value. There are ways to protect the home from Medicaid recovery, such as transfers to a spouse, disabled child, or irrevocable trust.

Medicaid Estate Recovery is a program where the state attempts to recover costs for long-term care services from the estate of a deceased Medicaid recipient. This often includes claims against their home or other remaining assets.

However, estate recovery doesn’t apply if:

• The deceased has a surviving spouse.

• There is a disabled or minor child living in the home.

• Proper Medicaid planning strategies were used to protect the home before the recipient passed away.

We can help you take proactive steps to prevent Medicaid from claiming your home.

When only one spouse applies for Medicaid, the Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to keep a portion of the couple’s assets to avoid impoverishment. The amount varies by state but is often around $30,000 to $150,000.

Similarly, the Minimum Monthly Maintenance Needs Allowance (MMMNA) allows the community spouse to retain part of the Medicaid applicant’s income if their own income is below a certain threshold.

These spousal protections ensure that the healthy spouse can maintain financial stability while the other spouse receives Medicaid coverage.

Medicaid has a five-year look-back period (in most states) that penalizes applicants who transfer assets for less than fair market value to qualify for benefits. If assets were gifted during this period, Medicaid may impose a penalty delaying eligibility.

However, some exempt transfers do not trigger penalties, including transfers to:

• A spouse.

• A disabled child.

• A caregiver child who has lived in the home for at least two years providing care.

If you have made gifts or asset transfers, we can help develop a strategy to reduce or eliminate Medicaid penalties.

Medicaid reviews:

• Income (Social Security, pensions, annuities, etc.)

• Assets (bank accounts, investments, property, life insurance cash value)

• Medical need (doctor’s certification and assessment)

• Financial transactions from the past 5 years (to check for disqualifying transfers)

If the applicant exceeds the limits, legal Medicaid planning can help reallocate assets to meet eligibility while preserving financial security.

The Medicaid application process typically takes 30 to 90 days, depending on the state and the complexity of the case. Delays often occur when required documents (such as financial records, medical assessments, or proof of spend-down) are missing.

We can help ensure your application is complete and accurate to avoid unnecessary delays.

f your application is denied, you have the right to appeal the decision. Common reasons for denial include:

• Excess income or assets.

• Missing documentation.

• Failure to prove medical need.

We can help review the denial, gather the necessary information, and file an appeal to improve your chances of approval.